Tendonitis in the hip

The hip is the largest ball-and-socket joint in the body. Its functions are twofold: it supports and stabilizes the body along with facilitating movement of the upper leg.

To an athlete, the hip is indispensable. Even less active sports, such as golf, depend on a healthy hip for maximum efficiency. Unfortunately, since athletes depend so much on their hips, they are more prone to injuring a hip due to their increased physical activity.

Dr. Hamilton at Beacon Orthopaedics & Sports Medicine is no stranger to hip problems in athletes. He specializes in, among other orthopaedic surgeries, minimally invasive hip repair. The following article contains information from Dr. Hamilton regarding common hip complications and what actions athletes can take to prevent injuries.

Anatomy of the Hip

In the most general sense, the hip joint is a ball-and-socket joint that is formed where the thigh bone (femur) meets the three bones of the pelvis: the ilium, the ischium, and the pubis. The femur has a spherical tip that fits into the socket formed by the hipbone.

Bony Structures:

Trochanter

The trochanter is a spur on the femur just before the ball of the femur forms.

Ischium

The ischium is the curved bone forming the base of each half of the pelvis.

Muscles:

Iliopsoas

The iliopsoas muscle is a powerful hip flexor that runs across the top of the hip joint and works to pull the knee up and off the ground. It’s made up of two muscles: the psoas and iliacus. These muscles run from the lower spine and pelvis, join together, then attach by a tendon to the upper thigh.

The iliopsoas is a workaholic muscle. Throughout the day it’s constantly activated by forward motions like walking, running and leg lifting. It also picks up the slack when weaker muscles can’t perform their movements effectively, which lead to overworking and injury.

Rectus femoris

The rectus femoris is of the four quadriceps muscles that attach to the kneecap (patella). It helps to extend the knee and flex the hip.

Sartorius

The sartorius is the longest muscle in the human body. It runs down the entire length of the front of the thigh. It assists with hip flexion, abduction, and lateral rotation of the hip, along with flexion of the knee.

Aside

The iliopsoas, rectus femoris, and sartorius are the three biggest/most important muscles of the hip flexors. These muscles, unsurprisingly, are responsible for the action of flexing the hip joint.

Piriformis

The piriformis is a small muscle that runs from the sacrum to the outside of the hip.

Bursae:

Bursae are sacs filled with an egg-white-like substance called synovial fluid. Bursae typically act as lubricators between bones and other structures, such as muscles or ligaments, but they also reduce friction between tendons, ligaments, and muscles. Bursae are named after the bone they envelop.

Trochanteric bursa

It is of the two major bursae of the hip. It is located on the outside point of the femur, called the greater trochanter.

Ischial bursa

It is located in the upper buttock area. It’s a deep bursa located over the ischium and lies between the M. gluteus maximus and the ischial tuberosity.

Common Hip Conditions

Iliopsoas Syndrome

Oftentimes, pain felt in the lower back, hip, and thigh actually has its origin at the iliopsoas muscle, earning the muscle the nickname “hidden prankster.”

When either the iliopsoas bursa or the tendon connecting the iliopsoas to the upper thigh get inflamed, it becomes painful to use the muscle, which causes pain to be felt in the front of the hip whenever the leg is raised. A snapping or clicking sensation may also be felt during movement.

Iliopsoas syndrome is most likely to affect track and field athletes, cyclists, triathletes, dancers, and tennis players due to their repetitive hip movements.

Hip Bursitis

Hip bursitis is a condition where one or more of the hip’s bursae become inflamed and painful. This pain is typically felt on the outside of the hip and later radiates down into the thigh.

Symptoms of hip bursitis also include joint pain/tenderness. Injured athletes will see swelling and feel warmth around the injured area. The pain is sharp at first, but later dulls and becomes achy. The pain is worst when getting out of a chair or bed, sitting for a long time, or after sleeping on the injured side.

Bursitis can either be acute or chronic. Acute bursitis is fast, flaring up and going away after mere hours (or in some cases, days). Chronic bursitis is slower and lasts longer—anywhere from a few days to several weeks. It can also return unexpectedly after a few weeks or months without any pain.

What Causes Hip Bursitis?

  • Rheumatoid arthritis
  • Gout
  • Pseudo gout
  • A sudden hip injury
  • Diabetes
  • Bone spurs (bony growths on top of normal bone) on the hip
  • Spine problems (like scoliosis)

Trochanteric bursitis

Trochanteric bursitis occurs near the top of the femus, and it causes pain and tenderness of the outer hip and thigh. One of the more unfortunate side effects of trochanteric bursitis is that those who have it have a hard time laying on the afflicted side, which makes sleep very difficult. Excessive walking, exercise, or stair climbing often makes the painful symptoms worse.

The most common causes of trochanteric bursitis are sudden hip injuries, bad posture, or extra stress (typically caused by arthritis, excess weight or uneven leg lengths)

Ischial bursitis

The ischial bursa is located in the upper buttock area. Ischial bursitis can cause dull pain in this area that is most noticeable when climbing uphill. The pain sometimes occurs after prolonged sitting on hard surfaces, which has earned the condition the nicknames “weaver’s bottom” and “tailor’s bottom.”

Ischial bursitis is most commonly caused by sitting on a hard surface for a long time. The hard surface presses against the ischial bursa, causing irritation and eventually bursitis.

Piriformis Syndrome

Despite being such a small muscle, the piriformis can cause massive problems when inflamed or overused. Because the piriformis runs over the sciatic nerve, it tends to put pressure on the nerve, which causes extreme pain around the gluteus and posterior hip area when the piriformis swells or spasms.

Long distance running and prolonged sitting are the two most common reasons one develops piriformis syndrome.

Hip Flexor Injuries

A hip flexor injury occurs when one (or more) of the hip flexor muscles are torn. The iliopsoas is the one that is most commonly injured, though. The amount of pain felt and how much functionality is lost depends entirely on how many muscle fibers are torn. When a small number of fibers get torn, function mostly stays the same (despite it still being painful). If enough fibers are torn, though, the injury becomes much more painful and is accompanied by a severe loss of function in the leg.

Pain from hip flexor injuries is typically felt in front of the hip/groin area and might also be accompanied by bruising, muscle spasms, and tenderness. Hip flexor injuries often make it difficult to walk normally.

While any athlete (or nonathlete) can wind up with a hip flexor injury, they are most common in athletes who do a lot of kicking, running, or jumping (which are all activities that engage the hip flexors).

Another common contributor to hip flexor injuries is weakness of the supporting muscles. When someone sits for long periods of time every day, the hip flexor muscles stay contracted for long periods of time, shortening and weakening them, making injuries far more likely.

Hip Flexor Tendonitis

Hip tendonitis is the inflammation of any tendon that’s a part of the hip flexors. It is typically accompanied by degeneration.

The most common symptom of hip flexor tendonitis is pain that gradually develops over time. Often this pain will decrease after activity as the tendons get more blood and stretch out, though the pain frequently returns worse later.

Ways to Prevent Hip Injury

Because of the diversity of hip injuries and possible causes, it is impossible to completely prevent hip injuries, however, there are three actions that drastically reduce an athlete’s risk of developing a hip injury:

  • Stop when fatigue sets in
  • Take care to use proper biomechanics
  • Warm up and stretch. (stretching isn’t effective at preventing injury unless a warm up routine is also present)

Exercises to Prevent Hip Pain

Because of the complexity of the hips and the different ways that different sport athletes use their bodies, it’s important to note that there is no catch-all hip pain prevention technique. But exercises, such as the following, can help relieve hip pain:

  • Bridge with alternating hip flexion
  • Abdominal crunches
  • Single and double knee to chest (supine) figure four piriformis stretch
  • Seated butterfly stretch

Dr. Hamilton is Your Local Hip Expert

If you’re an athlete who is concerned about their hips, reading this article was an important first step towards understanding and ultimately preventing hip damage.

The next step, whether you’ve been injured or not, is to schedule an appointment with Dr. Hamilton at Beacon Orthopaedics & Sports Medicine. If you’re injured, Dr. Hamilton and his team of experts will walk you through exactly what needs to happen for you to get back to the field (or court, green, or ice). Dr. Hamilton can help you prevent future injuries so you can stay in the game longer and achieve your personal best in whatever sport you specialize in.

Physio Works – Physiotherapy Brisbane

Article by J. Miller, Z. Russell

What is Gluteal Tendinopathy?

Gluteal tendinopathy is the most common hip tendonitis (hip tendon injury). It is a common cause of Greater Trochanteric Pain Syndrome.

Your gluteal tendons are the tough fibres that connect your gluteal muscle to your hip bone. A tendon injury may seem to happen suddenly, but usually, it is the result of many tiny tears to the tendon that have happened over time.

Typically, tendon injuries occur in three areas:

  • musculotendinous junction (where the tendon joins the muscle)
  • mid-tendon (non-insertional tendinopathy)
  • tendon insertion (eg into bone)

Non-insertional tendinopathies tend to be caused by a cumulative microtrauma from repetitive overloading eg overtraining.

What is a Tendon Injury?

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually, it is the result of repetitive tendon overloading. Health professionals may use different terms to describe a tendon injury. You may hear:

Tendinitis (or Tendonitis): This actually means “inflammation of the tendon,” but inflammation is actually only a very rare cause of tendon pain. But many doctors may still use the term tendinitis out of habit.

The most common form of tendinopathy is tendinosis. Tendinosis is a noninflammatory degenerative condition that is characterised by collagen degeneration in the tendon due to repetitive overloading. Therefore tendinopathies do not respond well to anti-inflammatory treatments and are best treated with functional rehabilitation. The best results occur with early diagnosis and intervention.

