Clinician-delivered care
Focused shockwave for persistent gluteal tendon pain / GTPS[1]
Consider when. Persistent lateral hip pain assessed as gluteal tendinopathy or greater trochanteric pain syndrome, particularly when loading care has been insufficient.
The clinician identifies the symptomatic tendon/trochanteric region and delivers focused ESWT alongside a progressive loading plan. Muscle-belly tenderness alone does not select this tendon pathway.
- Dose and review
- The 103-person trial used three weekly sessions plus exercise; the course describes that trial and does not establish an optimal dose.
- Progression
- Review night pain, side-lying and walking/stair function around 6–8 weeks; continue progressive tendon loading as tolerated.
- Stop or reassess
- Reassess marked abductor weakness, new inability to bear weight or worsening function before continuing.
- Evidence and limits
- At 2 months, average pain was 2.0/10 after focused ESWT versus 4.7 after low-energy sham, from 6.3 in both groups; functional outcomes generally favored treatment through 6 months. These results apply to GTPS, not selective medius/minimus trigger-point release.
Clinician-delivered care
Dry needling as a procedural alternative for assessed GTPS[2]
Consider when. A diagnosed lateral-hip pain syndrome when the patient and clinician are considering DN or a corticosteroid injection.
Discuss a limited DN trial targeted by a regional hip examination while maintaining load management. The trial did not isolate a specific gluteal muscle or establish tendon repair.
- Dose and review
- Treatment and observation in the small trial spanned six weeks; no universal session count is inferred.
- Progression
- Check a patient-selected task such as stairs or walking at 3–6 weeks, then decide whether further procedures add useful benefit.
- Stop or reassess
- Reassess sustained pain increase, new neurological symptoms or progressive weakness.
- Evidence and limits
- In 43 people (50 hips), DN met the prespecified noninferiority margin against cortisone injection for pain and function at six weeks. It was not compared with exercise alone and does not establish durable superiority.
Self-care and activity
Reduce painful lateral hip compression[7]
Consider when. Outer-hip pain aggravated by side-lying, crossed legs or hanging onto one hip, especially with suspected tendinopathy.
Try back-lying or the comfortable side with a pillow supporting both knees and ankles. Keep the sore upper hip from dropping across the midline. Break up prolonged one-leg standing and temporarily shorten painful hill or stair sessions.
- Dose and review
- Use during provoking tasks and sleep; choose changes by comfort. There is no established trigger-point-specific schedule.
- Progression
- Reintroduce one provoking activity at a time as walking and next-morning symptoms settle.
- Stop or reassess
- Abandon positions that increase pain. Do not use firm rollers or sustained ball pressure over the tender greater trochanter.
- Evidence and limits
- Load-management education was part of a successful gluteal-tendinopathy program. Its independent effect and benefit for isolated muscle tenderness are uncertain.
Exercise and rehabilitation
Begin tolerable hip-abductor loading[7]
Consider when. A lateral hip that tolerates gentle contraction but is too irritable for repeated single-leg work.
Lie on your back, knees bent and feet apart. With a light loop band above the knees, gently press the knees outward without moving the pelvis or letting them fall inward. Use light effort and breathe normally.
- Dose and review
- Example starting option: 4 gentle holds of 10–20 seconds with rest, once daily. This is a regional rehabilitation example, not a validated medius/minimus trigger-point protocol.
- Progression
- Build comfortable effort before adding repetitions or resistance; progress to standing abduction when the following morning is no worse.
- Stop or reassess
- Reduce load if sleep or next-day pain worsens. Stop for sharp groin pain, spreading tingling or new weakness.
- Evidence and limits
- Exercise benefits confirmed gluteal tendinopathy, but no single contraction type or this specific dose has been established as superior for trigger points.
Exercise and rehabilitation
Build walking and step capacity[7][5]
Consider when. Improving symptoms with remaining difficulty on stairs, longer walks or single-leg tasks.
Holding a counter, practice slow low-step step-ups. Keep the working knee comfortable and avoid a large trunk lean; use the rail as needed. Pair this with flat walks that finish before a pronounced limp develops.
- Dose and review
- Example: 1–2 sets of 6–8 step-ups on alternate days plus a short comfortable walk. Adjust to baseline capacity; this is not the published trial protocol.
- Progression
- Increase one variable—repetitions, step height or walking time—after several well-tolerated sessions, checking night and next-day symptoms.
- Stop or reassess
- Stop if weight bearing becomes sharply painful, the leg repeatedly gives way or symptoms accumulate across days.
- Evidence and limits
- Applies progressive-loading principles from regional hip rehabilitation. It trains the whole lower limb; it does not selectively release a deep muscle or prove which tissue caused pain.
Clinician-delivered care
PRP for persistent gluteal tendon pain[8][9][7]
Consider when. Persistent clinically assessed gluteal tendinopathy or GTPS when PRP is being considered after reviewing the loading program and possible tendon tear.
Review the tendon and bursal findings, previous rehabilitation and the activity most affected. Discuss the conflicting injection trials, expected cost and burden, and the option to continue or revise active care before deciding on PRP.
- Dose and review
- The 2018 trial compared one ultrasound-guided intratendinous PRP injection with one corticosteroid injection. The 2025 placebo trial targeted the trochanteric bursa and medius tendon. Further procedures should follow a review of the clinical response.
- Progression
- Track side-lying pain, walking or stair tolerance and hip function. If a procedure is chosen, reassess useful benefit over 6–12 weeks and at six months while maintaining an appropriate loading plan.
- Stop or reassess
- Reassess progressive weakness, a worsening limp or new inability to bear weight before a procedure. Following an injection, fever, spreading redness or rapidly increasing pain requires prompt medical review.
- Evidence and limits
- An 80-person trial favored PRP over corticosteroid for hip function at 12 weeks. A later placebo-controlled trial in 79 patients with refractory GTPS found no significant added benefit of leukocyte-rich PRP through six months. Different targets and comparators limit direct comparison; current findings do not support a routine PRP course for GTPS or establish an isolated medius/minimus muscle effect.
Clinician-delivered care
Use a tailored tendon or muscle rehabilitation plan[7][5]
Consider when. Persistent lateral hip pain, a significant limp, postoperative weakness or uncertainty about tendon versus muscle.
A physiotherapist maps pain location, measures abductor force and walking/step function, then selects tolerable loading and activity changes. Suspected significant tendon tear is assessed medically before progression.
- Dose and review
- Visit frequency follows need. The LEAP trial used 14 supervised sessions over eight weeks; that is a study program, not a mandatory prescription.
- Progression
- Move from supported loading to relevant stairs, carrying or sport demands once baseline function improves.
- Stop or reassess
- Reassess if pain or weakness worsens or gains fail to carry into daily activities; avoid an open-ended series of passive treatments.
- Evidence and limits
- Education plus exercise has direct evidence for persistent gluteal tendinopathy. It does not validate manual trigger-point release or guarantee the same result for isolated muscle pain.
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