Hip Tendonitis: Causes, symptoms, treatments and prevention of this dreaded, athletic injury
Posted May 30th, 2007 at 3:30 PM by Alexandra Haller
Section: Running & Training, Injury & Rehab, Health & Fitness, Injury & Rehab
All athletes have a dark, furtive, and silent fear of getting injured. It haunts all athletes; from professionals like Meb Keflezighi who was forced to drop out of last April’s Flora London Marathon at mile 16, to casual runners like myself.
Recently, I was sidelined with tendonitis in my right hip a month before I was to participate in my first half marathon.
When I told my sister, she instantly identified with my anguish by saying “So, it must be like going to write a big term paper and having your computer break down the night before it’s due.” Exactly.
When your body seemingly and unexpectedly fails you, you are frustrated, confused, and scared. Fortunately, you can minimize your worries and expedite your healing by educating yourself on the potential pitfalls of regular training, proper care for your athletic body, and ways to prevent such injuries.
Hip tendonitis is similar to tendinitis that can afflict many other parts of your body. Tendons are bands of fibrous tissues, much the same way a rope is made of many threads. Your tendons are what connect muscle to the bone. When the strain of any activity causes too much stress, your body will have difficulty pulling the muscle and to compensate the tendon becomes inflamed. According to the Gale Encyclopedia of Medicine,
“The injury is largely mechanical, but when it appears, the body tries to heal it by initiating inflammation. Inflammation increases the blood supply. The result is swelling, tenderness, pain and heat.”
These stress points are greatest at the joints. You probably have heard of swimmer’s shoulder and tennis elbow. In a high-impact sport, like running, the greatest pressure will be on your knee and hip joints, making those areas highly susceptible to tendonitis.
CAUSES
There are a variety of causes for hip tendonitis. It can be aggravated by old running shoes, running on uneven terrain or a leg length discrepancy. However, by far, the factor that dominantly contributes to this condition is overuse due to some combination of running too much, too fast or too soon without adequate recovery time. According to WebMD,
“Entrance into a demanding fitness program, a change in running mileage, or a dramatic change in a weight-lifting program may provide the key to understanding why hip pain developed.”
These are classic situations for runners, especially if you have upped your mileage for a longer race or decreased rest days. In my case, I failed to rest appropriately. I had taken a week off from running and initially that seemed to help—but only temporarily. As soon as I was back to midweek six-mile runs and longer weekend runs of 10 miles, the pain shot back furiously. That was a clear sign that something was going very wrong.
SYMPTOMS
Clearly, an exacerbation in pain is a strong indicator of injury. Since the innate structure of the hip joint serves to carry your weight and help you move, pain in that area will cause extreme discomfort. This may be felt even while resting and sleeping. Higher levels of inflammation will lead to increased pain and a decrease in your ability to stride properly. My pain felt like a twanging, as if some tendon were a guitar string being plucked at a ridiculous angle. When I failed to rest and continued running, the pain increased to such an extent that I could barely walk without limping. My normal gait was compensated. Eventually running was simply out of the question.
TREATMENT
The first step in treatment will be to swiftly rule out any more serious injuries, like a possible stress fracture. This is done with x-rays and MRIs. A thorough doctor will immediately insist on these diagnostic procedures.
At this stage of increasing, debilitating pain and the need to seek professional help, you need to discontinue running. If you have already trimmed your mileage, and/or slowed your pace, and/or dropped speedwork and yet you still have pain—STOP. Rest longer. Then even longer.
When your doctor can safely rule out a stress fracture, you will face the reality of dealing with tendonitis. Physically, this means letting the pain subside, the injury heal and finally, getting back to running s-l-o-w-l-y. You will need to see a physical therapist. John W. O’Kane, M.D. stresses the importance of this (Amer. Family Phys., Oct., 1999).
“Rehabilitation should also include scrutiny of the training program that led to the problem, correcting poor technique that may be causing tissue overload.”
My physical therapist believed part of the cause was lack of strength. He now has me on a program that strengthens my hips to help keep them strong as they support my body weight and the impact of running.. Don’t forget how important a positive mindset is. Truly, that will be your greatest help in the recovery process.
I speak from experience. I was devastated when after 4 months of training, telling everyone my goal, and ultimately feeling like a real athlete, I had to succumb to the fact that I could not participate in my first half marathon. However, setbacks are a part of life and training. We all have them; it’s how we deal with them that matters.
PREVENTION
Keep in mind that tendonitis can be tamed, if not avoided. The strategies for preventing tendonitis are very similar to the ways of preventing just about any injury. You must learn to sincerely listen to your body. That is the key to success.
- Stretch those muscles beforehand.
- Incorporate non-weight bearing exercise.
- Strengthen your lower body
- Let experience guide you toward a safer running career.
- Learn to trust yourself.
A proper warm up will prepare the muscles and tendons and increase blood flow. Without that, there will be a lack of nutrients and oxygen to the muscles—a certain recipe for muscle or tendon injury.
Your hips are affected by the repetitive pounding from carrying your body weight. Activities such as biking and swimming will keep your cardiovascular system in shape without aggravating the pain.
Don’t be afraid of weight-lifting and resistance training. Train your muscles to increase your muscle endurance.
When pain hits, take a few days off. Don’t berate yourself for not running five days a week like the “schedule” says. Training plans are general guidelines for a variety of people at different levels. Do not become manic in your quest to adhere to a plan that is not individually tailored.
As you strive toward becoming a lifelong runner, you will learn what your limits are, and the optimum ways of testing your limits. Remember that there is always another race to sign up for. You will have that indescribable moment of passing the finish line and hearing the cheers. All of the racing successes and running highs are out there for you to embrace, if only you learn how to trust your body.
Research sources and for more information: [The Online Stretching Handbook], [The National Institute of Health], [WebMD], [iTendonitis], [AAFP]
Photograph and diagram courtesy of: MuscularAndJointPainRelief.com and AAFP.org
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Tags: athletic injury, cause, hip, hips, injuries, injury, injury prevention, injury treatment, Meb Keflezighi, MRI, pain, prevention, rehab, rehabilitation, sports medicine, stress fracture, stretch, stretching, symptom, tendinitis, tendonitis, treatment, x ray
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The Final Sprint
This makes so much sense! I was having trouble with my news and eventually a physcial therapist said the same thing; strenthen the hips. I’m glad the word is getting out there, since weak hips seem to be common and one doesn’t hear too much about the problems that can cause. Thanks for the informative read.
May 30th, 2007 at 12:54 pmAlex, you rock! Great article—very informative and well-written.
May 30th, 2007 at 12:55 pmWell put together article. So often I read of athletes and their troubles they encounter. It was refreshing to add the treatment one must endure as well as prevention guidelines. Thanks for the great article!!
May 30th, 2007 at 4:00 pmThanks for the article…and good timing. I’m a couple of weeks away from a marathon I have been training for and have been experiencing some hip problems. In fact, I woke up this morning with pains after an easy run yesterday. I’ll replace my shoes. Any suggestions on good hip-strengthening exercises? I lift regularly, but for main body parts, nothing specific for hips.
May 30th, 2007 at 4:02 pmThanks for all the great information, Alex. I often push myself too hard without enough recovery time, and I didn’t realize how dangerous that could be. I feel much more informed now. Thanks!
May 31st, 2007 at 9:04 amTake one of those Thera-bands or the like put it under both feet and pull up on it with your hands toward your waist.Then walk side to side one step right one step left.
July 14th, 2007 at 1:52 pmI wouldn’t describe tendonitis as a “dreaded athletic injury”. If you’re having persistent pain in your hip, being diagnosed with tendonitis is probably the best outcome you could hope for. Be thankful you don’t an acetabular labral tear, or some other condition that requires surgery.
October 2nd, 2007 at 5:59 pmI found this a very good article, especially i have started to run seriously. I have applied to the London Marathon next year, which has always been a goal of mine.
There are no specifics in this article but to expand on it a bit here are some possible tips.
Stretching - IT band (foam roll is always good for this)
- Piriformis stretch
- Hip flexor stretch
- Calf strech
Hold these stretches for approx 20-30 secs.
Strengthening - Normal squats
- Single squat squats (important for stability)
- Lunges
- Leg press (single and/or double)
For these it’s important to maintain correct postural alignment to get the max benefit out it
I know there is much more to it, but it’s a good starting point. If in doubt go to local gym and ask a fitness instructor for more guidance.
Once again thanks for the great article and hopefully i added a little more to help anyne with similar problems
October 26th, 2007 at 3:28 pmTHANKS THAT,IT WAS A GOOD READ,I WAS OVER DOING IT AND NOT WARMING UP PROPERLY I THINK.
January 14th, 2008 at 11:36 amThis was a very informative article. However, I am unsure if hip tendonitis is what I have. I am actually a roller derby skater, and have been having pain in my hip for over a month now. It comes with more intense practices, and slowly subsides between practices, but never completely goes away. When it bothers me at practice, I usually take it easy and don’t push myslef as far.
March 1st, 2008 at 9:47 amCongratulations Alexandra.
March 28th, 2008 at 2:40 pmExcellente article… This type of article should be on the top of every running web page… Remember its better to prevent than treat an illness.
Its very difficult to get a comprehensive article like this about tendonitis.
Just to add some personal experience. If you feel hurt originated by sport, remember: your body is sending you an warning sign… If ache continues, you should STOP inmediately and see a doctor. Do not asume its only a tendonitis, because a stress fracture MUST BE ruled out (magnetic resonance may be sugested by your doctor). I know people that continue their sport activity and end with displaced fracture… a tragedy due to not listen to your body and then not seeing you doctor
I am 66 and have been running all my life. The sports Dr said I have arthritis. I got sciatica several years ago and the right leg has limited range of motion I am even pulled over and have to force myself to stand up straight. I have tried to stretch ( pariformis,etc). I have not run for 3+ months. I know a Dr who does Prolotherpy and am considering it. I went to a chiropractor for 4 months who had me work with a physical theapist. Did all types of strenthening exercises, but got no results.Riding a bicycle does not bother the hip. Not sure where to go next????
August 16th, 2008 at 2:39 pmCharles:
#1 limit your running to soft surfaces sucha as grass, trails, etc,
#2 reduce the amount of mileage you are running to the point that you don’t feel pain.
#3 implement an anti-inflammatory diet, and stick to it.
#4 accept the limitations of your age and act accordingly.
August 16th, 2008 at 7:32 pmCrap… well, at least i know what i’m dealing with. thanks for the advice and info.
August 26th, 2008 at 11:15 pmThanks for the info. I feel like we have the exact same story. I am training for my first mini and my hip has been bothering me for a couple weeks now. We are into week 7 out of 13 for our training. I have a 10K on Saturday, but my hip has not recovered from Tuesday’s run. I am going to take off of my Thursday run, but am hoping to push through th 10k. Advil helps, but still am limping a bit. Should I quit before it gets worse?
September 4th, 2008 at 1:39 pmThis website was very useful. I am 15 years old and i was diagnosed with tendonitis in my hip about 3 weeks ago and im a wrestler. its a bit of a dissapontment that i will have to stop my conditioning so that when football season starts up again i will be able to play. But my docter wrote me a note that says that i can endure normal activitys but i never gave that note to my coach. my docter gave me naproxen for pain. but that doesn’t help. but when i put icy hot on my hip it helps a whole lot better. but three months ago i woke up with so much pain that i couldnt even walk and it hurt to even sit down. how long do you think my injury will last, i hope its not going to last to much longer.
November 22nd, 2008 at 8:56 pm