PRP for Gluteal Tendinopathy: What the Research Shows for Lateral Hip Pain

Notes on procedural naturopathic medicine.

Pain on the outside of the hip can persist even after rest, stretching, a round of physiotherapy, or a cortisone shot. Many patients come to me at that point. Lying on that side wakes them at night, stairs and hills ache, and they want to know whether an injection like platelet-rich plasma (PRP) is worth considering.

In my practice at Tall Tree Cordova Bay, PRP is one of several ultrasound-guided options I offer for gluteal tendon pain, alongside cortisone, prolotherapy, and SportVis (a hyaluronic acid made for soft tissue and tendons). I use the Mindray MX7 ultrasound so the injection goes where it is meant to go. The encouraging news is that lateral hip pain often improves with the right plan. For the right patient, PRP has promising research behind it at the hip, especially when compared with cortisone.

So what is lateral hip pain, exactly?

For years, pain on the outside of the hip was called "trochanteric bursitis." Researchers now see gluteal tendinopathy as the main local source of that pain. The gluteus medius and minimus tendons attach to the bony point on the side of your hip (the greater trochanter), and when those tendons fall behind the load placed on them, they become painful. Today the umbrella term is greater trochanteric pain syndrome (GTPS).

It is common, especially in women in midlife and after menopause. Patients often describe:

• Pain and tenderness over the bony point on the side of the hip
• Pain lying on that side, which can disrupt sleep
• Aching with walking, stairs, or standing on one leg

It can affect sleep, work, and activity more than patients expect. In one study, quality of life with GTPS was similar to that of patients with severe hip arthritis, so it deserves to be taken seriously.

Why education and exercise come first

The strongest evidence for gluteal tendinopathy is for a specific kind of physiotherapy: education about how to load the tendon, plus progressive strengthening.

A big part of that education is reducing positions that squeeze the tendon against the bone. Crossing your legs, letting the hip drop out to the side while standing, or lying in positions that pull the thigh across the body all add compression. Gradually building strength in the hip muscles then helps the tendon tolerate more.

The best-known trial here is the 2018 LEAP trial in The BMJ. It followed 204 patients with lateral hip pain for more than three months. They received education plus exercise with a physiotherapist (14 sessions over 8 weeks), one cortisone injection, or a "wait and see" approach. At 8 weeks, 77% of the education plus exercise group reported success, compared with 58% after cortisone and 29% with wait and see. At one year, the education plus exercise group was still doing best on overall improvement.

That is genuinely good news: most patients have a strong first step that does not involve a needle. In my practice, any injection is planned around this kind of program, not instead of it.

So what is PRP?

PRP is made from a small sample of your own blood. The blood is spun to concentrate the platelets, and that concentrate is injected into the affected tendon under ultrasound guidance. Platelets carry growth factors involved in tissue repair.

PRP is not one single product. Preparations differ in how concentrated the platelets are and whether white blood cells are included (leukocyte-rich or leukocyte-poor). Studies also differ in where the PRP was placed, how many injections were given, and what rehab followed.

What the research actually shows

PRP compared with cortisone

The most-cited gluteal trial comes from Melbourne. Eighty patients with gluteal tendinopathy for more than four months (average age 60, mostly women) received a single ultrasound-guided injection of either leukocyte-rich PRP or cortisone into the tendon. Patients with full-thickness tendon tears were not included.

At 12 weeks, 82% of the PRP group had a meaningful improvement in their hip score, compared with 57% of the cortisone group. The two-year follow-up was even more encouraging. The benefit of cortisone peaked around 6 weeks and was not maintained beyond 24 weeks. The PRP group kept improving, and their scores were still well above where they started at two years. Patients who had not done well with cortisone were offered PRP after three months, and that group improved as well.

A smaller 2020 trial of 24 patients also compared ultrasound-guided PRP with cortisone. Both groups improved, and the PRP group had better pain and hip scores at 24 weeks.

What the reviews say

When researchers pool the studies, the picture leans positive for PRP:

• A 2021 meta-analysis comparing PRP with cortisone for GTPS concluded that PRP was more effective at about two years of follow-up.
• A 2026 review of randomized trials of PRP around the hip found that the gluteal tendinopathy trials, taken together, favoured PRP on hip function scores, while noting the trials were quite different from one another.
• A 2022 network analysis of 13 trials found that PRP gave better short-term pain relief than no treatment, and that structured exercise did best for function.

