Lateral hip pain is usually a tendon problem rather than a bursa problem, and that single distinction decides which orthobiologic is worth discussing. Patient information from Cambridge University Hospitals NHS Foundation Trust reports that 88% to 98% of patients with greater trochanteric pain syndrome have tendon pathology, while isolated bursitis appears in only about 2%. The practical consequence is that the conversation should start with the gluteal tendons, the stage of tendinopathy, and a loading plan — not with an injection choice.
Key takeaways
- Tendon pathology is present in 88% to 98% of patients with greater trochanteric pain syndrome; isolated bursitis is present in about 2%.
- The condition is far more common in women. Cambridge University Hospitals reports it in 23.5% of women and 8.5% of men between the ages of 50 and 79, with particular frequency in peri- and post-menopausal women.
- A 2021 systematic review of 1,103 patients across 27 studies found good evidence for platelet-rich plasma in grades 1 and 2 tendinopathy. Evidence is grade-dependent, so staging comes first.
- Orthobiologics are paired with rehabilitation. An injection that is not followed by a loading plan is treating half the problem.
- No orthobiologic has been shown to regrow or regenerate tendon or cartilage, and we do not describe any of them that way.
- Conservative care comes first. Surgery is considered only after conservative measures have been exhausted.
What gluteal tendinopathy is, and why the diagnosis decides everything after it
Tendon, not bursa
Gluteal tendinopathy is degenerative and overload change in the gluteus medius and minimus tendons where they attach at the greater trochanter. It presents as pain on the outside of the hip, typically worse with stairs, side-lying, single-leg standing, and prolonged walking. The old habit of calling this bursitis is what the Cambridge University Hospitals figures argue against, and the label matters because it points treatment at a different structure.
Who it affects
Cambridge University Hospitals patient information reports greater trochanteric pain syndrome in 23.5% of women and 8.5% of men between the ages of 50 and 79, with higher frequency among peri- and post-menopausal women. That skew is worth naming during evaluation, because hormonal and metabolic context shapes tendon tolerance and recovery.
What we confirm before discussing an injection
We combine history, examination, and imaging review to establish that the gluteal tendons are the pain generator, and to stage how far the change has progressed. Deep hip joint pathology, lumbar referral, and mixed presentations all look similar from the outside, and each would send the plan somewhere different.
Platelet-rich plasma: what the evidence supports, and where it stops
The systematic review that anchors the discussion
A 2021 systematic review in the Orthopaedic Journal of Sports Medicine, covering 1,103 patients across 27 studies with a mean age of 53.7 years and a roughly seven-to-one female predominance, produced a stage-adjusted treatment recommendation. Its conclusion included good evidence for using platelet-rich plasma in grades 1 and 2 tendinopathy.
Why grade-dependence changes the conversation
The biological environment of a mildly affected tendon is not the same as that of an advanced, partially torn one, and the evidence separates outcomes accordingly. That is why staging precedes the injection decision here rather than following it, and why a result reported for early-grade disease should not be quoted to a patient with late-grade disease.
PRP is not one product
Preparation, platelet concentration, leukocyte content, injected volume, and the exact target all vary between studies. When you read a PRP result, you are reading a result for that protocol at that target, which is one reason we describe what is planned rather than naming a category. What each option involves is set out on our orthobiologics service page.
Bone marrow aspirate concentrate and fat-derived options
Where BMAC enters the discussion
Bone marrow aspirate concentrate is a marrow-derived option considered when the clinical goal, the stage, and the target tissue line up. There is no single protocol applied to everyone, and the evidence base for tendon applications is thinner than for platelet-rich plasma. We say so rather than smoothing it over.
Lipogems and fat-derived orthobiologics
Lipogems is a fat-derived option that appears in orthobiologic discussions for musculoskeletal conditions. As with the others, we explain the rationale and the intended target, and we keep the stated goal at symptom reduction and functional improvement rather than a structural outcome that has not been demonstrated.
What none of them do
No orthobiologic has been shown to regrow or regenerate tendon or cartilage. In advanced knee osteoarthritis, trial authors frame platelet-rich plasma as a safe bridge therapy prior to joint replacement, and the same restraint applies to how we talk about the hip.
