Hip pain when you lie on your side
StemWave plus ultrasound-guided PRP at FirstCall DPC, Santa Rosa Beach
See if I'm a candidateOuter hip pain gets called bursitis almost every time, and most of the time it is not. On ultrasound we look at the gluteal tendons where they attach to the bone, check for a tear, and look at the bursa. The tendon is usually the problem, and that is what changes the plan.
Is this you?
- You cannot sleep on that side. Lying on the other side with the top leg hanging hurts too.
- Getting out of a low chair or the car, that first step, grabs you.
- Walking the beach or the bike path is fine for a mile and then it is not.
- You have been told it is bursitis and had a cortisone shot. It came back.
- Stretching makes it feel better for an hour and worse the next day.
If the pain is in the groin or deep in the joint, that is a different problem, often the hip joint itself, and PRP into the tendon is not the answer. The exam sorts that out in five minutes.
How it works
1.Exam and ultrasound
I test the gluteal muscles with your hip loaded, then scan the tendons where they attach to the bone on the outside of the hip. We are looking for a worn tendon or a partial tear. We also look at the joint itself so we do not treat the wrong thing.
2.StemWave sessions
Six StemWave sessions over three to four weeks before the injection, aimed at the gluteal tendon attachment we found on ultrasound. The tendon sits deep, so this is where a focused wave earns its keep over the cheaper radial devices.
3.PRP under ultrasound
We draw your blood, spin it, and place the platelet layer into the worn tendon while watching the needle. The gluteal tendons sit deep under muscle. Without guidance the injection lands in the bursa, which is why cortisone there so often fails.
4.Loading plan
A gluteal strengthening program starts within a week, plus the two things that matter most for this tendon: stop the stretching that compresses it, and change how you stand and sleep. The injection helps. The habits decide whether it lasts.
For gluteal tendinopathy we use the Rebuild package: six StemWave sessions, then one ultrasound-guided PRP injection within two or three days of the last session, then the gluteal program. Night pain often improves in four to six weeks. Full strength takes three months.
What the evidence says
The one large trial that compared PRP to cortisone for gluteal tendinopathy found the PRP group better at twelve weeks and still better at two years, while cortisone had faded. One good trial is not a mountain of evidence, but it is a well-run trial and it matches what we see. I will not oversell it.
“If I ever have to exaggerate the evidence to justify offering something, I probably shouldn't be offering it.”Dr. Petersen
What it costs
- Reset3 StemWave sessions + 1 ultrasound-guided PRP injection$1,395
- Elite Recovery10 StemWave sessions + 2 ultrasound-guided PRP injections$2,995
FirstCall DPC members get 15% off every package.
Both sides or a second site: add $600 per PRP site and $500 per StemWave region.
The exam and the ultrasound are included. HSA and FSA accepted. Financing available.
Dr. Petersen chooses the package at the exam based on what the ultrasound shows. If a single ultrasound-guided PRP injection without StemWave is the right call for you, that is offered through the main practice and he will say so.
Outer hip pain is the tendon, not the bursa, in most of the people I see. That is why the cortisone shot in the bursa helps for a few weeks and then stops, and why stretching the outside of the hip, which compresses that tendon against the bone, makes it worse.
The fix is to look at the tendon, treat the tendon, and stop doing the things that squeeze it. PRP is one part of that. It is not the whole plan.
Meet the physicians
Erik Petersen, DO
Board-certified in Internal Medicine. Twenty years of emergency medicine, and the person holding the ultrasound probe.
Co-founder of FirstCall DPC. Former All-American football player who still thinks a loading program beats a shortcut.
Will Carlson, MD
Board-certified in Internal Medicine. Emergency medicine experience, and the slower, more careful half of this partnership.
Co-founder of FirstCall DPC. He is the one who asks what happens if we are wrong, which is why we rarely are.