JEFFREY PENG MD
SPORTS MEDICINE & FAMILY MEDICINE
GLUTEAL TENDINOPATHY
TREATMENT IN SAN JOSE, CA
Gluteal tendinopathy — also known as greater trochanteric pain syndrome (GTPS) or commonly misdiagnosed as trochanteric bursitis — is one of the most common causes of lateral hip pain, affecting up to 17.6% of adults aged 50 to 79, with a strong predominance in women. If you have been told you have “hip bursitis,” imaging studies show that in most cases, the real problem is degeneration of the gluteal tendons rather than inflammation of the bursa.
Dr. Jeffrey Peng is a board-certified sports medicine physician in Campbell, CA specializing in non-surgical treatment for gluteal tendinopathy — including PRP injections, shockwave therapy, percutaneous needle tenotomy, and targeted rehabilitation. A landmark double-blind RCT found that a single PRP injection produced significantly better pain and functional improvement than cortisone — with results sustained for over 2 years (PMID: 30840831).
What Is Gluteal Tendinopathy?
Pain on the outside of the hip is incredibly common and can be difficult to treat. For decades, doctors called this condition “trochanteric bursitis” — assuming the pain came from inflammation of the bursa at the outer hip. But imaging studies have shown that only a minority of patients have true bursitis. The vast majority actually have gluteal tendinopathy: degeneration of the gluteus medius and/or gluteus minimus tendons where they attach to the greater trochanter.
The medical community now refers to this spectrum of conditions as greater trochanteric pain syndrome (GTPS), which encompasses gluteal tendinopathy, trochanteric bursitis, and partial tears of the gluteal tendons. This updated terminology reflects our better understanding that the primary driver of lateral hip pain is tendon degeneration, not bursal inflammation.
Like other tendinopathies, gluteal tendinopathy is an overuse and overloading condition. Chronic stress leads to the accumulation of microtears in the tendon fibers. Over time, these fibers become disorganized, weakened, and replaced by scar tissue. Blood flow decreases, growth factors disappear, and the tendon becomes biologically stuck — unable to repair itself regardless of how much rest or physical therapy you give it.
This is why anti-inflammatory treatments like cortisone provide only temporary relief. Cortisone calms symptoms but does nothing to repair the underlying tendon damage — and its effects typically peak at 6 weeks and fade completely by 24 weeks. What the tendon actually needs is help restarting the healing process, which is exactly what PRP and percutaneous tenotomy are designed to do.
Symptoms of Gluteal Tendinopathy
The hallmark symptom is pain on the outside (lateral aspect) of the hip, typically over the bony prominence of the greater trochanter. This pain is often worst when lying on the affected side at night — a complaint that distinguishes GTPS from many other hip conditions. You may also experience pain when walking (especially uphill or on uneven ground), climbing stairs, standing on one leg, getting in and out of a car, or sitting with legs crossed.
Many patients describe a deep ache that progressively worsens over months. The condition can also cause referred pain into the thigh, and because the gluteal muscles are critical for hip stability and gait mechanics, gluteal tendinopathy frequently contributes to knee pain and low back pain as well.
Dr. Peng uses diagnostic musculoskeletal ultrasound to visualize the gluteal tendons in real time — identifying tendinopathy, partial tears, bursitis, and calcifications without the need for an MRI referral. This allows for immediate diagnosis and a same-day treatment plan.
Non-Surgical Treatment for
Gluteal Tendinopathy
Stretching & Targeted Rehabilitation
The foundation of gluteal tendinopathy treatment is a structured exercise program focusing on progressive loading of the gluteal muscles. Hip abductor strengthening — particularly isometric and isotonic exercises for the gluteus medius — has the strongest evidence base for GTPS. The key is gradual, progressive loading that stimulates tendon remodeling without overloading the tissue. Compressive loads (like lying on the affected side or sitting cross-legged) should be minimized during the acute phase.
Shockwave Therapy
Extracorporeal shockwave therapy (ESWT) promotes neovascularization, collagen synthesis, and pain modulation in the degenerated gluteal tendons. A systematic review of 8 RCTs involving 754 patients (PMID: 39297780) found that ESWT is an effective treatment for GTPS, with significant improvements in both pain and function. An RCT comparing focused shockwave to ultrasound therapy (PMID: 30585498) found shockwave produced significantly better outcomes at both 2-month and 6-month follow-up.
PRP Injections for Gluteal Tendinopathy
Gluteal tendinopathy has some of the strongest PRP evidence of any tendinopathy — thanks to a landmark double-blind, randomized controlled trial that followed patients for 2 full years.