Rehabilitation is not the optional half
Loading is the treatment the tendon responds to
Tendon tissue adapts to progressive load, and an injection does not change the mechanics that overloaded it. Every orthobiologic plan here is paired with a structured loading and biomechanics program, along with symptom-guided progression you can follow between visits.
What we ask you to track
We ask for specific markers rather than a global pain score: walking distance before symptoms start, tolerance for side-lying, and stair capability. Those are the measures that show whether the loading program is working.
When more than one area is involved
Hip plus spine
Many patients arrive with more than one pain generator, and lumbar referral can imitate or accompany lateral hip pain. When the evaluation supports it, spinal contributors are addressed on their own terms rather than folded into the hip plan.
Hip plus knee
Knee and hip questions are kept distinct even when they arrive together, because what is appropriate for a degenerative knee joint is not what is appropriate for a gluteal tendon. Mixing the two is how expectations get set wrong.
What to expect at Regen.MD
Physician-led evaluation, conservative first
Dr. Gurpreet Singh Padda, MD, MBA, MHP directs Regen.MD and leads the Clinical Evaluation. He is a surgeon, and the practice does provide surgery when conservative measures have been exhausted — which is exactly why the conservative pathway is taken seriously rather than treated as a formality.
Where we are
The office is at 4477 Woodson Rd, Suite 103, St. Louis, MO 63134, next to St. Louis Lambert International Airport. Directions and parking are on our St. Louis location page.
Find out what is actually driving your lateral hip pain
Regen.MD begins with a physician-led Clinical Evaluation — a review of your history, imaging, and metabolic data, and a written terrain roadmap. Evaluation is contingent upon review of your data.
Questions? Call (314) 295-3000 or text (314) 886-5902.
Frequently asked questions
Is my lateral hip pain bursitis or tendinopathy?
Patient information from Cambridge University Hospitals NHS Foundation Trust reports that 88% to 98% of patients with greater trochanteric pain syndrome have tendon pathology, while isolated bursitis appears in about 2%. That is why the working assumption starts with the tendon and gets confirmed by examination rather than assumed from a scan. You can see how we sort this out across the conditions we evaluate.
Is platelet-rich plasma actually supported for gluteal tendinopathy?
For part of the condition, yes. A 2021 systematic review in the Orthopaedic Journal of Sports Medicine, covering 1,103 patients across 27 studies, concluded there was good evidence for platelet-rich plasma in grades 1 and 2 tendinopathy. That grade-dependence is exactly why staging comes before any injection decision, as set out in our approach to care.
Will an injection fix it without rehabilitation?
No. Orthobiologics are paired with a loading and rehabilitation plan, because the mechanical drivers of tendon overload do not change on their own. The realistic goals are symptom reduction and better tolerance of progressive loading, not a structural repair. Our patient education library explains how we set those expectations.
Are peptides sold as part of this?
No. Peptides are discussed at Regen.MD as clinical and educational subjects and are not sold. If your questions run toward metabolic and recovery topics, start with our physician-directed peptide therapy education, and keep it separate from the tendon decision.
Who performs the evaluation, and what should I bring?
The Clinical Evaluation is physician-led. Bring your imaging, your prior treatments, and a clear account of which activities provoke the pain. You can read the background of Dr. Gurpreet Singh Padda, MD, MBA, MHP before requesting one.
Sources
- Ladurner A, Fitzpatrick J, O’Donnell JM. Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation. Orthopaedic Journal of Sports Medicine, 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC8330465/ — referenced for the 1,103 patients across 27 studies, the mean age of 53.7 years and female predominance, and the conclusion of good evidence for platelet-rich plasma in grades 1 and 2 tendinopathy.
- Cambridge University Hospitals NHS Foundation Trust. Gluteal tendinopathy. Patient information, accessed August 2026. https://www.cuh.nhs.uk/patient-information/gluteal-tendinopathy/ — referenced for tendon pathology in 88% to 98% of patients versus isolated bursitis in about 2%, and for the prevalence of 23.5% in women and 8.5% in men between the ages of 50 and 79 with higher frequency in peri- and post-menopausal women.