Tendinitis occurs when a muscle is overused and pulls on the tendon that attaches it to the bone. In the hip, tendons perform an important role by keeping strong muscles attached to the femur (thighbone) as the legs move.
Hip abductor tendon tears
Hip abductor tendons are crucial for good gait and stability in the hip joint. When I see someone with hip pain and they have a good range of motion and no sign of degenerative arthritis, that is the clue that we are looking at something in the soft tissue, be it the labrum, the ligaments complex or the hip tendon complex. In many people, it is a combination of all three.
As mentioned, I see the person who may have degenerative or traumatic injury tears to their hip tendons. They do have outside hip pain and a degree of muscle weakness. This person is typically the athlete or person who does physically demanding work and a lot of them are trying to continue with activity or job with the pain.
Sometimes I see the patient who has continued pain after hip replacement. Sometimes the tendons and muscles are injured during the surgery.
A September 2020 (1) study outlines the various challenges and treatments a patient with hip abductor tendons may be subjected to.
- Abductor tendon lesions and insertional tendinopathy are the most common causes of lateral (outer side) thigh pain.
- Gluteal tendon pathology is more prevalent in women and frequency increases with age.
- Chronic atraumatic (degenerative wear) tears result in altered lower limb biomechanics. (Your gait is put off).
Recommended conservative care:
- Abductor tendinosis treatment is mainly conservative, including non-steroidal anti-inflammatory medications, activity modification, local corticosteroid injections, plasma-rich (plasma or PRP), physical and radial shockwave therapy.
- The limited number of available high-quality studies on treatment outcomes and limited evidence between tendinosis and partial ruptures make it difficult to provide definite conclusions regarding the best management of gluteal tendinopathy.
- Surgical management is indicated in complete and partial gluteal tendon tears that are unresponsive to conservative treatment.
- There are various open and arthroscopic surgical procedures for direct repair of abductor tendon tears. There is limited evidence concerning surgical management outcomes.
Many people find effective treatments in conservative care
A study in the Muscles, ligaments and tendons journal (2) gave a broad assessment of these treatments:
A comparison was made of tendon treatments while a person continues with active training consists of exercises focused in muscular strengthening, mainly eccentric, with special emphasis on the adductor muscles, as well as training muscular coordination to improve the postural stability of the pelvis, while those who were not actively training are generally provided with electrotherapy (laser and transcutaneous electrical nerve stimulation), and exercise therapy (stretching). The results showed that patients who continued active training during treatment faired better in terms of pain reduction and return to sport participation at preinjury level.
Those who continued to actively train did better with a multi-modal treatment program consisting of heat therapy, manual therapy, stretching and returning to running program. The researchers of this study did point out however that the effectiveness of the treatment noted in this study was lower than the results obtained in other studies.
One kind of tendinitis that occurs as a result of overuse is called iliacus tendinitis or iliopsoas tendinitis. The iliac muscle, which starts at the hip bone, and the psoas muscle, which starts in
your lower spine, are used when lifting the leg toward the chest. They come together in a tendon at the top of the femur, and that is the point where tendinitis occurs.
The study team noted that one paper proposed a rehabilitative protocol based on gluteus medius strengthening, observing that a concomitant weakness of the gluteus medius in many cases of iliopsoas tendon pathology is often present.
Stem Cell Therapy for Hip Tendinopathy
There is currently no direct research published on the effectiveness of stem cell therapy for hip tendinopathy. There are studies on the general overall study of stem cell therapy for tendon injury.
A paper published in the journal Stem cells international (3) suggests that Mesenchymal stem cells offer some promise in tendon repair because the stem cells can proliferative (grow) in numbers and release tendon growth factors. Further, cell-based treatments offer great potential due to their ability to regenerate connective tissues including those found in tendons.
PRP for hip tendinopathy
PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration. PRP puts specific components in the blood to work. Blood is made up of four main components; plasma, red blood cells, white blood cells, and platelets. Each part plays a role in keeping your body functioning properly. Platelets act as wound and injury healers. They are first on the scene at an injury, clotting to stop any bleeding and immediately helping to regenerate new tissue in the wounded area.
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1 Kenanidis E, Kyriakopoulos G, Kaila R, Christofilopoulos P. Lesions of the abductors in the hip. EFORT Open Reviews. 2020 Aug;5(8):464-76.
2 Frizziero A, Vittadini F, Pignataro A, Gasparre G, Biz C, Ruggieri P, Masiero S. Conservative management of tendinopathies around hip. Muscles, ligaments and tendons journal. 2016 Jul;6(3):281.
3 Young M. Stem cell applications in tendon disorders: a clinical perspective. Stem Cells International. 2012 Jan 1;2012.