Trochanteric tendinopathy
Trochanteric tendinopathy
Pain on the outer hip bone — impossible to sleep on your side at night?
Pain on the outer hip bone is frequently labeled "hip osteoarthritis" or "bursitis." In most cases neither gets to the heart of it. What is actually behind it is a tendon degeneration of the gluteal muscles — a tendinopathy of the hip-stabilizing tendons. It responds well to treatment when the therapy addresses the tendon and not just the bursa.
Four weeks, five appointments, one team. You’re not left alone with your symptoms.
10–25%
lifetime prevalence — the most common cause of lateral hip pain
>90%
permanently symptom-free with conservative treatment in published studies
4:1
women to men — most common peak: 40–60 years
Your APPOINTMENT at OMC
Four weeks, five appointments, one team.
Orthopedics and internal medicine in one integrated concept — for patients who value thorough diagnostics and structured treatment.
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Final appointment: assessment and next steps
Personal review with Dr. Klein after four weeks. Three possible paths: pain-free — handover to the home maintenance program; improved but not yet complete — follow-up appointment in four weeks; insufficient improvement — PRP escalation or further diagnostics (MRI to assess partial tears).
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Weeks 2–4: three supervised therapy sessions
Weekly appointments in the therapy room with the three-person therapy team. Multimodal treatment package (shockwave, magnetic field, cryo), correction and progression of the gluteal strengthening, progress review based on the pain diary. Daily internal case discussion — every patient stays in view.
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First appointment: diagnosis and immediate start of treatment
History, clinical examination, ultrasound of the gluteal tendons, AI gait analysis (Trendelenburg quantification). Immediately afterward: treatment begins in the therapy room — shockwave, magnetic field, cryotherapy, guidance on the strengthening program from the team. You leave the practice with a plan, the pain diary, and four scheduled follow-up appointments.
Four weeks, five appointments, one team — a clear plan from day one.
Trochanteric tendinopathy is fully treatable conservatively in over 90% of cases — when the therapy addresses the tendon and not just the bursa. Those who start early and stick with the strengthening program have a very good chance of lasting freedom from symptoms.
Radiation into the buttock or the outer thigh
Pseudoradicular radiation is possible — an important differential diagnosis from a disc herniation. Unlike sciatica, the pain rarely radiates below the knee, and the lateral pressure pain is consistently palpable.
Pain when crossing the legs or getting into the car
Adduction movements load the tendon insertion directly. Avoiding these positions becomes an everyday routine: keeping the legs straight when sitting, getting carefully into the car, taking care when dressing.
Pain when standing on one leg for a long time
Pain when climbing stairs, walking uphill, or after longer walks
Load-dependent; especially during eccentric deceleration and on long walking distances. In daily life, stairs are avoided and the elevator preferred — a typical sign that the tendon is structurally overloaded.
Nocturnal pain when lying on the affected side
Compression pain of the tendon insertion when lying down — considerably disrupts restful sleep. Many patients have been unable to sleep on one side for months, change position several times a night, and sleep with a pillow between the knees.
Pain on the outer hip bone — right where you can feel the bone
Precisely localizable pressure pain on the lateral hip bone — typical of tendon-insertion complaints. Even the pressure of trousers, a waistband, or a bag at the side can become uncomfortable.
"For months I haven’t been able to sleep on my right side. My orthopedist diagnosed bursitis — the cortisone shots helped for two weeks, then everything was back the way it was."
This is one of the most common patterns we see. The bursa is often involved — but it is not the cause. The actual pathology sits in the gluteal tendons. Anyone who treats only the bursa doesn’t solve the problem. What works is treating the tendon structure — combined with targeted strengthening of the hip-stabilizing muscles.
Recognizing symptoms
Does this sound familiar?
Trochanteric tendinopathy has a very characteristic pain pattern: pain on the outer hip bone, nocturnal pain when lying on the affected side, pain when climbing stairs. Many of our patients recognize the following symptoms:
Common pitfalls
Why it often doesn’t get better
Trochanteric tendinopathy often becomes chronic — not because it’s hard to treat, but because it is usually misclassified: as bursitis or as hip osteoarthritis. Neither is usually accurate.
Missing gluteal strengthening — the most important measure is left out
An exercise sheet handed over on the way out is not a treatment plan. Without guidance, correction, and regular progress checks, half the exercises end up only half correct — and the tendon doesn’t respond. Tendon healing needs support, not just a recommendation. At OMC the therapy team supports you weekly.