Where the research is still settling

Two placebo-controlled trials give a more cautious view. In a 2019 New Zealand trial of 48 patients and a 2025 UK trial of 79 patients, both groups improved, and PRP did not do better than a placebo injection. In the New Zealand trial, everyone also did the same exercise program. The UK trial's authors do not support routine use of PRP for this condition.

So the fair summary is this: PRP has held up well against cortisone, especially over the longer term, but it has not yet clearly beaten placebo. Many patients improve over time with a good plan whether or not an injection is added. Researchers have suggested that how PRP is prepared and where it is placed may matter, which could explain some of the mixed results. That is why I talk this through with each patient rather than offering PRP as a default.

Is this a fit for you?

Patients who may be a reasonable candidate:

• Lateral hip pain that has persisted despite a good education and exercise program, usually for 3 months or more
• A diagnosis that fits gluteal tendinopathy on assessment
• A preference to avoid repeated cortisone, or pain that came back after cortisone wore off
• Willingness to keep up the exercise program before and after the injection

When PRP is less likely to help, or another path may fit better:

• You have not yet had a structured education and exercise program. That is usually the better first step.
• The pain may be coming from somewhere else, like the hip joint itself, your lower back, or a nerve.
• There is a suspected significant or full-thickness tendon tear. That usually needs imaging and a surgical opinion, often through your GP or a sports medicine physician.
• You are expecting one injection to replace rehab.

How PRP fits next to other options

• Cortisone. Cortisone can bring faster relief in the first weeks. In a Dutch primary care trial, 55% of patients who had cortisone had recovered at 3 months, compared with 34% with usual care. By 12 months the groups were similar. For some patients, that early window of relief is exactly what they need to get going with exercise.
• Physiotherapy. A good physiotherapist often builds and progresses your program. This is complementary care, not competing care.
• Prolotherapy and SportVis. These are other tendon injections I offer. We can talk through what is known for the hip and whether either suits your situation.
• Surgery. For significant tendon tears, surgical repair is an option, and a surgical opinion is worth having when the history or imaging points that way.

Often a good plan combines a few of these, timed around your rehab.

What PRP can't do

PRP will not instantly rebuild a tendon, and it is not a substitute for loading. Any benefit tends to build over weeks to months alongside exercise, and not every patient responds.

Questions to ask your provider

• Do my symptoms and exam fit gluteal tendinopathy, or could my hip joint or back be involved?
• Have I had a structured education and exercise program, and was it progressed?
• Is there any sign of a tendon tear, and would imaging change the plan?
• Which PRP preparation do you use, and is it leukocyte-rich or leukocyte-poor?
• How many injections are you suggesting, and why?
• How will my exercise program change in the weeks after the injection?
• What are the alternatives for my situation, including cortisone or more time with rehab?

What happens at the visit

Initial assessment. We go over your history, what you have already tried, your exercise program so far, and any imaging. I examine the hip and the areas around it. This is where we decide together whether PRP, another option, or more time with rehab makes the most sense.

Injection visit. If PRP is a fit, a small blood sample is drawn and prepared. The skin is cleaned using aseptic technique, local anaesthetic is used for comfort, and the PRP is injected under ultrasound guidance with the Mindray MX7. Before you leave, we review aftercare and how to ease back into your exercise program.

Common questions

Is lateral hip pain the same as bursitis? Not usually. Most lateral hip pain comes from the gluteal tendons, and the bursa, when involved, is usually involved alongside them rather than on its own. That is why treatment now focuses on loading the tendon well, not only calming inflammation.

Is PRP better than cortisone for hip pain? In the head-to-head trials, PRP did better than cortisone at 3 months and beyond, and the benefit lasted to two years in the largest trial. Cortisone tends to work faster but fade sooner. Both can have a place, and we can weigh them for your situation.

How soon would I notice a difference? Tendons change slowly. In the main PRP trial, the difference from cortisone showed up at 12 weeks and grew by 24 weeks. Think in months, not days.

Do I still need physio if I have PRP? Yes. Education and exercise are the foundation, and the strongest evidence for lateral hip pain sits there. PRP is meant to support that work, not replace it.

Is PRP covered by insurance? Extended health plans vary. Many cover naturopathic visits but not injectable products. It is worth checking with your plan before your visit.

If pain on the outside of your hip is getting in the way of sleep, walking, or the things you love to do and you are in British Columbia, you are welcome to book a consult. We can sit down together and map whether PRP, or another approach, is a good fit for you.

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Sources

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Disclaimer

This content is general educational information, not medical advice, and not a substitute for individualized care from your own qualified provider. Dr. Sydney Green, ND provides clinical care only to patients within British Columbia.