In the initial trial (PMID: 29293361), 80 patients with chronic gluteal tendinopathy (symptoms lasting over 4 months) were randomized to receive either a single PRP injection or a single cortisone injection, both administered under ultrasound guidance. At 12 weeks, the PRP group had significantly better pain and function scores than the cortisone group. Eighty-two percent of PRP patients achieved clinically meaningful improvement, compared to just 56.7% of the cortisone group.
The 2-year follow-up study (PMID: 30840831) revealed even more dramatic differences. The PRP group continued to improve all the way out to 2 years, with sustained and significant gains in pain and function from a single injection. Meanwhile, the cortisone group peaked at 6 weeks and then declined — the improvement was not maintained beyond 24 weeks. Twenty-seven patients who failed cortisone were allowed to cross over to PRP, and they too showed significant and sustained improvement out to 2 years.
The authors concluded that among patients with chronic gluteal tendinopathy, a single PRP injection performed under ultrasound guidance results in significantly greater improvement in pain and function than a single cortisone injection — and this improvement is sustained at 2 years.
This is why professional and collegiate athletes have moved away from cortisone for tendinopathies. PRP puts the body in the best position to heal because it delivers your own concentrated platelets and growth factors — the biological ingredients responsible for tissue healing, remodeling, and pain control — directly into the injured tendon.
Percutaneous Needle Tenotomy for
Gluteal Tendinopathy
For chronic gluteal tendinopathy that has not responded to rehabilitation, shockwave, or PRP alone, percutaneous needle tenotomy offers a minimally invasive option. Using real-time ultrasound guidance, an FDA-cleared powered device mechanically breaks up the scar tissue, disorganized collagen, and any calcific deposits preventing the tendon from healing.
The procedure restarts the healing process by triggering fresh bleeding, growth factor release, and new collagen production. A meta-analysis (PMID: 37148349) of 35 studies and over 1,600 patients found that tenotomy significantly reduces pain at every time point, with benefits that continued to improve at long-term follow-up. A separate prospective study (PMID: 33727517) found nearly 80% pain reduction by one year across multiple tendon locations.
Dr. Peng often combines tenotomy with PRP for chronic gluteal tendinopathy: tenotomy clears out the damaged tissue, and PRP delivers concentrated growth factors directly into the freshly cleared space. The entire procedure takes about 20-30 minutes in the clinic under local anesthesia. No incisions, no stitches, same-day discharge.
Insurance note: Most insurance plans, including Medicare, PPOs, and HMOs, cover the ultrasound-guided tenotomy portion. PRP is currently self-pay. Tenotomy alone has strong standalone evidence (PMID: 37148349).
Why Dr. Peng Limits Cortisone for
Gluteal Tendinopathy
Cortisone injections for “hip bursitis” have been a standard treatment for decades. But the evidence tells a clear story: cortisone provides maximal relief at 6 weeks, and that relief is not maintained beyond 24 weeks (PMID: 30840831). Meanwhile, a single PRP injection produces sustained improvement for over 2 years.
Beyond the temporary nature of cortisone, there are growing concerns about its effects on tendon tissue. Cortisone can weaken already-damaged tendons, potentially accelerating degeneration rather than healing it. Dr. Peng may use cortisone in very specific situations for acute pain management, but for chronic gluteal tendinopathy, he recommends PRP, shockwave, or tenotomy — treatments that promote actual tissue repair.
Watch: Gluteal Tendinopathy Rehab Exercises
Dr. Peng demonstrates a gluteal tendinopathy / trochanteric pain syndrome rehabilitation program.
Frequently Asked Questions
Frequently asked questions
Why Choose Dr. Jeffrey Peng for Gluteal Tendinopathy Treatment in San Jose?
Dr. Jeffrey Peng is a board-certified sports medicine and family medicine physician specializing in non-surgical treatments for sports injuries and orthopedic conditions. He completed his residency with the Stanford Family Medicine Residency Program and his sports medicine fellowship with the Stanford Primary Care Sports Medicine Fellowship in San Jose.
Dr. Peng has co-authored peer-reviewed research on platelet rich plasma with leading orthobiologics researchers and clinicians — no other PRP provider in the San Jose, Los Gatos, and Campbell area combines published research credentials with this level of clinical experience. He is an active faculty member training the next generation of sports medicine physicians and runs a popular YouTube channel with over 400,000 subscribers, making complex PRP research accessible to patients worldwide.
Every PRP injection is performed under real-time ultrasound guidance to ensure accurate placement into the targeted tissue. Studies show that ultrasound-guided injections are significantly more accurate than blind injections, which directly impacts treatment effectiveness.