TENDINOPATHIES AROUND THE HIP
The hip is a joint that has a very special anatomy, in which muscles and tendons play a very important role. When there is any misbalance amongst function, selective overloading of the muscles can occur, leading to pain and contracture. This is essentially the origin of the so-called tendinitis or tendinopathies of the hip.
Psoas muscle is located over the anterior part of the hip (groin area) and is involved mainly in the flexion of the thigh. Its overloading or soreness is usually felt as pain in the groin, associated occasionally with clicking or snapping. This condition is commonly related with contact sports and those that require loading over a flexed hip (rugby, football, etc). Repeatedly, problems within the psoas muscle are a sign of other conditions that may affect the hip articular cartilage; therefore, it is always important to rule out these problems. The treatment with stretching and specific physiotherapy is usually useful to improve symptoms. Selective injections may also help in refractory cases.
Greater trochanter pain syndrome and gluteal tendinopathy:
There are several conditions grouped under the name of greater trochanter pain syndrome. These have in common pain and tenderness over the lateral aspect of the thigh, which usually irradiates to the knee and, occasionally, associates evident snapping. It is critical to search for signs of dysfunction of the gluteal tendon together with a thorough evaluation of the hip joint itself. Physiotherapy is usually effective for uncomplicated cases, nevertheless it is important to evaluate the response to the treatment as part as of the decision-making of these conditions.
Gluteus medius is the main muscle involved in the lateral elevation of the thigh, and its function is essential not only for an adequate gait cycle but also for practicing any sport. There are a broad variety of possible injuries to this muscle, starting from tendinitis or tendinopathy up to a complete rupture of the tendon. The most part of them respond to the treatment with physiotherapy and occasionally injections. Most severe cases require a surgical suture of the tendon.
Ischiotibialis tendinopathy and subgluteal space syndrome:
The gluteus maximus muscle is located over the hinder part of the hip joint. Underneath this muscle there is a complex anatomic region, which can potentially be a source of pain. Intervertebral disc pathology is usually responsible of a great part of these cases, as a consequence of a herniated disc; nevertheless, some of them are due to a lack of space of the nerves and tendons underneath this group of muscles, leading to a condition that is globally called subgluteal space syndrome.
Ischiotibial muscle pathology runs from a simple soreness to a detachment and complete loss of function of the muscle origin, which commonly affects professional sportsmen and sportswomen. The treatment will depend on the degree of injury; therefore it includes a range that goes from physiotherapy to surgery.
Adductor tendinopathy and pubic osteopathy:
A typical injury seen in sports that involve torqueing over a fixed leg (e.g. football) is the dynamic osteopathy of the pubis or pubic osteopathy. It presents with pain over this specific area, as well as in the origin of the adductor muscles. Occasionally, it corresponds to a compensating pattern of a misbalanced hip and therefore it is always important to rule out any hip problems. Treatment of pubic osteopathy includes physiotherapy and injections and, in some cases, even surgery.