In this article you will find out everything you need to know about hip tendonitis, the most effective treatments available including an advanced treatment called prolotherapy.
The hip joint is a fascinating piece of machinery made by mother nature. Your hips literally “have your back” when it comes to lifting weights and locomoting. Your hips comprise multiple bones, muscles, and soft tissues. An important soft tissue structure present in the joints is the tendons.
Tendons are specialized structures that connect muscles to bones. Inflammation of tendons leads to tendon pain which gravely affects the quality of life. If the inflammation occurs in the hip tendons, it is termed hip tendonitis. Hip discomfort is an evident feature of the condition.
Statistics suggest that the incidence of chronic hip pain in adults is 30 to 40%. The high incidence shows that pain in the hips is a major contributor to functional disability. In a study on elderly experiencing lower limb pain, 19.2% suffered from hip pain alone.
Hip tendonitis is an umbrella term that covers different types of tendinopathies (inflammation of tendon fibres). Hip tendonitis include:
Iliopsoas Tendonitis
Your hip joint relies on the harmonious working of various strong muscles and tendons. The strongest flexor is the iliopsoas muscle which plays a crucial role in the external rotation of the leg bone (femur). This sturdy hip flexor is also responsible for supporting the lower spine.
Inflammation of the hip flexor tendons is common, leading to hip flexor tendonitis. Chronic pain arises due to repetitive flexion of the hip. The irritated tendons become swollen, giving rise to hip tendonitis. Hip bursitis is also seen in many cases due to the bursa being in close proximity to the hip flexor tendons.
The iliopsoas muscle comprises the iliacus muscle, psoas major and minor muscles. Swelling of the tendon fibres of the iliacus muscle lead to iliacus tendonitis. Overuse injuries (as in sports) are major contributors to iliopsoas tendonitis. This type of hip tendonitis is common in soccer players who often experience pain in the groin region.
Studies show that this type of hip tendonitis arises from snapping hip syndrome. Patients experience popping/clicking sounds in the affected joint on moving the hip. There is a high risk of iliopsoas tendonitis after hip arthroscopy. Rheumatoid arthritis patients also have a tendency to develop tendonitis. Physical therapy offers some help.
Iliotibial Band Hip Tendonitis
Hip pain outside the joint can be due to inflammation of the iliotibial band. As the name suggests, the iliotibial band is a group of tendons present on the outside of the hip which connects the hip muscles to the buttocks. Persistent pain in runners and enthusiasts doing too much exercise are more prone to developing hip tendonitis. Improper foot mechanics can lead to muscle imbalances that contribute to iliotibial band tendon pain.
Running for long periods (as in marathon running) can trigger tendonitis symptoms. The most common symptom of iliotibial band syndrome is pain outside the hip that increases on ascending/descending stairs. Studies show this condition is a typical overuse injury that can be managed well with non surgical treatment. However, refractory cases require surgery for complete pain relief.
Trochanteric Bursitis/Tendonitis
Another contributor to outside hip pain is the trochanteric tendon. Trochanteric pain syndrome is a condition in which the patients experience pain on the side of the hip area. Over usage leading to injury of the tendons/bursa paves the way for trochanteric pain syndrome.
Swelling of the trochanteric bursa (present deep to the gluteus maximum muscle) causes discomfort and lays the foundation for hip arthritis. According to a study, the small fluid sac, i.e., the bursa, lubricates the gluteus tendons, and swelling of the trochanteric bursa limits movement.
Women (especially those involved in games) are more likely to develop trochanteric bursitis than men. Weakness of the buttock muscles is highlighting and one of the common symptoms of the condition.
Risk Factors & Causes of Hip Tendonitis
It is an overuse disorder; therefore, individuals involved in hectic physical activity (running, playing, athletics) are more prone to developing hip tendonitis. Specific sports, such as soccer and track n field games, have a higher risk of injury/disorder than others. Groups at a higher risk of developing hip tendonitis include:
- Ballet dancers
- Cyclists
- Rowers
- Soccer players
- Gymnasts
- Athletes (especially runners)
Due to the high prevalence of hip tendonitis in dancers and players, iliopsoas tendonitis is often referred to as “dancer’s hip” or “jumper’s hip.” Dancers frequently complain of popping sounds in their hips, for example snapping hip syndrome. Research suggests that snapping the hip is extremely common in ballet dancers, potentially leading to hip tendonitis.
The most common cause of hip tendonitis is repetitive or excessive usage. In some cases, the condition may arise after arthroscopy, a minimally invasive surgery for repairing hip joints.
Signs And Symptoms
Hip Pain And Stiffness
Most people experience pain in different regions of the hip (depending on the tendons involved). The most common symptom is hip pain which increases gradually. Mild swelling of a tendon might not pose many problems, but persistent use can cause significant hip tendonitis pain. Extensive research in the differential diagnosis of hip pain has led to the diagnosis of soft tissue disturbances.
Hip pain is accompanied by stiffness. The mild swelling of a tendon makes it stiff restricting movement. In most cases, tightness of the hip flexor muscles interferes with normal activities. This gravely reduces the quality of life. Keeping the hip joint persistently in the same position can lead to discomfort. Patients often complain of pain after prolonged sitting.
Swollen joints usually present with tenderness. You can find appreciable tenderness in hip tendonitis patients.
Lower Back Pain (LBP)
Low back pain is also associated with hip tendonitis. A large number of patients reported experiencing hip pain in the lower back and buttocks region. According to a retrospective study, iliopsoas tendinopathy can lead to chronic low back pain. Treatment for hip tendonitis alleviated symptoms indicating a clear link between hip tendonitis and LBP. Diagnosing the condition can be tricky at times. Another study found low back pain to be a prevalent symptom of iliopsoas tendinopathy.
Reduced Motion And Muscle Weakness
Chronic pain in the hips can significantly reduce the joint’s range of motion. Therefore, it is important to treat tendonitis. Snapping hip syndrome, a major cause of hip tendonitis in dancers, results in a reduced range of motion and muscle weakness. Patients find stretching of the muscles to be painful.
Posture And Gait Issues
Other symptoms of hip tendonitis include posture and gait abnormalities. Postural and gait issues arise from tendonitis-induced muscle imbalances. As the tendons provide support to the spine, damage can lead to posture changes (and subsequent gait abnormalities). Patients with tendon dysfunction show abnormal kinematics of gait.
Diagnosis of Hip Tendonitis
Full physical examination
Your doctor will start by taking your complete medical history, followed by a thorough physical examination. The history and location of the pain help clear the diagnosis. However, a confirmed diagnosis is made only with the help of radiographic imaging.
X-ray Imaging
An X-ray of the hip and pelvic region is usually advised to visualize the bones and the connective tissues. X-rays reveal the alignment of the hip and help rule out hip fractures or arthritis.
MRI Scan
Magnetic Resonance Imaging (MRI) scans are better suited for diagnosing soft tissue disorders. Thus, an MRI plays an important part in diagnosing hip tendonitis.
How To Treat Hip Tendonitis?
There are multiple ways to treat hip tendonitis. You can follow the treatment plan that suits you the most.
Rest And Cold Application
Physical activity aggravates the condition. By continuing the hectic routine, you can further harm the damaged tissue of the affected area. Ice pack application on the injured area is an effective manoeuvre in reducing inflammation.
Medications
The primary care modality for tendonitis is rest, ice application and painkiller medications. Non-steroidal anti-inflammatory drugs (NSAIDs) can ease pain and lower swelling. Muscle relaxants may also be advised to reduce muscle spasms.
Steroid Injections
In many cases, the chronic pain from tendonitis can not be managed with rest and over-the-counter painkillers. Thus, your doctor might suggest you get cortisone injections into the affected tendons. The steroids administered into the joint quickly bring down inflammation and alleviate symptoms.
Exercise
Tendon pain can be debilitating, but light stretching and exercise can help you with symptoms. Individuals getting tendonitis due to excessive exercise should abstain from it completely.
Non Surgical Treatments
The main aim of the non surgical treatments is to reduce inflammation without putting the patient under the knife.
Dry Needling
It is a safe and effective treatment for hip tendonitis. The introduction of dry needles helps stimulate the healing process of the body. When employed in hip arthritis patients, the treatment modality reduces pain and increases hip mobility and physical function. In this treatment, solid needles are inserted into the painful muscles and tendons to decrease the tightness. This step improves blood flow and aids healing.
Physical Therapy
A visit to a physical therapist can help reduce inflammation and associated hip pain. Physical therapy enhances localized blood flow and amp natural body healing. In addition to performing physical therapy, a physical therapist teaches you different exercises to relieve symptoms. The different types of physical therapy exercise good for your hip flexors include:
- Isometric hip press
- Hip bridges
- Pelvic tilt with marching
- Leg raises and circles (lying position)
Ultrasound Guided Injections
A potent treatment for painful hip tendonitis is hip joint injections. A radiologist inserts needles into the joint under ultrasound guidance in this treatment. Different medications can be delivered via this method. The most commonly administered medications include steroids, anaesthetics and hyaluronic acid. Studies show that hyaluronic acid injections ease the gliding of the tendon fibres while improving the integrity of the fibres.
Platelet Rich Plasma (PRP Injections)
Modern research focuses on investigating the effects of platelet-rich plasma on the human body. PRP injections are widely popular treatments for halting skin ageing. The multipotent plasma solution can evidently stimulate healing when injected into injured/diseased soft tissues. It was revealed in a randomized controlled study that PRP injections showed better results than single-dose steroid injections.
Surgical Treatments
Arthroscopic surgery is the least invasive surgery for hip tendonitis. In general, a combination of rest, sports medicine (physical) therapy and NSAIDs is the mainstay of hip tendonitis. This surgery is carried out to heal the tendons via a small incision. It is more effective than conventional surgery.
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat hip tendonitis.
Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to repair the damage and help hip tendonitis.
As prolotherapy is helping to treat the root cause of hip tendonitis, it is deemed to be a permanent fix, preventing the symptoms from returning.
Frequently Asked Questions
What does tendonitis feel like in the hip?
The initial presentation of hip tendonitis is hip tenderness. The patient then feels stiffness on prolonged sitting, transforming into pain (without treatment). Hip pain is most pronounced with hip movement (especially during flexion). Depending on the tendons involved, hip pain can be felt in different areas of the hip; however, the most common site is outside of the hip. Some patients also experience low back pain.
What are the two symptoms of hip tendonitis?
The two most common symptoms of hip tendonitis include hip pain and reduce range of motion. The majority of patients complain of hip pain on prolonged sitting. Pain from tendonitis increases by the end of the day. Persistent pain and inflammation of the joint reduce mobility and range of motion.
How do you fix hip tendonitis?
The simplest way to fix hip tendonitis is to do sufficient rest and apply ice on the affected joint. Taking painkiller medicines provides pain relief. Severe cases of pain require steroid injections. Non surgical treatment of tendonitis includes dry needling, physical therapy and PRP injections. Arthroscopic surgery is reserved for severe cases.
Does hip tendonitis go away on its own?
Yes, mild swelling of the hip tendons can go away with ample rest and conservative strategies. Tendons take time to heal; thus, it is a long and lengthy process. Inflamed tendons can heal on their own, but surgery is indicated in the case of torn tendons.
Is it OK to walk with hip tendonitis?
Hip flexor tendonitis makes flexion of the hip a difficult task. Individuals with iliopsoas tendinopathy can have a hard time walking or running. So, it is advised to take rest and avoid walking if diagnosed with hip tendonitis.
What aggravates hip tendonitis?
Muscle overuse is the main underlying cause of hip tendonitis. Overactivity and excessive physical activity (running, cycling, etc.) after tendonitis diagnosis can aggravate hip tendonitis.