Hip flexor tendonitis, a.k.a: hip tendinopathy, or even more accurately, iliopsoas tendonitis is inflammation of any one of several tendons in the hip, generally associated with degeneration of the tendon. Because tendons tend to have poor circulation, these injuries are often slow to heal.
This week, we will begin a study of Hip flexor tendonitis. In Part 1, we will discuss common causes and symptoms, and risk factors for hip tendonitis.
Biomechanics
The muscle involved with this condition is called the iliopsoas. The iliopsoas muscle flexes the hip, bends the trunk towards the thigh and rotates the thigh bone. It’s made up of two muscles -- the psoas and iliacus. These muscles run from the lower spine and pelvis, join together, and then attach by a tendon to the upper thigh. This tendon can get irritated from overu
se, muscle weakness and muscle tightness, causing tenderness and pain.
The injury is not only associated with athletes. Ironically, it can also be caused by a simple lack of flexibility in the hip joint. Sitting for long periods of time, with the legs at 90° to the trunk, as is common with many modern jobs or the disabled, can cause a shortening and weakening of the muscle-tendon unit associated with the hip area.
People with iliopsoas tendonitis often complain of “clicking” in the hip and pain while running, walking or kicking. Even putting on socks can be painful!
Causes
Hip tendonitis occurs when the hip tendon is put under a lot of strain, either doing something that it is not used to, doing the activity more than normal or due to biomechanical problems
This condition can affect athletes who participate in sports like cycling, running, swimming, hockey and baseball. Spin classes, high-intensity interval training (HIIT) workouts and activities involving kicking, squatting and jumping are also associated with this type of injury.
Conversely, people who spend many hours in a sitting position can develop hip flexor tendonitis.
Symptoms
The first symptom of Hip tendonitis is a gradually increasing pain in the hip. The hip will be tender at a specific point from where the tendon originates and stretching the muscle involved may be uncomfortable. The hip may feel stiff in the mornings or after a long rest period. Often pain decreases with activity as the tendon warms up only to return worse later. Eventually it may interfere with daily movements such as climbing stairs, walking for long periods or running. The pain often causes the patient to develop a limp and may interfere with any physical activity
Risk Factors
A combination of factors may contribute to the development of Hip tendonitis, these include:
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Overuse. Athletes who participate in sports that put a lot of strain on the hip joint, like cycling, running, and baseball are at a high risk of developing this injury. Martial arts, high-intensity interval training (HIIT) workouts and activities involving kicking, squatting and jumping are also at risk for this type of injury.
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Lack of physical activity. Today’s sedentary lifestyle, workplace and computer culture is causing more people to sit for longer periods of time than ever before. The result is that leg muscles shorten and the hip joint weakens. This leads to muscular imbalance.
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Muscular imbalance. If some muscles in the legs are much stronger than other muscles, the stronger muscles could pull harder on the hip tendons. This uneven pull can cause tendonitis.
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New or renewed physical activity. An abrupt change in the type or duration of physical activity can cause hip pain. This is often due to the fact that the body has adapted to its previous routines. It will take time to adapt to new ones.
Hip flexor tendonitis, a.k.a: hip tendinopathy, or even more accurately, iliopsoas tendonitis is inflammation of any one of several tendons in the hip, generally associated with degeneration of the tendon. Because tendons tend to have poor circulation, these injuries are often slow to heal.
Last week, we began a study of Hip flexor tendonitis. In Part 2, we will discuss treatment options that can be performed by a qualified therapist and preventive measures the patient can take to avoid future pain and injury of the hip.
Treatment
Home remedies
When the patient first develops hip pain, it may help to temporarily reduce or avoid activities that trigger symptoms. The second home treatment is using the “RICE principle” - rest, ice, compression, elevation.
If the pain continues or worsens, interferes with the ability to perform routine daily activities, or is associated with swelling or redness about the joint, it’s time to call a doctor.
Medications
Pain relievers such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may provide short-term relief from pain associated with Hip tendonitis.
Therapy
For most people, treatment of Hip tendonitis begins with physical therapy to stretch and strengthen the iliopsoas muscle. Specific physical therapy techniques can help reduce the symptoms associated with Hip tendonitis, including:
- Stretching exercises. Regular, gentle stretching exercises can reduce muscle spasm and help lengthen the muscle-tendon unit.
- Strengthening exercises. Weak thigh muscles contribute to the strain on the hip tendon. Gentle strengthening exercises for the associated muscles and tendons are particularly helpful. Eccentric strengthening is particularly important for tendon rehabilitation.
- Sports massage. This simple, deep-tissue therapy, delivered by a qualified professional can be a soothing, effective treatment option.
- “Electronic therapy”. Ultrasound therapy and Iontophoresis may both be effective treatment options for hip tendonitis. The lesser-known Iontophoresis treatment involves spreading a corticosteroid medicine on the skin covering the affected area and then using a device that delivers a low electrical charge to push the medication through the skin.
Home remedies and lifestyle changes
The sufferer of Hip flexor tendonitiscan often identify what behaviors caused the condition and make efforts to reduce or eliminate those behaviors. If the pain is caused by too much sitting, for instance, the sufferer can make a habit of standing and stretching at more frequent intervals.
Other preventive measures include:
- Adjust your seat height so hips sit higher than knees to avoid “hip pinching”
- Maintain a flexible, strong core and hips
- Discuss proper form with your trainer to prevent muscle compensation
- Strengthen the muscle in its lengthened and shortened state
Prevention
To prevent further symptoms, increasing the length of the muscle-tendon unit with stretching and increasing joint flexibility are most important. Active stretching of the injured muscle must be accomplished to improve its length. At the same time, the injured muscle must be strengthened. Eccentric exercises, in which the muscle is lengthened and tightened at the same time (such as with lunges) should be added once full lengthening has returned. Once the proper length of the muscle has been attained and its strength restored, the addition of activity and sport-specific exercises completes the rehabilitation. Increasing the flexibility and strength of the opposing muscle groups is also required.
If you are experiencing pain in your hips, don’t wait for your family physician; visit Excel Rehabilitation Services on Burnside Ave. in Gonzales, Louisiana. You will receive personalized care from an experienced, professional physical therapist!
If you are experiencing pain in your hips, don’t wait for your family physician; visit Excel Rehabilitation Services on Burnside Ave. in Gonzales, Louisiana. You will receive personalized care from an experienced, professional physical therapist!
Online Sources:
American Academy of Orthopedic Surgeons (AAOS): http://orthoinfo.aaos.org/topic.cfm?topic=A00409
WebMD, Inc.: http://www.webmd.com/fitness-exercise/features/hip-tendonitis#1
Other sources:
- http://emedicine.medscape.com/article/87169-treatment
- http://www.sportsinjuryclinic.net/sport-injuries/hip-groin-pain/hip-tendonitis
Picture credit to: http://www.aidmybursa.com/bursitis-hip/illiopsoas-bursitis-anatomy.php