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Bethesda, MD(301) 530-1010
Dr. Marc GrunerSports & Regenerative Medicine
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Hip Specialist

Hip pain specialist — arthritis & tendon pain

The short answer

Dr. Gruner is a hip specialist treating hip arthritis, gluteal tendinopathy (outer hip pain), and hamstring tendinopathy. He begins with activity modification, weight management, and physical therapy, adding image-guided injections and orthobiologics like PRP and microfragmented fat to delay or avoid hip replacement.

Medically reviewed by Marc Gruner, DO, MBA, RMSK
Sports medicine physician, Mayo Clinic fellowship. Last reviewed June 2026

Hip pain can come from arthritis inside the joint (felt in the groin) or from the tendons on the outside of the hip and at the sit-bone. An accurate diagnosis — often with ultrasound — is essential, because these problems are treated very differently.

Dr. Gruner tailors treatment to the source: hip abductor strengthening and activity strategies, precise cortisone or orthobiologic injections (PRP, microfragmented fat), and clear guidance about hip replacement only when conservative measures fall short.

What is hip pain?

Hip pain means different things depending on where it's felt. Pain deep in the groin usually points to the hip joint itself — most often arthritis. Pain on the outside of the hip, worse when lying on that side, usually comes from the gluteal tendons (gluteal tendinopathy, often mislabeled 'bursitis'). Pain at the sit-bone that flares with running and sitting suggests high hamstring tendinopathy.

Because the hip refers pain to the groin, thigh, and buttock, patients are frequently treated for the wrong problem — which is why Dr. Gruner emphasizes a precise, ultrasound-informed diagnosis.

What causes hip pain?

Hip osteoarthritis develops from cartilage wear related to prior trauma, the shape of the hip or pelvis, labral injury, and aging. Outer-hip and sit-bone pain are overuse tendon injuries. Snapping hip, labral tears, and adductor (sports hernia) strains can also cause hip and groin pain in active people.

How is hip pain treated without surgery?

For arthritis, Dr. Gruner combines activity and weight strategies, hip abductor strengthening, and image-guided injections or orthobiologics (PRP, microfragmented fat) to reduce pain and delay or avoid hip replacement. For gluteal and hamstring tendinopathy, targeted strengthening is the foundation, with ultrasound-guided PRP for persistent cases.

Hip conditions we treat

Hip ArthritisGroin pain and stiffness from hip cartilage wear that limits walking and rotation.Gluteal TendinopathySide-of-hip pain from injury to the gluteal tendons at the greater trochanter.Hamstring TendinopathySit-bone pain from injury to the hamstring tendons at the ischial tuberosity.Sports Hernia (Adductor Strains)Chronic groin pain from strain of the lower abdominal and adductor attachments, common in cutting sports.Snapping Hip, FAI & Labral TearsGroin pain, catching, and snapping from hip impingement (FAI) and labral injury.

Treatments and procedures for the hip

OrthobiologicsPRPConcentrated platelets from your own blood, injected under ultrasound guidance to support healing in joints and tendons.OrthobiologicsMicrofragmented AdiposeA minimally processed sample of your own fat — microfragmented adipose tissue (MFat) — injected to cushion and support arthritic or injured joints.OrthobiologicsBMACCells and growth factors concentrated from your own bone marrow for select joint and tendon conditions.DiagnosticsMSK UltrasoundIn-office, real-time imaging of tendons, ligaments, nerves, and joints — no radiation — to pinpoint the source of pain.

Rehabilitation protocols

What to expect week by week after your procedure. Your plan is individualized; follow these alongside your physical therapist.

Hip (Gluteal Tendon) — Ultrasound-Guided Lipogems / PRP Protocol
Download full protocol (PDF)

  1. Week 1

    Protect the tendon

    • No weight-bearing 4 days, then toe-touch; wean off crutches by end of week 1
    • Gentle hip-flexion ROM from day 4, 4×/day
    • Optional BFR from day 4

  2. Week 2

    Pain-free ROM

    • Progress weight-bearing with crutches
    • Begin isometrics, straight-leg raises, clamshells
    • Core stability; pool once wound healed

  3. Weeks 3–6

    Build strength

    • Progress hip-abductor strengthening
    • May begin stationary bike

  4. Weeks 6–12

    Return to sport

    • Sport-specific exercises; balance and higher-impact activity
    • Soft-tissue work (no foam rolling until week 6)

Do not use NSAIDs (ibuprofen, Aleve, aspirin) for 4 weeks, and avoid ice for the first week — both blunt the healing response. Acetaminophen (Tylenol) is fine for discomfort. Care is tailored to you; use these guidelines with your physical therapist.

Hip (Hamstring Tendon) — Ultrasound-Guided Lipogems / PRP / Tenex Protocol
Download full protocol (PDF)

  1. Week 1

    Protect the tendon

    • No weight-bearing 4 days, toe-touch with crutches to day 7
    • Gentle hip-flexion ROM; use a seat cushion for comfort

  2. Week 2

    Range of motion

    • Wean off crutches; no eccentric strengthening
    • Begin isometrics, straight-leg raises, heel slides
    • Core stability; pool once wound healed

  3. Weeks 3–6

    Build strength

    • No eccentrics yet; progressive strengthening
    • Gentle hamstring stretching; knee-flexion and hip-extension strengthening
    • Balance exercises

  4. Weeks 6–12

    Return to sport

    • Activities as tolerated
    • Sport-specific exercises

Do not use NSAIDs (ibuprofen, Aleve, aspirin) for 4 weeks, and avoid ice for the first week — both blunt the healing response. Acetaminophen (Tylenol) is fine for discomfort. Care is tailored to you; use these guidelines with your physical therapist.

Knee & Hip Joint — Ultrasound-Guided PRP / Adipose / BMAC Injection Protocol
Download full protocol (PDF)

  1. Day 1–2

    Protect the joint

    • Weight-bear as tolerated; crutches as needed
    • Keep bandage dry; no submerging for 72 hours
    • Gentle ROM as tolerated; monitor wound

  2. Day 3–7

    Begin gentle loading

    • Avoid excessive joint loading
    • Start low-grade closed-chain program
    • Light squats/lunges (bodyweight); optional BFR

  3. Day 8–14

    Add resistance

    • Avoid impact and heavy lifting to the joint
    • Light open-chain exercises; add resistance as tolerated
    • May begin swimming and low-resistance biking

  4. Day 14–28

    Functional progression

    • Avoid impact activities
    • Progress functional program; light agility and proprioception
    • Resume light aerobic activity (walking)

  5. Beyond 28 days

    Long-term prevention

    • Establish a long-term home exercise program
    • Correct biomechanical issues that contributed to the injury

Do not use NSAIDs (ibuprofen, Aleve, aspirin) for 4 weeks, and avoid ice for the first week — both blunt the healing response. Acetaminophen (Tylenol) is fine for discomfort. Care is tailored to you; use these guidelines with your physical therapist.

Frequently asked questions

Is my outer hip pain arthritis?
Often not — pain on the outside of the hip is frequently gluteal tendinopathy (sometimes mislabeled bursitis), while true hip arthritis is usually felt in the groin. Ultrasound helps distinguish them so treatment is targeted correctly.
Can I avoid a hip replacement?
For many patients, yes — at least for years. Physical therapy, weight and activity management, and image-guided injections or orthobiologics can control pain and maintain function, delaying or avoiding surgery.

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