Hip bursitis is one of those conditions that can quietly take over a person’s life. The pain on the outer hip that makes lying on your side impossible, that flares after a walk, that catches you every time you climb stairs. It is persistent, it is frustrating, and it is frequently undertreated.
Shockwave therapy has become an increasingly discussed option for hip bursitis — but what does the evidence actually say, and is it the right fit for you?
What Is Hip Bursitis?
The bursa is a small, fluid-filled sac that sits between tissues to reduce friction. At the outer hip, the main bursa sits over the greater trochanter — the bony prominence on the side of the hip — and its job is to allow the gluteal tendons to glide smoothly over the bone during movement.
When this bursa becomes irritated and inflamed, the result is pain directly on the outer hip that is typically worse with direct pressure, prolonged walking, climbing stairs, or lying on the affected side at night.
It is worth noting that the clinical picture around hip bursitis has evolved considerably. Research has shown that what was traditionally labelled “trochanteric bursitis” is, in many cases, actually driven primarily by gluteal tendinopathy — degeneration and irritation of the tendons themselves rather than the bursa. The two frequently coexist, and the distinction matters for treatment.
What Is Shockwave Therapy?
Shockwave therapy delivers high-energy acoustic waves into the tissue through a handheld device applied to the skin. These pressure waves stimulate a biological response in the targeted tissue — promoting cellular repair, increasing blood flow, disrupting pain signalling, and stimulating collagen production.
There are two main types:
- Radial shockwave delivers lower-energy diverging waves and is the more widely available form in clinical settings. It is effective for more superficial targets.
- Focused shockwave delivers higher-energy converging waves to a precise depth and is used for deeper or more recalcitrant presentations.
For hip bursitis and the associated gluteal tendinopathy, both forms have been used in the research literature, though focused shockwave has been more commonly studied for this region.
What Does the Research Say?
The evidence for shockwave therapy in the management of greater trochanteric pain syndrome — the umbrella term now used to capture trochanteric bursitis and gluteal tendinopathy together — is genuinely encouraging.
A well-designed randomised controlled trial by Rompe and colleagues found that shockwave therapy produced significantly greater improvements in pain and function at fifteen months compared to home exercise alone, and comparable results to corticosteroid injection at the same timepoint — with the important distinction that shockwave effects continued to improve over time while injection effects tended to wane.
A subsequent study comparing shockwave to a supervised exercise programme found both to be effective, but shockwave produced faster initial improvement in pain — a clinically meaningful finding for patients who are significantly limited in their ability to exercise due to pain levels.
A systematic review published in the Journal of Orthopaedic Surgery and Research concluded that shockwave therapy is an effective and safe treatment for greater trochanteric pain syndrome, with low rates of adverse effects and meaningful improvements in pain and function across multiple studies.
The key finding across the literature is that shockwave tends to produce durable results — not just short-term relief. This distinguishes it meaningfully from corticosteroid injection, which can provide faster initial relief but may be associated with tendon degeneration with repeated use and less favourable long-term outcomes.
How Does It Work in Practice?
A typical course of shockwave therapy for hip bursitis involves three to six sessions spaced approximately one week apart. Treatment is applied directly over the greater trochanter, targeting the bursae and the gluteal tendon insertions.
The sessions are not painless — some degree of discomfort during treatment is normal and expected. The pressure waves need to penetrate into the tissue to be effective, and for most people this is tolerable. Temporary post-treatment soreness lasting twenty-four to forty-eight hours is common and is considered part of the biological response rather than a sign of harm.
There is typically no requirement to stop activity between sessions, though loading the hip in ways that significantly aggravate the underlying tendinopathy should be avoided during the treatment course.
Is Shockwave Enough on Its Own?
This is an important question, and the honest answer is: it depends, but usually not in isolation.
Shockwave is most effective when it is used as part of a broader management approach that also addresses the biomechanical factors driving the condition. Gluteal tendinopathy and hip bursitis are frequently driven by a combination of:
- Compressive loads on the tendon — including crossing the legs, hip adduction during walking, and certain sitting positions
- Gluteal muscle weakness, particularly of the gluteus medius, which places greater demand on the tendon and bursa during weight-bearing
- Altered load patterns from the lumbar spine, pelvis, or lower limb that change how force is distributed through the hip
Shockwave addresses the tissue response to irritation. Rehabilitation addresses why the tissue became irritated in the first place. Both are needed for durable recovery.
Who Is a Good Candidate?
Shockwave therapy tends to produce the best outcomes in people who:
- Have had symptoms for at least three months and have not responded adequately to activity modification and basic rehabilitation
- Have not had complete resolution with corticosteroid injection, or want to avoid repeated injections
- Have confirmed greater trochanteric pain syndrome on clinical assessment, with or without imaging confirmation
It is not appropriate for everyone. Contraindications include pregnancy, blood clotting disorders, active infection in the treatment area, and local malignancy. A thorough assessment before commencing treatment is essential.
The Bottom Line
Shockwave therapy has a genuine evidence base for hip bursitis and greater trochanteric pain syndrome. It is not a quick fix, but it is a well-tolerated, non-invasive treatment that produces durable improvements in pain and function — particularly when combined with targeted rehabilitation.
If outer hip pain has been limiting your sleep, your walking, or your daily activities, it deserves a proper assessment rather than ongoing management of symptoms alone.
Call us on (02) 8018 8883 to speak with one of our Chiropractors at Aret Chiropractic in North Ryde, or book online for a consultation.
References
Rompe, J. D., et al. (2009). Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. American Journal of Sports Medicine, 37(10), 1981–1990.
Mani-Babu, S., et al. (2015). The efficacy of extracorporeal shock wave therapy in lower limb tendinopathy. American Journal of Sports Medicine, 43(3), 752–761.
Lustenberger, D. P., et al. (2011). Efficacy of treatment of trochanteric bursitis: A systematic review. Clinical Journal of Sport Medicine, 21(5), 447–453.
Ladurner, A., et al. (2021). Treatment of greater trochanteric pain syndrome: A systematic review. Journal of Orthopaedic Surgery and Research, 16(1), 1–10.
Grimaldi, A., & Fearon, A. (2015). Gluteal tendinopathy: Integrating pathomechanics and clinical features in its management. Journal of Orthopaedic and Sports Physical Therapy, 45(11), 910–922.
Long, S. S., et al. (2013). Imaging of greater trochanteric pain syndrome. Skeletal Radiology, 42(11), 1521–1533.