"That’s the hip osteoarthritis" — wrong localization
True hip osteoarthritis causes inguinal pain — that is, pain in the groin, often with restricted hip movement. Pain on the outer hip bone is usually NOT hip osteoarthritis, but trochanteric tendinopathy. Anyone who doesn’t make this distinction treats past the problem. Clinical examination and ultrasound clarify it within minutes.
"Bursitis" as the sole diagnosis
The bursa can be involved — but it is not the cause. The actual pathology sits in the gluteal tendons. Anyone who only treats the bursa doesn’t solve the problem. Ultrasound shows directly whether the tendon is degeneratively changed — which fundamentally changes the treatment plan.
Cortisone directly into the tendon tissue
The most common and most consequential mistake. Cortisone into the bursa can be useful in the short term in confirmed acute bursitis — but cortisone directly into the gluteal tendons inhibits collagen synthesis, weakens the tissue, and increases the risk of rupture. The short-term pain relief is bought at the price of long-term damage.
The OMC approach
What’s different at OMC.
Tendons don’t heal through isolated measures but through the right system: ultrasound as the foundation, AI-based gait analysis to clarify the cause, multimodal therapy, and support over four weeks — consistent and structured.
Internal-medicine perspective as routine
Vitamin D status, thyroid function, a rheumatology screen (HLA-B27, CRP, anti-CCP) where the course is atypical, leg-length measurement. At the OMC Tendon Center this is not an add-on but part of every examination.
AI gait analysis: making Trendelenburg visible
The AI gait analysis quantifies pelvic drop during single-leg stance — not just assessed, but measured. That is the basis for a targeted strengthening program and for load correction. Trendelenburg is not only a clinical sign but a measurable quantity.
Multimodal treatment package as standard
Shockwave, magnetic field therapy, and cryotherapy combined in every session — that is the OMC standard for every tendon patient. Gluteal strengthening is guided and corrected weekly. PRP is used specifically as an escalation when the standard package isn’t enough.
Ultrasound as the foundation — no guesswork
Ultrasound of the gluteal tendons shows the extent of the tendon change, the state of the bursa, and the location directly — the basis for every treatment decision. In terms of differential diagnosis, hip osteoarthritis is clearly distinguished: lateral trochanteric tendinopathy vs. inguinal coxarthrosis.
Specialist in
Internal
medicine
Assessment of thyroid function, vitamin D status, diabetes status, and medication history. Whatever blocks tendon regeneration from within is found and treated." und „Ultrasound, clinical differential diagnostics, ESWT, PRP injection, eccentric training protocol, ergonomics advice — all from a single source.
Specialist in
Orthopedics &
trauma surgery
Ultrasound, clinical differential diagnostics, ESWT, PRP injection, eccentric training protocol, ergonomics advice — all from a single source.
What we examine
Diagnostics at the OMC practice
With typical symptoms, the clinical diagnosis of trochanteric tendinopathy is usually clear — ultrasound confirms the findings and differentiates it from hip osteoarthritis. The AI gait analysis identifies the biomechanical cause.
01
Clinical examination and differential diagnosis
Pressure pain on the lateral hip bone, provocation tests for the gluteal tendons, Trendelenburg test (pelvic drop in single-leg stance), hip range of motion. Clear differentiation from hip osteoarthritis (inguinal pain, restricted movement), sciatica (radicular radiation), and sacroiliac joint pathologies.
> Distinguishes trochanteric tendinopathy from other causes of lateral hip pain
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Ultrasound of the gluteal tendons
Tendon structure and thickness at the lateral hip bone, state of the bursa, extent of the tendon change directly visible. Neovascularization as a source of pain, signs of partial tears. Ultrasound confirms the diagnosis and serves for progress monitoring: has the tendon responded to therapy?
> The basis for targeted therapy rather than guesswork
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AI gait analysis — quantifying Trendelenburg
Analysis of pelvic drop during single-leg stance and the gait cycle. Quantifies the weakness of the gluteal muscles in degrees and time proportion. The basis for the individual strengthening program and load correction. Trendelenburg is a measurable symptom — not a subjective impression.
> Makes the cause measurable — not just visible
The OMC advantage: structured therapy instead of isolated measures
Ultrasound confirms the diagnosis and clearly differentiates it from hip osteoarthritis. AI gait analysis quantifies the Trendelenburg weakness. The multimodal treatment package (shockwave + magnetic field therapy + cryotherapy) is the standard — combined with a guided strengthening program. PRP is used specifically when the standard therapy isn’t enough.
Treatment concept
Therapy approach.
Individual & multimodal
Trochanteric tendinopathy follows a clear phase model: from pain reduction through building the hip-stabilizing muscles to a load-capable return to everyday life. Four weeks, five appointments, one team at your side — each phase with clear goals.
