Tendonitis, the irritation or inflammation of a tendon, is a condition most commonly associated with joints like the elbow, shoulder, or knee. Despite the hip being a large ball-and-socket joint, its tendons are susceptible to this painful overuse injury. The condition is often referred to as tendinopathy, reflecting the chronic degenerative changes that occur in the tendon tissue over time. Hip pain is frequently misdiagnosed as bursitis due to the close proximity of bursae and tendons. Confirming the specific tendon involved is the first step in effective management and recovery.
The Tendons Affected in the Hip Region
The hip area is complex, containing several major tendons that can develop irritation or inflammation from repetitive strain. Hip tendinopathies are typically categorized by their anatomical location, which correlates directly with where the patient feels pain.
A common location is the front of the hip, involving the iliopsoas tendon. This tendon is formed by the convergence of the iliacus and psoas muscles, acting as the primary hip flexor responsible for lifting the leg. Pain from iliopsoas tendinopathy is felt deep in the groin area and can radiate down the front of the thigh. This condition is frequently seen in athletes involved in repetitive hip flexion, such as runners and dancers, and may be accompanied by a clicking or “snapping” sensation when the hip moves.
The outer side of the hip is the site of gluteal tendinopathy, affecting the tendons of the gluteus medius and gluteus minimus muscles. These muscles are essential for stabilizing the pelvis when walking or standing. Pain in this area is localized to the bony prominence on the side of the upper thigh, known as the greater trochanter. This tendinopathy is often confused with trochanteric bursitis, but both conditions are sometimes grouped under the term Greater Trochanteric Pain Syndrome.
A third common presentation is proximal hamstring tendinopathy (PHT), which causes pain deep in the buttock. This injury affects the hamstring tendons where they attach to the ischial tuberosity, often called the “sit bone.” PHT pain is aggravated by activities that stretch the hamstring, such as lunging or running, and is painful when sitting on hard surfaces due to direct compression.
Why Hip Tendonitis Develops
Hip tendinopathy rarely results from a single traumatic event but develops due to cumulative strain that overloads the tendon’s capacity to repair itself. The primary mechanism is overuse, where repetitive movements cause micro-damage to the tendon fibers faster than the body can heal them. This condition is highly prevalent in endurance athletes like cyclists and long-distance runners who perform thousands of similar hip movements.
Underlying biomechanical factors often contribute to this overload by creating abnormal forces on the hip tendons. For instance, a measurable leg length discrepancy (LLD), even a mild difference, can alter a person’s gait. This asymmetry leads to uneven loading across the pelvis and hips, causing excessive stress on the tendons of the longer or shorter limb.
Muscle imbalances also play a role in developing hip tendon irritation. Weakness in the core or gluteal muscles forces smaller tendons, such as the iliopsoas or hamstring tendons, to overcompensate during dynamic activities. When these stabilizer muscles are insufficient, the tendons must absorb forces they are not designed to handle, leading to chronic irritation and pain. The natural aging process also contributes, as tendons lose elasticity and tolerance for stress after the age of 40, making them susceptible to injury from repetitive motion.
Recovery and Treatment Options
The management of hip tendinopathy centers on conservative, non-invasive methods aimed at reducing pain and restoring the tendon’s strength. The foundational step is activity modification, which involves temporarily reducing or altering the activities that provoke pain to allow the tendon to rest and begin repair. This is often paired with temporary measures like applying ice and using over-the-counter anti-inflammatory medications to manage acute discomfort.
Physical therapy is a cornerstone of long-term recovery, focusing on strengthening the tendon through a progressive loading program. This rehabilitation incorporates eccentric exercises, which focus on the muscle and tendon lengthening phase of a movement. This type of loading stimulates tendon healing and increases its tolerance to stress. A therapist will also address underlying issues, such as poor movement patterns or weakness in the glutes and core, to prevent recurrence.
In cases where pain persists despite dedicated rehabilitation, a medical professional may consider localized intervention. Corticosteroid injections, often performed using ultrasound guidance, can provide rapid, temporary pain relief by reducing inflammation. However, these are limited due to the potential risk of weakening the tendon over time. Regenerative options like Platelet-Rich Plasma (PRP) injections, which use the patient’s own blood components to stimulate healing, may also be considered for chronic issues.