Hip Bursitis: Treatment Options, Relief and Regenerative Care in Bangkok

What is hip bursitis?

Hip bursitis is irritation or inflammation of a bursa, a small fluid-filled sac that reduces friction between tendons and bone. The most common type affects the trochanteric bursa on the outer hip, over the bony bump called the greater trochanter. A less common type, iliopsoas bursitis, causes pain at the front of the hip or groin, and ischial bursitis causes pain at the sitting bone.

Modern imaging studies have shown that many people diagnosed with “trochanteric bursitis” actually have gluteal tendinopathy: wear or small tears in the gluteus medius and minimus tendons. Doctors therefore often use the term greater trochanteric pain syndrome (GTPS). This matters because the best hip bursitis treatment targets the tendons, not just the bursa. The NHS page on bursitis describes the general condition and self-care.

Symptoms

• Pain and tenderness on the outer side of the hip, sometimes spreading down the outer thigh
• Pain lying on the affected side at night
• Pain climbing stairs, getting up from a low chair, or standing on one leg
• Pain after sitting with the legs crossed
• Usually no groin pain (groin pain points more toward the hip joint itself)

Causes and risk factors

• Compressive load on the tendons, for example sitting with legs crossed or standing with the hip “hitched” to one side
• Sudden increase in activity, such as more walking, running or hill work
• Weak hip abductor muscles
• Menopause and hormonal changes (GTPS is more common in women over 40)
• Leg length differences, low back problems or hip osteoarthritis that change how you walk
• Direct injury from a fall onto the side of the hip
• Rarely, infection or inflammatory arthritis

How is it diagnosed?

Diagnosis is mainly clinical: tenderness over the greater trochanter and pain with specific tests such as standing on one leg for 30 seconds. Ultrasound or MRI can show bursal fluid, tendon thickening or a tendon tear, and help rule out other causes like hip osteoarthritis, referred pain from the lumbar spine, or a stress fracture.

If you have had imaging, the report often guides what treatment is sensible. You can send your MRI or ultrasound for a doctor review and get an opinion on whether you have bursitis, tendinopathy, a tear or something else.

Finding	What it usually means	Typical next step
Fluid in the trochanteric bursa only	Bursitis	Load management, physiotherapy, possible injection
Thickened gluteal tendon	Gluteal tendinopathy	Progressive strengthening; PRP if persistent
Partial gluteal tendon tear	More advanced tendon damage	Rehab, image-guided injection; surgical opinion if severe
Full-thickness tear with weakness	Structural failure	Orthopaedic surgical review
Hip joint changes on X-ray	Possible osteoarthritis contributing	Treat the joint as well

Standard treatments

Conventional care helps most people. The landmark LEAP trial (Mellor et al., BMJ, 2018) found that education about load management plus exercise gave better outcomes at 8 weeks than a corticosteroid injection or a wait-and-see approach in gluteal tendinopathy.

1. Education and load management. Avoid sleeping on the painful side (use a pillow between the knees), avoid crossing legs and avoid hanging on one hip when standing.
2. Targeted strengthening physiotherapy. Gradual loading of the hip abductors, starting with isometric holds and progressing over 8–12 weeks.
3. Pain relief. Short courses of anti-inflammatory medicine or topical gels if safe for you.
4. Corticosteroid injection. Often relieves pain within days, but benefits tend to fade over months and repeated injections may weaken tendons.
5. Shockwave therapy. Some evidence for persistent GTPS.
6. Surgery. Bursectomy, iliotibial band release or gluteal tendon repair, reserved for refractory cases or significant tears.

Regenerative options and the evidence

PRP injections

PRP therapy is the regenerative option with the best evidence in this area. Randomised trials in chronic gluteal tendinopathy have reported that a single ultrasound-guided leucocyte-rich PRP injection gave better pain and function scores at around 12 weeks than a corticosteroid injection (for example Fitzpatrick et al., American Journal of Sports Medicine, 2018). Trials are small and not all results agree, so it is usually offered when strengthening physiotherapy has not worked.

Cell-based injections

Stem cell therapy has been studied for tendon disorders in small early-phase trials, but there is little hip-specific evidence. It is considered experimental for GTPS and is generally discussed only for tendon tears or when other options have failed.

Regulatory status

PRP is widely used in sports medicine in the US, UK and Australia, but is often not covered by public health systems or insurers. MSC injections for tendon problems are not FDA-approved, and the FDA warns about unapproved stem cell therapies.

Who may be a candidate, and who should not

May be a candidate for PRP or a regenerative program:

• Outer hip pain for more than 3–6 months
• Diagnosis confirmed by examination and ideally ultrasound or MRI
• Little improvement after a structured strengthening programme
• Recurring pain after steroid injections

Should not have injections, or needs a different plan:

• Suspected infection, fever, or a hot, red swelling
• Full-thickness tendon tear with major weakness (needs a surgical opinion)
• Pain that is actually from the spine or hip joint
• Bleeding disorders, active cancer, pregnancy, or low platelet counts (for PRP)

Injections never replace the strengthening programme. Without it, pain often returns.

Risks

• Post-injection pain flare for a few days, especially with PRP
• Bruising or soreness at the blood draw or harvest site
• Infection (rare)
• No improvement

Cells, where used, are prepared in ISO 9001:2015-certified partner laboratories.

What a Bangkok program looks like

1. Share your imaging. Send your MRI, ultrasound or X-ray and a short history on WhatsApp.
2. Doctor review. You get an honest view on whether injections make sense, or whether physiotherapy alone is the better route.
3. In-clinic assessment. Examination and, if needed, ultrasound on arrival.
4. Ultrasound-guided injection. Usually a short outpatient visit.
5. Rehab handover. A written strengthening programme for home.

Read how it works for timing, travel and follow-up. Patients often combine a short visit with an orthopaedic assessment of the hip joint or low back.

Aftercare

• Expect a sore hip for 2–5 days after PRP
• Avoid anti-inflammatory medicines after PRP for the period your doctor advises
• Walk normally but avoid hills, running and long stairs for 1–2 weeks
• Restart progressive strengthening as guided, usually from week 1–2
• Keep sleeping with a pillow between your knees
• Follow up with your local doctor or physiotherapist and send progress updates

Sources

• NHS: Bursitis
• Mellor R, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy (LEAP trial). BMJ, 2018.
• Fitzpatrick J, et al. Leucocyte-rich PRP vs corticosteroid injection in gluteal tendinopathy. American Journal of Sports Medicine, 2018.
• U.S. FDA: Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes