Hip Injuries

Hip Flexor Tendinitis (Iliopsoas Tendinitis)

The hip flexor muscles are located on the front of the hip and inside the pelvic bone. Flexing the hip (such as when marching) repeatedly can cause inflammation to the tendons. Athletes predisposed to hip flexor tendinitis include ballet dancers, cyclists, rowers, track and field participants, soccer players, and gymnasts.

Treatments

Treatment for hip flexor tendinitis will include strengthening the weak muscles found on the exam, working on the tendon manually as needed, loading the tendon to improve healing as appropriate, and progressing strengthening exercises so the athlete is able to return to their sport.

Gluteus Medius Tendinopathy

The gluteus medius muscle is located on the outside of the hip. This muscle keeps the pelvis level while walking and standing on one leg. With gluteus medius tendinitis, there is pain and tenderness over the lateral part of the hip. At times, this pain may radiate down the outside of the thigh. This problem is most commonly found in runners although often occurs without cause. Findings include pain with stairs, running, lying on the affected side, prolonged sitting, and sitting with legs crossed.

Treatments

Treatment choices will depend on when the pain began. If early, then rest, ice, pain-free exercises, and anti-inflammatories may abolish the problem. If the pain has persisted longer than a month, treatment will include strengthening of the weak hip musculature, manual work such as deep friction or soft tissue mobilization, joint mobilization, dry needling, improving shoe wear, and modifying activity level temporarily. For runners, checking running mechanics and modifying their training program is vital.

Hip Impingement/Labral tears

The hip socket has a fibrous ring that lines the outer rim of the socket called the labrum.  The labrum provides a tight seal and adds stability to the hip joint. Hip impingement (medically known as femoroacetabular impingement) is a pinching that occurs to the hip often due to an abnormality to the ball or socket of the hip joint. Often, the labrum can be damaged when friction or pinching occurs. Excessive hip mobility, weak hip musculature, and hip tightness to the back of the hip may predispose an athlete to hip impingement. Pain and sometimes catching or popping is felt in the groin and possibly buttocks and can be exacerbated during sporting activities, especially those requiring twisting, turning, squatting, pivoting, and climbing.

Treatments

Non-surgical treatment for hip impingement includes strengthening exercises of the weak hip muscles, joint mobilization and stretches to improve joint mobility to the back of the hip, soft tissue work if needed, and activity modification.

If conservative care does not allow for adequate recovery, surgical intervention is an option. An arthroscopic repair of the labrum may be performed as well as surgical management of any bony deformities. The athlete will return home the same day wearing a hip spica brace using crutches. It is important to avoid or minimize weight-bearing in order to prevent re-tearing of the labrum. Therapy will begin within a week from surgery with a focus on education, manual work, and modalities to lessen pain,  gaining hip mobility safely, and improving lower extremity strength.

A stationary bike will be started within the first 1-2 weeks of therapy. By 4-6 weeks, weight-bearing will be gradually introduced and weight-bearing exercises will be added to the exercise program. Emphasizing glute strength and restoring hip joint mobility is extremely important. Manual work may be needed to lessen muscle tension. Return to the sport may vary widely from 4-8 months and will depend on successfully completing the functional testing exam. These time frames may vary widely depending on the surgeon.