There are several tendons that originate or insert around the hip area and these can be the cause of pain and discomfort, which is felt in and around the groin. They are therefore extra-articular (outside the HIP JOINT) causes of hip pain.
- Iliopsoas tendonitis/bursitis
The iliopsoas muscle originates from the lower back and travels across the pelvic brim and across the hip joint to be inserted into the lesser trochanter. It has a bursa underneath it as it crosses the joint. It is primarily a hip flexor, but also acts as a pelvic stabiliser. This complex can become inflamed with repetitive flexion exercise and external rotation of the thigh. It is common in cyclists and other sports involving a lot of kicking.
At presentation, patients may note pain with specific sports-related activities, such as jogging, running, or kicking. Pain with simple activities, such as putting on socks and shoes, rising from a seated position with the hips flexed for some time, walking up stairs or inclines, or brisk walking may be reported.
Pain may radiate down the anterior thigh toward the knee.
Reports of an audible snap or click in the hip or groin commonly are reported and associated with internal snapping hip syndrome.
- Adductor tendonitis
The adductor muscle group originates from the pelvis and travel to the inner aspect of the thigh bone and knee. They are most commonly injured during forced push off (side to side movement) or lunging. After injury there may be a palpable gap or lump in the muscle.
Tendonitis tends to develop with multiple repetitive injuries and the pain is usually felt at the origin of the muscle near the pelvis. Pain is reproduced by abduction of the hip and palpation at the origin of the muscle group.
Tendonitis usually responds to conservative treatment with physiotherapy being key. In the initial period , especially after injury,rest, ice and anti-inflammatory medication help. Rehabilitation concentrates on strengthening the muscle group to improve the force- absorbing capability of the muscle tendon unit.
Occasionally injection treatment either in the form of corticosteroids or the newer Platelet Rich Plasma (PRP) will be required.