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Hip Tendonitis: Tendonitis of Hip Abductor Symptoms Causes Treatment Preventions & More All you need to know

December 28, 2021

Abductors of the hip are the muscles that move or rotate the hip and leg away from the body towards the outside. When these muscles get inflamed, the condition is called hip tendonitis or tendonitis of the hip abductors.

Inflammation of the tendons of hip abductors can become worse to cause muscle tears. The condition is sometimes referred to as rotator cuff tears of the hip. The tendon becomes red, swollen, and is painful to touch. Chronic tendonitis is called tendinopathy.

Hip abductor tendonitis is a painful condition and can limit movement of the lower limbs.

Hip Tendonitis Tendonitis of Hip Abductor Symptoms Causes Treatment Preventions

Anatomy of the hip abductors

Hip abductors are the muscles that sit on the side of the hip and surround it. They function to functions to move your leg away from the midline of your body. They also anchor the pelvis to the thigh bone, femur while standing on one leg.

There are three main layers of the hip abductor muscles that are involved in the tendonitis of the hip;

1. Deepest layer

The Gluteus minimus is the smallest muscle that is attached to the capsule of the hip joint. It arises from the outer side of the pelvis and gets attached to the greater trochanter on the femur.

2. Middle Layer

Gluteus medius lies in the middle layer, and as the name implies, it is a medium-sized muscle. The muscle joins the pelvis to the femur and contributes to controlling the position of the pelvis.

3. Superficial or top layer

The upper part makes the top layer of the abductor's gluteus maximus and the tensor fascia lata muscle. Gluteus maximus is the largest muscle. These muscles are connected to a long fibrous band, the iliotibial band, that runs along the outside of the hip, thigh, and knee regions. It affects the lateral hip movements through this band.

The main bursae of the hip muscles are three in number;

  • The trochanteric bursa
  • The subgluteus medius bursa
  • The subgluteus minimus bursa

Causes of tendonitis of the hip abductor muscles

The reason lies in;

  • Overuse of the muscles usually occurs during various sports activities.
  • Too weak or too strong surrounding muscles, resulting in an imbalance of muscles that exhibit itself during the hip joint movements.
  • Tendon overuse resulting in tiny micro-tears can cause pain from inflammation or weakened tendons.

Acute tendon tear or strain often affects the gluteus maximus and gluteus medius muscles. In addition, sometimes, the tensor fascia lata muscle gets affected.

Movements involving rapid sidestepping or change of direction when running can result in tendonitis.

The structures involved in abductor tendonitis result in the corresponding injury. For example; Gluteal tendinopathy; pain, inflammation, or a tear of one or more of the gluteal tendons

  • Gluteus medius or minimus tendinopathy
  • Trochanteric bursitis or hip bursitis
  • Greater Trochanteric Pain Syndrome (GTPS); a combination of some of the injuries mentioned above

Symptoms of tendonitis of hip abductors

The most common symptoms of hip tendonitis, tendinopathy, or abductor tears include:

  • Lateral hip pain and weakness located near the hip bone at the start of the tendon
  • Worsening of pain on walking, running, climbing stairs, or even standing
  • Pain is classically relieved by warming the area
  • Achiness in the abductors
  • Snapping sounds, buckling sensation, or locking of the hip
  • Muscle stiffness
  • The local hardness of the muscle or swelling
  • limited range of motion
  • Tenderness, especially near the greater trochanter
  • Worsening of pain upon lying on the affected side
  • Radiating pain to the lateral thigh and knee
  • Positions like sitting while crossed legs, prolonged sitting aggravates the pain
  • Weakness in the hip abductors

An x-ray, ultrasound, or MRI confirms the diagnosis.

Treatment of hip abductor tendonitis

The treatment follows the severity of the injury. It includes the following;

  1. Immediately after the injury to the first few days
  1. RICER

Rest, ice application, compression, elevation are the initial mandatory treatment protocols

  • Medication

NSAIDs are the usual line of defense. In addition, Tenocyte injections, corticosteroid injections, and injections of platelet-rich plasma help the condition.

  • TENS

TENS therapy helps to alleviate any lingering pain on the lateral side of the hip.

  • After few weeks
  • Massage

A thigh massage targets the hamstring and quadriceps muscles located at the front and back of the upper half of the leg. The techniques of the thigh massage help reduce muscle tightness and stiffness, relieve pain and increase blood circulation.

Relaxed hamstrings and quadriceps also contribute to preventing hip abductor tendonitis by creating a balance in the function of hip muscles.

There various techniques included during a thigh massage include:

  • Effleurage
  • Kneading
  • Frictions
  • Wringing
    • Therapeutic ultrasound

Therapeutic ultrasound helps to heal the torn muscles and ease away inflammation.

  • Active rehabilitation

Active rehabilitative exercises should be started with first teaching the patient load management techniques. These include avoiding all positions that can cause or aggravate pain.

In athletes, rest and modified training techniques should be employed. Quick changing methods should be avoided at all costs.

Athletes must reduce training the outer muscle range to help reduce the compression on the tendon.

Some muscle loading techniques can reduce pain in tendons.

Sustained isometric contractions with a certain degree of load benefit in relieving pain. Five repetitions lasting 45 seconds are beneficial for pain relief. A rest period between each isometric contraction lasting for about two minutes is essential to reap the benefits.

Isotonic loading exercises are initiated after the pain is relieved enough. High load, slow velocity exercises that cause minimal hip adduction are employed. It helps to prevent compression of the gluteal tendons.

Exercises that result in isolated hip abductor strengthening should be employed as well in the advance rehabilitative stage. In addition, functional strengthening and endurance training should be part of the exercise regime.

Some exercises for active rehabilitation include;

Static abduction while lying

This exercise gently activates the deep glutes at the side of the hip.

  • Lie in your back
  • Position your knees a bit wider than the hip-width.
  • Place a pillow under the knees and wrap a belt under the lower portion of the thigh.
  • Slowly move your thighs outwards. The movement should accommodate the slack in the belt.
  • A deep stretch should be felt on the side of the hips.

Double Leg Bridge

  • Lie on your back with a pillow supporting your neck and shoulders.
  • Keep your knees bent and place your feet shoulder-width apart.
  • Contract your glutes without tilting or moving the pelvis.
  • Press your heels into the ground but keep the feet relaxed.
  • Lift your hips from the ground slowly.
  • There should be no pain or discomfort in the hamstrings (the front of the thigh).
  • Keep the position for few seconds before bringing it to the starting position.

Double leg squats

  • Stand comfortably and position your feet at your shoulder's width.
  • Relax your thighs and buttocks relaxed.
  • Put your weight equally on both heels while placing two-third on the heels.
  • Bend slowly at the hips and knees.
  • Your body will bend as sitting in a chair. Make sure to keep the knees straight.
  • Keep your back straight. Ensure not to arch it.
  • Stay low for few seconds before coming back up slowly.
  • Repeat for few more reps.

Prevention

Here is how to prevent hip abductor tendonitis;

  • Proper warm-up
  • Stretching exercises, especially for the hamstring and quadriceps muscles
  • Using proper technique during your regular activities
  • Easing up on everyday activities
Abdur Rashid
Medically Reviewed By Abdur Rashid
MSC Public Health, MCSP, MHCPC
BSC (Hon) Physiotherapy
Consultant Neuro-spinal & Musculoskeletal Physiotherapist

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