What Is Trochanteric Bursitis?
Trochanteric bursitis — more correctly called Greater Trochanteric Pain Syndrome (GTPS) — is one of the most common causes of lateral hip pain. Classically, the term "bursitis" suggested that the trochanteric serous bursa was inflamed, but MRI studies show that in more than 90% of cases the main problem is a tendinopathy of the gluteus medius and minimus, not a true bursitis.
The condition predominantly affects women between 40 and 60 years, with characteristic pain on the lateral aspect of the hip that worsens when lying on the affected side, when crossing the legs, and when climbing stairs. Excessive adduction during gait and weakness of the gluteus medius are central biomechanical factors.
Although benign, GTPS can be very disabling and difficult to resolve with conventional treatments alone. Medical acupuncture offers an approach that simultaneously reduces inflammation of the bursa and deactivates trigger points in the periarticular musculature.
High Prevalence
Affects 1.8/1000 people per year, with prevalence 3 times higher in women. It is frequently misdiagnosed as hip osteoarthritis.
Tendinopathy, Not Bursitis
In 90% of cases, MRI shows tendinopathy of the gluteus medius and minimus — not true bursitis. This changes the treatment.
Effective Needling
Direct dry needling of trigger points in the gluteus medius is highly effective at deactivating the source of pain.
Why Are Conventional Treatments Not Always Sufficient?
Corticosteroid injection into the trochanteric bursa is frequently the first medical recourse — and can offer significant immediate relief. However, since the main problem is usually gluteal tendinopathy (not bursitis), the effects of the corticosteroid are time-limited (4–12 weeks) and can deteriorate the tendon with repeated applications.
Physiotherapy with gluteus medius strengthening is effective, but requires that the patient can perform exercises without pain — which is difficult in the acute phase. NSAIDs offer temporary symptomatic relief. In many cases, GTPS becomes recurrent and chronically disabling without an approach that resolves both the inflammatory component and the muscle imbalance.
TREATMENTS FOR GREATER TROCHANTERIC PAIN SYNDROME
| TREATMENT | IMMEDIATE EFFECT | DURABILITY |
|---|---|---|
| Injected corticosteroid | Excellent (90%) | Short (4-12 wk), high recurrence |
| Oral NSAIDs | Moderate | Symptomatic only |
| Physiotherapy alone | Slow (painful in acute phase) | Good if maintained |
| Dry needling | Good (2-4 sessions) | Excellent (12 months) |
| Acupuncture + PT | Good | Excellent (low recurrence) |
How Does Medical Acupuncture Work in Trochanteric Bursitis?
The main mechanism involves dry needling of trigger points in the gluteus medius and minimus. These muscles, when chronically overloaded (especially in women with excessive hip adduction during gait), develop taut bands that compress the adjacent bursae and tendons, perpetuating the pain-spasm cycle.
The local twitch response to needling followed by deep muscle relaxation reduces compression on the tendon insertion at the greater trochanter. In parallel, segmental neuromodulation in the L1–L3 and S1 dermatomes reduces the nociceptive signal of the lateral hip, providing lasting relief.
Mechanism of Action in Trochanteric Bursitis
Identification and needling of trigger points
Systematic palpation of the gluteus medius and minimus identifies taut bands; precise dry needling provokes the twitch response.
Muscle relaxation of the gluteus medius
Release of spasm reduces excessive compression on the trochanteric bursa and the tendon insertion.
Reduction of local neurogenic inflammation
Decrease in peripheral substance P and CGRP, reducing sensitization of local nociceptors.
L1–S1 segmental neuromodulation
Inhibition of the lateral hip nociceptive signal in the spinal dorsal horn via A-delta fibers.
Improvement of gait biomechanics
With the gluteus medius relaxed and less painful, the patient can perform corrective strengthening exercises.
What Does the Research Show?
Studies on GTPS suggest that dry needling and acupuncture may offer benefits comparable to corticosteroid injections in some outcomes, with possible advantage in durability at longer follow-up — findings still to be confirmed in larger and more homogeneous studies. The potential benefit is particularly relevant in patients with a history of multiple injections without lasting result.
What Is Different About the Modern Approach?
The modern protocol of the medical acupuncturist integrates deep dry needling of the gluteus medius and minimus with low-frequency electroacupuncture (2 Hz) to enhance the release of endorphins and the reduction of central sensitization — frequent in chronic cases.
In addition to needling, the physician provides guidance on fundamental postural modifications: avoid crossing the legs, do not sit with one hip higher than the other, and avoid sleeping in a position that adducts the affected hip. These guidelines, combined with closed-chain gluteus medius strengthening exercises, complete the comprehensive conservative protocol.
When to See a Physician?
If you feel pain on the outer side of the hip that worsens when lying on that side, when crossing the legs, or when walking for prolonged time, seek medical evaluation. Differential diagnosis with hip osteoarthritis, lumbar radiculopathy, and piriformis syndrome requires specialized physical examination.
Frequently Asked Questions
They are related terms, but GTPS (Greater Trochanteric Pain Syndrome) is the more current and accurate term, since it includes both true bursitis and tendinopathy of the gluteus medius and minimus — which is the predominant cause. Most cases classified as "bursitis" in clinical practice are, in fact, gluteus medius tendinopathy.
Acute cases (less than 3 months) respond in 4 to 6 sessions. Chronic cases with a history of multiple injections without lasting result may need 8 to 12 sessions. Improvement in nocturnal pain when lying down usually occurs in the first 2 or 3 sessions of dry needling.
Yes, and this is one of the classic indications. Patients with failure of one or more corticosteroid injections frequently respond very well to dry needling of the gluteus medius, since the problem was not in the bursa (where the corticosteroid was applied) but in the peritendinous musculature.
In most cases, yes. Endoscopic bursectomy is indicated only for cases refractory to all conservative treatment (at least 6 months of physiotherapy, 2 to 3 injections, and medical treatment). With adequate dry needling, most cases resolve without need for surgery.
In general, acupuncture can be considered during pregnancy for musculoskeletal pain, always with adaptations and by a medical acupuncturist experienced with pregnant patients. Points classically contraindicated in pregnancy are avoided and needling is usually more superficial. The indication, protocol, and timing in gestation should be individualized, with obstetric follow-up. Trochanteric bursitis is particularly common in the third trimester due to increased hip adduction.