Greater Trochanteric Pain Syndrome (Hip Bursitis) Treatment in Singapore: A Complete, Evidence-Based Care Pathway
Outer Hip Pain — Why It Hurts When You Walk or Lie on Your Side
Greater Trochanteric Pain Syndrome (GTPS), often referred to as hip bursitis, causes pain on the outer side of the hip.
It commonly presents as:
- Pain when lying on the affected side
- Discomfort when walking, climbing stairs, or standing
- Tenderness over the outer hip
- Pain radiating down the thigh
Although often labeled as “bursitis,” GTPS frequently involves tendon irritation (gluteal tendinopathy) rather than just inflammation.
Without a structured approach, symptoms may persist or recur.
What Evidence-Based Guidelines Recommend
Clinical guidelines and musculoskeletal consensus support a stepwise, conservative-first approach:
- Clinical diagnosis (with imaging when appropriate)
- Exercise-based rehabilitation and load management
- Medication for symptom control
- Adjunct therapies (e.g., shockwave)
- Injection therapy in selected cases
- Surgical referral when necessary (rare)
The Pain Relief Clinic aligns its care model with this pathway.
1. Diagnosis First: Identifying the Source of Hip Pain
Lateral hip pain may arise from:
- Gluteal tendinopathy
- Bursal irritation
- Referred pain from the lower back
- Other hip joint conditions
Accurate diagnosis helps determine:
- The primary pain source
- Whether the tendon, bursa, or joint is involved
At The Pain Relief Clinic:
- Clinical assessment is performed
- Imaging such as ultrasound, X-ray, or MRI may be arranged within 1 working day when appropriate
This supports more targeted treatment.
2. Physiotherapy & Rehabilitation: Core Treatment
Exercise-based rehabilitation is considered the mainstay of treatment.
Active Rehabilitation
Programmes may include:
- Gluteal strengthening
- Hip stability exercises
- Load management strategies
- Movement retraining
- Gradual return to activity
These are tailored based on:
- Severity of symptoms
- Functional goals
- Activity levels
Passive Non-Invasive Support
To support recovery:
- Shockwave therapy (commonly used for tendon-related conditions)
- Radiofrequency-based deep tissue therapy
- Manual therapy where appropriate
These may help reduce pain and improve tolerance to exercise.
Integrated Physiotherapy (Key USP)
- Physiotherapists are MOH AHPC-licensed
- Rehabilitation is closely coordinated with the doctor
- Programmes are adjusted based on diagnosis and response
3. Medication: Supporting Symptom Control
Medication may help:
- Reduce pain
- Improve function
- Enable participation in rehabilitation
First-Line Options
- Paracetamol
- Topical NSAIDs
- Oral NSAIDs
Second-Line / Subsequent Options
- COX-2 inhibitors
- Short-term oral opioids (used cautiously)
Medication is:
- Typically short-term
- Used alongside physiotherapy
- Not a standalone long-term solution
4. Injection Options for Persistent Hip Pain
When symptoms persist despite structured care:
Local Anaesthetic Injections
- Temporary relief
- May help confirm diagnosis
Corticosteroid Injections
- May reduce inflammation
- Used for symptom control
PRP (Platelet-Rich Plasma)
- Considered in selected cases
- Evidence is evolving
Pulsed Radiofrequency
- May be used for chronic pain modulation
Viscosupplementation
- Not typically used for tendon/bursal conditions
Injection therapy is generally:
👉 Used as an adjunct when rehabilitation alone is insufficient
5. Integrated, Team-Based Care
GTPS management benefits from coordinated care.
At The Pain Relief Clinic:
- Care is led by Dr. Terence Tan, a licensed medical doctor (SMC)
- With over 20 years of clinical experience
- Working closely with in-house AHPC-licensed physiotherapists
Treatment plans are adjusted based on:
- Diagnosis
- Functional progress
- Response to therapy
6. Load Management & Lifestyle Factors
GTPS is often influenced by:
- Overuse
- Weak hip stabilizers
- Poor movement mechanics
- Prolonged standing or walking
Management may include:
- Activity modification
- Strength correction
- Movement retraining
- Weight management where relevant
These help reduce recurrence and improve long-term outcomes.
7. When Is Surgery Considered?
Surgery is rarely required but may be considered when:
- Symptoms persist despite prolonged structured care
- Significant functional limitation remains
- Conservative and injection therapies have not been effective
In such cases, The Pain Relief Clinic:
- Provides assessment and imaging
- Refers patients to orthopaedic specialist partners
- Coordinates care before and after intervention
Common Causes of Greater Trochanteric Pain Syndrome
- Gluteal tendinopathy
- Repetitive hip loading
- Weak hip muscles
- Poor biomechanics
- Overuse
- Prolonged standing
- Age-related tendon changes
- Previous hip injury
- Lumbar spine contribution
- Combined mechanical factors
When Should You Seek a Structured Approach?
You may benefit from coordinated care if:
- Outer hip pain persists
- Pain affects walking or sleep
- Symptoms recur repeatedly
- Rest alone does not resolve symptoms
- You are considering injections
Final Takeaway
Greater trochanteric pain syndrome is best managed through a structured pathway:
- Accurate diagnosis
- Targeted physiotherapy and load management
- Medication for symptom control
- Adjunct therapies such as shockwave
- Injection therapy in selected cases
- Surgical referral when appropriate
The Pain Relief Clinic provides these components in an integrated, coordinated, and evidence-aligned manner, supporting recovery and function.
FAQ
Q1: Is hip bursitis the same as GTPS?
GTPS is a broader term that often includes tendon-related causes beyond bursitis.
Q2: Can physiotherapy help?
Yes, it is a key component of treatment.
Q3: Do I need imaging?
Imaging may be useful if symptoms persist or diagnosis is unclear.
Q4: Can this condition come back?
Yes, especially if underlying factors are not addressed.
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