Physical Therapy Treatment for Hip Tendonitis/Tendinopathy

Hip tendonitis can affect multiple tendons attaching to the hip. Although the term “tendinitis” indicates the presence of inflammation (“itis” means “inflamed”), newer research indicates that the main driver of tendon pain comes from non-inflammatory pathologies known as tendinopathies.

Two common hip tendinopathies treated in physical therapy include gluteal tendinopathy and iliopsoas tendinopathy. 

Gluteal Tendinopathy
Gluteal tendinopathy, also known as greater trochanteric pain syndrome or trochanteric bursitis, is the most common tendinopathy affecting the lower extremity.  It refers to irritation of the gluteal muscle tendons where they attach to the outside of the thigh bone. It affects women greater than men, and is usually prevalent in individuals over the age of 40. 

Symptoms include:

• Moderate to severe pain over the outside aspect of the hip
• Pain with weight bearing activities including walking, stairs or running
• Tenderness to the touch of the outside of the hip over the great trochanter
• Pain with laying on the affected side, often impacting sleep 
• Pain with prolonged sitting
• Pain with crossing the legs

Physical Therapy treatments includes:

• Education regarding modifying positions that increase compression forces through the gluteal tendons and activities that aggravate your symptoms
• Manual therapy techniques to decrease pain and improve hip joint mobility
• Muscle and tendon strengthening to assist in tissue healing
• Functional movement re-training and gradual re-introduction to daily and recreational activities

Iliopsoas Tendinopathy
The Iliopsoas is a muscle that attaches to the front aspect of the thigh bone (femur). It is the primary hip flexor and it assists in externally rotating the femur, playing an important role in hip stability. Iliopsoas tendinopathy occurs most commonly from overuse through repetitive hip flexion or external rotation, or through acute trauma. It is commonly seen in athletes who participate in cycling, ballet, soccer, track, rowing and inclined running. However, it can also occur in non-athletes.

Symptoms of Iliopsoas Tendinopathy include:

• Pain in the front of the hip or the groin. Pain may have a “warm-up” effect, meaning it commences with the onset of activity and diminishes shortly after.
• Intermittent groin pain, typically described as a deep ache
• Audible clicking or catching sensation from the hip or groin area
• Radicular symptoms along the anterior thigh down to the knee
• Aggravating factors may include tying shoe laces, rising from a seated position after prolonged sitting, and inclined walking.

Dysfunction of the psoas muscle is commonly associated with various complaints to the lumbosacral region, which may include low back pain, discomfort into the gluteal or thigh region, and the inability to stand fully erect.

Physical Therapy treatments includes:

• Education regarding modifying movements to improve force distribution through the hip 
• Manual therapy techniques to decrease pain and improve hip joint mobility
• Muscle and tendon strengthening to assist in tissue healing
• Functional movement re-training and gradual re-introduction to daily and recreational activities

References:

• Anderson, C. N. (2016). Iliopsoas: pathology, diagnosis, and treatment. Clinics in sports medicine, 35(3), 419-433.
• Garry JP. Iliopsoas tendinitis [Internet]. Background, epidemiology, functional anatomy. Medscape; 2019 [cited 2020Sep24]. Available from: https://emedicine.medscape.com/article/90993-overview 
• Grimaldi, A., Mellor, R., Hodges, P., Bennell, K., Wajswelner, H., & Vicenzino, B. (2015). Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Medicine, 45(8), 1107-1119.
• Grimaldi, A., & Fearon, A. (2015). Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. Journal of orthopedic & sports physical therapy, 45(11), 910-922.

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