Hip Tendonitis: Overview and More

Hip tendonitis is caused by inflammation of the tendons of the hip flexor muscles, which function to lift the leg up. Hip tendonitis usually results from overworking these muscles without adequate rest to allow them to recover. 

This article describes causes and symptoms of hip tendonitis, plus how it's diagnosed and treated.

What Is Tendonitis?

Tendonitis is inflammation in a muscle’s tendon, which leads to pain and tenderness that gets worse the more the muscle is used.

Tendonitis is an overuse injury. This means the tendon becomes repeatedly stressed through repetitive muscle contractions, which causes micro-tearing of the muscle and tendon fibers. Without enough rest to allow those micro-tears to heal, a chronic cycle of pain and inflammation develops within the affected tendon.

In addition to the hip flexors, other areas of the body that are prone to developing tendonitis include:

• Common tendon of the wrist extensors (tennis elbow)
• Common tendon of the wrist flexors (golfer's elbow) 
• Achilles’ tendon (Achilles tendonitis)
• Patellar tendon (jumper's knee)
• Tendons of the thumb (De Quervain's tenosynovitis)

Causes

The hip flexors primarily refer to the iliopsoas muscle, the conjoined unit of the iliacus, psoas major, and psoas minor muscles of the hip. The iliopsoas originates in the pelvis and vertebrae of the lower spine and attaches to the top of the femur (thigh bone).

Collectively, the iliopsoas functions to bring the hip into flexion—this is the movement of the hip joint that brings your leg closer to the front of your body, such as lifting your leg up to step up or jump. It also helps keep your torso stable when you're standing with one or both feet on the ground, and it helps you rise from a lying position.  

Iliopsoas tendonitis most often results from physical activities that require repeated lifting of the leg when stepping, running, kicking, and jumping. These may include running, dancing, doing gymnastics, performing martial arts, cycling, and playing soccer. 

Iliopsoas tendonitis can also occur after hip arthroscopy. This is a minimally invasive surgical procedure to repair structures within the hip joint, due to altered joint movement and muscle activation patterns after surgery.

Symptoms

The primary symptoms of hip tendonitis include a soreness or deep ache in the front of the hip that worsens after physical activity, and limited range of motion due to pain. Other symptoms of hip tendonitis include:

• Tenderness to touch in the front of the hip
• Hip flexor tightness
• Low back pain
• Discomfort after prolonged sitting
• Altered gait (walking) pattern characterized by shortened steps 
• Altered posture, with the pelvis rotated forward and an exaggerated curve in the lower back

Diagnosis

Hip tendonitis is diagnosed through a physical examination and a medical history that reviews your symptoms. You may also have an X-ray of your hip performed to examine your hip joint alignment and determine if a fracture or arthritis is present. 

Treatment

Initial treatment for iliopsoas tendonitis involves rest from aggravating activities, along with ice and gentle stretching. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used if needed to ease pain and swelling, decrease inflammation, and reduce muscle spasms. 

If chronic pain persists, you may receive a cortisone injection into your iliopsoas tendon.

A structured physical therapy program focusing on hip flexor stretching and strengthening of the hip flexors, glutes, and core will help you to recover more fully. 

Surgery

For cases that do not improve after three months of treatment, surgery may be performed to lengthen the iliopsoas tendon. The procedure is called a tenotomy. It involves making a small cut into a portion of the iliopsoas tendon, allowing the tendon to increase in length while decreasing tension as it fully heals back together.

While a tenotomy to the iliopsoas tendon temporarily reduces the strength of the iliopsoas, this weakness typically resolves within three to six months after surgery.

Prognosis

Tendonitis, in general, has an excellent prognosis for full recovery if adequate rest from activities that aggravate the condition is taken to allow your inflamed tendon to heal. 

For chronic and severe cases of iliopsoas tendonitis that require surgery, the postsurgical prognosis is usually good.

Summary 

Hip tendonitis is inflammation of the iliopsoas tendon of the hip, most commonly caused by overuse of the hip flexors from running, jumping, and kicking movements. Hip tendonitis can be diagnosed with a physical examination; symptoms include pain in the front of the hip that worsens with movement and restricted hip flexibility. 

Treatment for hip tendonitis involves rest, ice, NSAIDs, stretching, and physical therapy, with an excellent prognosis for full recovery. Chronic cases of hip tendonitis that do not improve with treatment may require a cortisone injection into the iliopsoas tendon to decrease inflammation or a surgical release of the iliopsoas tendon to decrease tightness and pain.

A Word From Verywell

Hip tendonitis can cause nagging pain that limits your ability to comfortably perform everyday activities and engage in your favorite forms of exercise. Luckily, it's easily treated by taking appropriate rest. Once your symptoms start to calm down, performing strengthening exercises for the hip flexors and glutes can help improve any muscle imbalances that could be contributing to the problem.