What Causes a Tendon Injury?

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

Your tendons are designed to withstand high, repetitive loading, however, on occasions, when the load being applied to the tendon is too great for the tendon to withstand, the tendon begins to become stressed.

When tendons become stressed, they sustain small micro tears, which encourage inflammatory chemicals and swelling, which can quickly heal if managed appropriately.

However, if the load is continually applied to the tendon, these lesions occurring in the tendon can exceed the rate of repair. The damage will progressively become worse, causing pain and dysfunction. The result is a tendinopathy or tendinosis.

Researchers current opinion implicates the cumulative microtrauma associated with high tensile and compressive forces generated during sport or an activity causes a tendinopathy.

What are the Symptoms of Tendinopathy?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.

  • The pain may get worse when you use the tendon.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice a crunchy sound or feeling when you use the tendon.

The symptoms of a tendon injury can be a lot like those caused by bursitis.

Tendinopathy Phases

The inability of your tendon to adapt to the load quickly enough causes tendon to progress through four phases of tendon injury. While it is healthy for normal tissue adaptation during phase one, further progression can lead to tendon cell death and subsequent tendon rupture.

1. Reactive Tendinopathy

  • Normal tissue adaptation phase
  • Prognosis: Excellent. Normal Recovery!

2. Tendon Dysrepair

  • Injury rate > Repair rate
  • Prognosis: Good. Tissue is attempting to heal.
  • It is vital that you prevent deterioration and progression to permanent cell death (phase 3).

3. Degenerative Tendinopathy

  • Cell death occurs
  • Poor Prognosis – Tendon cells are giving up!

4. Tendon Tear or Rupture

  • Catastrophic tissue breakdown
  • Loss of function.
  • Prognosis: very poor.
  • Surgery is often the only option.

It is very important to have your tendinopathy professionally assessed to identify it’s injury phase. Identifying your tendinopathy phase is also vital to direct your most effective treatment, since certain modalities or exercises should only be applied or undertaken in specific tendon healing phases.

How is a Tendon Injury Diagnosed?

To diagnose a tendon injury, your physiotherapist will ask questions about your past health, your symptoms and exercise regime. They’ll then do a physical examination to confirm the diagnosis. If your symptoms are severe or you do not improve with early treatment, specific diagnostic tests may be requested, such as an ultrasound scan or MRI.

How is Tendinopathy Treated?

In most cases, you can start treating a tendon injury at home. To get the best results, start these steps right away:

  • Rest the painful area, and avoid any activity that makes the pain worse.
  • Apply ice or cold packs for 20 minutes at a time, as often as 2 times an hour, for the first 72 hours. Keep using ice as long as it helps.
  • Do gentle range-of-motion exercises and stretching to prevent stiffness.
  • Have your biomechanics assessed by your physiotherapist.
  • Undertake an Eccentric Strengthen Program. This is vital!

Your gluteal (buttock) muscles control your hip joint movement. Gluteal tendinopathy is an injury to the gluteal tendon complex and is often associated with trochanteric bursitis.

What Causes a Gluteal Tendinopathy?

The most common onset of gluteal tendinopathy is due to poor hip and gluteal muscle control that leads to overstressing of the gluteal tendons, causing pain and hip-pelvis instability.

Continued hip instability can cause you to walk or run with poor control, which causes you hip bursa to become under friction load, leading to trochanteric bursitis.

What are the Symptoms of Gluteal Tendinopathy?

Gluteal tendinopathy usually causes lateral hip pain, muscular stiffness, and loss of strength in the hip muscles.

  • The pain may get worse when you use the tendon eg running or hopping.
  • You may have more hip pain and stiffness during the night or when you get up in the morning.
  • Pain is often worse when you lie on your affected hip.
  • The lateral hip may be tender, red, warm, or even swollen if there is inflammation of the hip bursa.

How is a Gluteal Tendinopathy Diagnosed?

In most cases, your doctor or physiotherapist will accurately suspect your gluteal tendinopathy diagnosis in their clinic.

If your symptoms are severe or you do not improve with early treatment, specific diagnostic tests may be requested, such as an ultrasound scan or MRI.

Gluteal Tendinopathy Treatment

  • In most cases, you can start treating your hip tendon injury at home using a RICE regime.
  • Rest the painful area, and avoid any activity that makes the pain worse.
  • Apply ice or cold packs for 20 minutes at a time, as often as second hourly, for the first 72 hours. Keep using ice as long as it helps.
  • Do gentle hip range-of-motion exercises and stretching to prevent stiffness.
  • Have your hip joint and muscle function professionally assessed by your physiotherapist.
  • Undertake a “Hip Core Stabilisation Program”. This is vital to prevent a recurrence.
  • Visualise and retrain your hip muscle control via Real-time Ultrasound.
  • Modify your return to sport under the advice of your physiotherapist.
  • Despite the common use of painkillers and anti-inflammatory medications the cause is related to hip control, so it is your control that should be retrained as a priority. Persisting tendon injuries are best managed by exercise under the guidance of your physiotherapist.
  • Should your tendinopathy be slow to improve you have the option of a steroid injection under ultrasound guidance. For the best long-term results, you should continue to strengthen your hip rather than rely solely on the steroid effects.
  • In severe cases, hip surgery may be required.

How to Return to Sport after Gluteal Tendinopathy

As soon as you are cleared by your physiotherapist you can return to your activity, but take it easy for a while.

  • Don’t start at the same level as before your injury. Build back to your previous level slowly, and stop if it hurts.
  • Warm up before you exercise.
  • After the activity, apply ice to prevent pain and swelling.
  • Continue your hip stabilisation exercises.
  • If these steps don’t help, you may require a re-visit to your physiotherapist.
  • It may take weeks or months to fully rehabilitate a gluteal tendinopathy.
  • Be patient, and stick with your treatment. If you start using the injured tendon too soon, it can lead to more damage and further time delays.

If you have any concerns please seek the advice of your physiotherapist.

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Gluteal Tendinopathy Treatment Options

  • Early Injury Treatment
  • Avoid the HARM Factors
  • What to do after a Muscle Strain or Ligament Sprain?
  • Acupuncture and Dry Needling
  • Sub-Acute Soft Tissue Injury Treatment
  • Core Exercises
  • Closed Kinetic Chain Exercises
  • Active Foot Posture Correction Exercises
  • Gait Analysis
  • Biomechanical Analysis
  • Balance Enhancement Exercises
  • Proprioception & Balance Exercises
  • Agility & Sport-Specific Exercises
  • Medications?
  • Orthotics
  • Real Time Ultrasound Physiotherapy
  • Soft Tissue Massage
  • Brace or Support
  • Dry Needling
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Joint Mobilisation Techniques
  • Kinesiology Tape
  • Neurodynamics
  • Prehabilitation
  • Running Analysis
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • Yoga
  • Helpful Gluteal Tendinopathy Products

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    Related Hip Injuries

    General Information

    • Hip Pain
    • Groin Pain

    Hip Joint Pain

    • Hip Arthritis – Osteoarthritis
    • Hip Labral Tear
    • Hip Pointer
    • Femoroacetabular Impingement – FAI
    • Perthes Disease
    • Slipped Femoral Capital Epiphysis
    • Stress Fracture
    • Avascular Necrosis of the Femoral Head

    Lateral Hip Pain

    • Gluteal Tendinopathy
    • Greater Trochanteric Pain Syndrome
    • Trochanteric Bursitis

    Adductor-related Groin Pain

    • Adductor Tendinopathy
    • Groin Strain

    Pubic-related Groin Pain

    • Osteitis Pubis

    Inguinal-related Groin Pain

    • Inguinal hernia
    • Sportsman’s hernia

    Iliopsoas-related Groin Pain

    • Hip Flexor Strain

    Other Muscle-related Pain

    • Piriformis Syndrome
    • Muscle Pain -Muscle Strain
    • Poor Hip Core
    • DOMS -Delayed Onset Muscle Soreness
    • Cramps
    • Core Stability Deficiency

    Systemic Diseases

    • Rheumatoid Arthritis
    • Fibromyalgia
    • Osteoporosis

    Referred Sources

    • Sacroiliac Joint Pain -SIJ
    • Sciatica
    • Lower Back Pain
    • Pinched Nerve

    Hip Surgery

    • Hip Replacement

    FAQ’s about Gluteal Tendinopathy

  • Common Physiotherapy Treatment Techniques
  • What is Pain?
  • Physiotherapy & Exercise
  • Massage Styles and their Benefits
  • What Causes Post-Exercise Muscular Pain?
  • Can Kinesiology Taping Reduce Your Swelling and Bruising?
  • Heat Packs. Why Does Heat Feel So Good?
  • How Do You Improve Your Balance?
  • Post-Run Soreness: Should You Be Concerned?
  • Running Recovery: 6 Helpful Tips
  • Sports Injury? What to do? When?
  • What are Growing Pains?
  • What are the Common Massage Therapy Techniques?
  • What are the Early Warning Signs of an Injury?
  • What Can You Do To Help Arthritis?
  • What is a TENS Machine?
  • What is Chronic Pain?
  • What is Musculoskeletal Physiotherapy?
  • What is Nerve Pain?
  • What is Sports Physiotherapy?
  • What is the Correct Way to Sit?
  • What to expect when you visit PhysioWorks?
  • What’s the Benefit of Stretching Exercises?
  • Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker
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