Hip tendonitis refers to the irritation or inflammation of the tendons—thick, fibrous cords that connect muscle to bone—around the hip joint. This condition most commonly affects the iliopsoas tendon in the groin area or the gluteal tendons (gluteus medius and minimus) on the outside of the hip. Outer hip pain is often mistakenly called trochanteric bursitis, but advanced imaging frequently shows the underlying cause is gluteal tendinopathy. Managing hip tendonitis involves reducing discomfort and restoring the tendon’s capacity to handle physical demands, starting with immediate self-care and progressing to professional and long-term recovery strategies.
Understanding Hip Tendonitis
Hip tendonitis is an overuse injury resulting from repetitive strain or a sudden increase in physical activity. Tendons are slow to heal due to limited blood supply. When the load placed upon them exceeds their capacity, they develop micro-tears or structural changes. Common activities leading to this condition include running, cycling, or increasing workout intensity too quickly. This overloading causes the tendon structure to break down, resulting in persistent pain.
Symptoms are localized, presenting as aching discomfort. This pain is felt either deep in the groin (iliopsoas issues) or on the outside of the hip over the greater trochanter (gluteal issues). The pain often worsens with activity, such as walking, climbing stairs, or standing on one leg. Stiffness in the joint, especially after periods of rest or upon waking, is also a common complaint.
Immediate Conservative Care at Home
The first step involves modifying activities to reduce the load on the irritated tendon. For gluteal tendinopathy, avoid positions that compress the tendon against the bone, such as standing with weight shifted to one side or sitting with legs crossed. When sleeping on your side, lie on the non-painful hip and place a pillow between your knees. This keeps the affected hip in a neutral, non-compressed alignment.
Applying ice to the painful area helps manage discomfort and localized swelling during the initial acute phase. Use a cold pack wrapped in a thin towel for 15 to 20 minutes, allowing at least 30 minutes between applications. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can be taken for one to two weeks to decrease pain. Always take these medications with food to minimize the risk of stomach irritation.
Professional Medical and Physical Therapy Treatments
If home care is insufficient, professional physical therapy is the most effective long-term treatment. A physical therapist assesses movement patterns to identify biomechanical issues, such as weakness in the hip abductors or core muscles, that contribute to tendon overload. Interventions often involve manual therapy, including targeted soft tissue work and joint mobilizations, to reduce pain and improve hip range of motion. Other modalities like therapeutic ultrasound or dry needling may be used to stimulate blood flow and facilitate tendon healing.
When pain is severe and unresponsive to initial conservative care, a physician may recommend medical injections. Corticosteroid injections offer immediate pain relief by reducing inflammation, but their effects are often temporary. They may not be advised for chronic tendinopathy due to potential long-term tendon weakening. For chronic cases, regenerative treatments like Platelet-Rich Plasma (PRP) injections or Extracorporeal Shock Wave Therapy (ESWT) may be considered. PRP uses the patient’s own concentrated growth factors injected into the tendon to encourage tissue repair, while ESWT uses acoustic waves to stimulate healing.
Strategies for Long-Term Prevention and Recovery
Long-term recovery relies on a progressive loading program designed to increase the tendon’s strength and tolerance to stress. This program often begins with isometric exercises, which involve holding a muscle contraction without movement for 45 to 60 seconds. This technique provides a powerful pain-relieving effect. As pain decreases, the focus shifts to strengthening exercises, particularly targeting the gluteal muscles and the core.
Eccentric loading, which involves slowly lengthening the muscle and tendon under tension, is the standard for tendon rehabilitation. This exercise helps remodel the tendon structure, making it more resilient to stress. Successful recovery requires a gradual return to activities, ensuring the tendon is not overloaded before it has fully adapted. Maintaining core stability and hip abductor strength through consistent exercise is necessary to prevent recurrence.