Tendinopathy of the hip involves chronic pain and dysfunction in the tendons connecting hip muscles to the bone. Unlike an acute strain, this issue represents a persistent problem where the tendon’s ability to repair itself has been outpaced by the demands placed upon it. Hip pain is common, and the underlying source of discomfort is often related to these tendon structures rather than the hip joint itself. This article will explain the specific tissues involved in hip tendinopathy and detail the proven methods for conservative treatment.
Understanding the Pathology and Location
Tendinopathy is an umbrella term for a tendon disorder characterized by tissue breakdown and failed healing, distinct from acute tendinitis (short-term inflammation). In the hip, the condition most frequently involves the gluteal tendons—specifically the Gluteus Medius and Gluteus Minimus—where they anchor onto the greater trochanter (the prominent bony point on the side of the thigh bone). This presentation is often grouped under the diagnosis of Greater Trochanteric Pain Syndrome (GTPS). While other tendons, such as the proximal hamstring or adductor tendons, can be affected, gluteal tendinopathy causing lateral hip pain is the most recognized form. The pathology involves a degenerative change where the organized collagen structure becomes disorganized and thickened due to an imbalance between tissue wear and repair.
Identifying Common Causes and Risk Factors
The development of hip tendinopathy is driven by a sudden change in mechanical load placed on the tendon. Tendons possess a load threshold, and when activities are increased too quickly—such as starting a new running routine or significantly increasing walking distance—this threshold is exceeded, leading to tissue changes. Repetitive strain without adequate recovery time also contributes to this cumulative damage.
An equally significant factor is prolonged compressive loading, where the tendon is pressed against the greater trochanter bone. Certain postures, like standing with weight shifted onto one hip (“hip hanging”) or sitting with the legs crossed, can repeatedly compress the gluteal tendons. The condition is much more prevalent in women, particularly those in perimenopausal or postmenopausal stages. Biomechanical issues, such as poor movement control or muscle weakness/imbalance, can further alter the loading environment, predisposing the tendon to injury.
Recognizing the Symptoms
The hallmark symptom of hip tendinopathy is localized pain on the side of the hip, which can radiate down the outer thigh toward the knee. Patients commonly describe the discomfort as a deep ache or a burning sensation directly over the greater trochanter. This pain is exacerbated by activities requiring single-leg loading, such as climbing stairs or standing up from a chair.
A defining feature is “start-up pain,” where discomfort is high immediately upon beginning movement after a period of rest, such as the first few steps after prolonged sitting. Symptoms are also worse at night, especially when lying on the affected side due to direct tendon compression. Lying on the unaffected side can also cause pain because the top leg drops across the body, stretching and compressing the gluteal tendons.
Conservative Management and Recovery
The mainstay of treatment is conservative management, focusing on load modification and specific, progressive strengthening exercises. The initial step involves load management: reducing painful activities without resorting to complete rest, which can decondition the tendon further. Patients must identify and modify daily habits that compress the tendon, such as avoiding crossing the legs while sitting or standing with all weight resting on the painful hip.
Position modification during sleep is an immediate strategy. This includes avoiding lying directly on the sore hip and placing a pillow between the knees and ankles when lying on the unaffected side to keep the top hip level. Physical therapy is the gold standard for long-term recovery, centered on rebuilding the tendon’s capacity to tolerate load.
The rehabilitation program typically begins with isometric exercises, which involve holding a static muscle contraction for short periods (around 45 seconds) to provide immediate pain relief and re-engage the muscle. Once pain levels are manageable, the program progresses to heavy slow resistance (HSR) training to stimulate structural changes. This technique involves lifting heavier weights slowly to maximize the time the tendon is under tension. This controlled, mechanical loading is the stimulus needed to strengthen the tendon tissue over time.
While corticosteroid injections offer short-term pain relief, exercise-based rehabilitation and education are superior for long-term outcomes. Because tendinopathy is a degenerative process, not purely inflammatory, anti-inflammatory medications (NSAIDs) may provide brief symptomatic relief but do not address the underlying structural failure. Recovery from chronic tendinopathy is slow, often requiring consistent adherence to a structured physical therapy program for several months to achieve a successful return to full activity.