Gluteal strengthening — the indispensable core of therapy
A targeted strengthening program for the gluteus medius and minimus: side-lying leg abduction, single-leg stance, clamshell, single-leg bridge. Three times a week, progressively over 8–12 weeks, pain-controlled. Important everyday rule: don’t cross the legs, use a pillow between the knees when side-sleeping. Without this step, every other measure remains ineffective.
Treating internal-medicine cofactors as well
Whatever blocks tendon regeneration from within must be treated too:
Vitamin D3 + K2 — essential for connective tissue and muscle regeneration.
Assess thyroid function — hypothyroidism slows tendon healing.
In an atypical course: rheumatology screen (HLA-B27, CRP, anti-CCP) to rule out spondyloarthritis or rheumatoid involvement.
Leg-length measurement and compensation where needed — directly alters the loading of the gluteal tendons.
Load management and everyday adaptation
Sleeping with a pillow between the knees (side-lying), avoiding prolonged crossing of the legs, controlled stair-climbing (slow, eccentric deceleration). For a leg-length difference, fitting where needed via a cooperating orthopedic shoemaker. Footwear with adequate cushioning. Load management is part of the therapy, not an add-on.
ESWT · magnetic field · cryotherapy
The multimodal standard package at OMC — as a fixed combination in every therapy session.
Focused shockwave therapy (ESWT) — at the tendon insertion; stimulates tissue regeneration and reduces neovascularization; typically 3–5 sessions.
Pulsed magnetic field therapy (PEMF) — adjunctive to ESWT; supports tissue regeneration.
Cryotherapy — local pain relief and reduced irritation after loading.
PRP — as an escalation when the standard package isn’t enough; ultrasound-guided into the altered gluteal tendon.
Internal-medicine perspective — the OMC distinction
Rheumatology screen in cases of morning stiffness, back complaints, or skin symptoms: HLA-B27, CRP, anti-CCP. Vitamin D3 + K2 — essential for muscle strength and tendon regeneration. Normalize thyroid function — hypothyroidism promotes multiple tendinopathies.
Healing perspective
What you can realistically expect
Trochanteric tendinopathy has a very good prognosis — over 90% of patients become permanently symptom-free with structured conservative treatment. Patience is the most important variable: tendon regeneration and muscle building take months, not weeks.
"The gluteal tendons are the rotator cuff of the hip — and we treat them with the same principles as the shoulder: no cortisone into the tendon tissue, multimodal therapy for regeneration, targeted strength training for stabilization. What we often see: patients who received cortisone injections into the bursa for years while the tendon underneath continued to degenerate. It doesn’t have to be that way."
Dr. Roman Klein, MD, Ortho Motion Concept
Prior cortisone treatment into the tendon tissue
Complete tear of the gluteal tendon — possible surgical indication
Status after total hip replacement (altered lever arm of the gluteal muscles)
Untreated systemic disease (rheumatic disease, hypothyroidism)
Daily gluteal strengthening program carried out consistently
Early start of treatment before a complete tear
Internal-medicine cofactors treated (vitamin D, thyroid)
Leg-length difference compensated where relevant
3–6
months to sustained improvement with consistent training
4 weeks
structured program — five appointments, one team
>90%
permanently symptom-free without surgery
Frequently asked questions
What patients ask us
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Isn’t this hip osteoarthritis?
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Why doesn’t the bursa injection help me permanently?
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Can I sleep normally again at night?
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How long until I’m symptom-free?
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What does PRP achieve in trochanteric tendinopathy?
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Can I be treated after a hip replacement too?
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What is the difference between the OMC Tendon Center and a standard orthopedic practice?
Your next step
Injections didn’t help.
Now comes tendon therapy.
Book your first appointment now. You leave the practice with a clear diagnosis, a written four-week plan, and the start of your therapy. You don't come in for an examination — you enter a structured program with a team that won't leave you on your own.
What you actually get:
- Ultrasound-confirmed diagnosis — clear differentiation from hip osteoarthritis
- AI gait analysis with Trendelenburg quantification
- Multimodal treatment package: shockwave, magnetic field, cryo available on site
- Gluteal strengthening as the core of therapy — guided weekly
Medical note
This content serves general medical information and does not replace individual medical advice or examination. For persistent, unclear, or worsening complaints, please consult a physician. Dr. Roman Klein, MD, Specialist in Orthopedics & Traumatology and Internal Medicine · Ortho Motion Concept · Europastraße 3 · 67433 Neustadt an der Weinstraße.