Hip Tendonitis

Hip tendonitis is a common problem causing pain and irritation around the hip and upper thigh.

It is typically an overuse injury causing pain during hip and leg movements or after activity.

There are four main types of tendonitis of the hip, depending on which tendon is affected, each causing pain in slightly different places.

Tendonitis in the hip is a common condition that can affect people of all ages and activity levels, but when caught early, it is highly treatable.

In this guide, we will look at what hip tendonitis is, what causes it, symptoms and diagnosis, and the best ways to treat it, including simple exercises and prevention tips to help you stay active and pain-free.

What Is Hip Tendonitis?

Types of Hip Tendonitis

There are several different tendons around the hip that can develop tendonitis. The most common types of hip tendonitis are:

1. Hip Flexor Tendonitis

Hip flexor tendonitis affects the tendons at the front of the hip, most commonly iliopsoas tendonitis. It is common in athletes, dancers, and anyone who does repetitive hip flexion e.g. running or kicking

2. Gluteal Tendonitis

Gluteal tendonitis typically causes outer hip pain especially when lying on your side, walking or climbing stairs. It may develop in any of the three gluteal tendons, the most common being gluteus medius tendonitis. It is especially common in runners and women over 40 and is sometimes mistaken for ischial bursitis.

3. Hamstring Tendonitis

Proximal hamstring tendonitis typically presents as pain in the lower buttock or back of the hip, and is often aggravated by prolonged sitting or sprinting. You can also get distal hamstring tendonitis at the back of the knee.

4. Adductor Tendonitis

Adductor tendonitis affects the tendons in the groin area. It causes inner thigh pain and groin pain, and is common in footballers and those doing side-to-side movements. NB Not the same as a groin strain where there is overstretching of one of the adductor muscles

5. ITB Tendonitis

The iliotibial band is a thick band of fascia rather than a tendon. When irritated, iliotibial band syndrome can cause outer hip pain and friction over the greater trochanter or pain down to the knee.

Each type of tendonitis in the hip has slightly different symptoms depending on the location, but they all result from similar mechanisms.

Causes of Hip Tendonitis

Tendonitis of the hip is usually the result of repetitive stress or overloading of one of the hips tendons without sufficient rest time to recover. Common causes of hip tendinopathy include:

• Overuse from repetitive activities like running, cycling, or stair climbing
• Sudden increase in activity levels e.g. returning to sport after time off or taking up a new sport
• Muscle imbalances that cause some muscles to overwork while others underperform. There is often a combination of muscle weakness and tightness
• Poor biomechanics or posture, especially with walking or running
• Age-related degeneration, where tendons become less resilient over time

Symptoms of Hip Tendonitis

The symptoms of hip tendinopathy vary slightly depending on which tendon is affected, but the general signs to watch out for include:

• Pain Around The Hip Joint: typically localised to the front (hip flexor tendonitis), outer side (gluteal tendonitis or ITB syndrome), inner side (adductor tendonitis) or back of the hip (hamstring tendonitis) that worsens when stretching or contracting the involved muscle
• Pain That Worsens With Activity: especially repetitive movements
• Tenderness: when pressing over the affected tendon
• Stiffness: after periods of rest or in the morning that eases with gentle movement
• Weakness: or reduced endurance in the surrounding muscles
• Clicking: or snapping sensation with movement may occur

Hip tendonitis pain may start as a dull ache and gradually worsen to more of a stabbing or burning pain if the underlying issue is not addressed

Hip Tendonitis Diagnosis

Diagnosing tendonitis in the hip starts with a thorough history and physical exam. A physiotherapist or doctor will look for patterns of pain and movement that suggest tendon involvement.

What to expect in a clinical assessment:

• Discussion of symptoms, activity levels, and aggravating movements
• Palpation of the hip to identify areas of tenderness
• Range of motion tests to see if pain occurs during stretching
• Strength testing, particularly of the glutes, hip flexors, or hamstrings
• Functional movements like squats or walking to assess biomechanics

Your doctor may send you for imaging studies to confirm the diagnosis or rule out other conditions, such as:

• Ultrasound: Good for identifying tendon inflammation or tears
• MRI: Provides more detail if symptoms persist or are severe
• X-ray: Generally used to rule out other issues like arthritis or bone spurs

Differential Diagnosis

#CommissionsEarned from Amazon on qualifying purchases

Treatment for Hip Tendonitis

Treating hip tendonitis is all about reducing pain, promoting healing, and correcting the underlying issues that caused the problem in the first place. The goal is to get you moving comfortably again, and to prevent the pain from coming back.

1. Rest and Activity Management

The best place to start when treating hip tendonitis is to rest from aggravating activities. While it might sound tempting to completely stop all activity, total rest can actually slow healing and cause muscle weakness. Instead, aim to:

• Modify activities that worsen symptoms. For example, reduce or temporarily take a break from running, jumping, or hill climbing.
• Make sure you have rest days between training sessions to allow the muscles and tendons time to recover
• Avoid sudden changes in activity levels. Gradually build up intensity and duration once pain improves.
• Incorporate low-impact exercise like swimming, cycling, or walking on flat surfaces to maintain fitness without overloading the hip.
• Listen to your body. If an activity causes sharp pain or worsens symptoms the next day, reduce the intensity or duration.

2. Ice and Anti-inflammatories

Managing inflammation and pain early on helps speed up recovery with hip tendonitis:

• Ice: Apply an ice pack wrapped in a towel over the painful area for 15–20 minutes, 2-3 times per day, especially after activity.
• Anti-Inflammatory Medications: Non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, can help reduce pain and swelling in the short term. However, they should not be used long-term without medical advice.

3. Physiotherapy and Rehab

Physical therapy is the cornerstone of hip tendonitis treatment. A tailored program can help restore strength, flexibility, and movement patterns:

• Strengthening Exercises: Focus on weak muscles that support the hip joint, especially glute strengthening, hip flexor strengthening, hamstrings strengthening, and core muscle work. Examples include clamshells, side-lying leg lifts, bridges, and resistance band work
  
  
• Stretching Exercises: It is really important to stretch tight muscles that might be placing extra strain on the tendons, such as hip flexors, IT band, and adductors. Gentle, sustained stretches can improve mobility and reduce tension
  
  
• Eccentric Loading: For chronic tendinopathy, eccentric exercises where you work the muscle as it lengthens rather than as it shortens, like slow, controlled lowering movements have strong evidence for tendon healing
  
  
• Manual Therapy: Hands-on techniques by your therapist such as joint mobilisation and deep transverse friction massage can help improve joint mobility, reduce muscle tightness, and promote circulation and healing with hip tendinopathy
  
  
• Gradual Return To Activity: Your therapist will guide you through progressively increasing activity loads while monitoring symptoms to make sure symptoms don not return

4. Shockwave Therapy and Dry Needling

For stubborn or long-standing tendon issues, adjunct therapies can be beneficial:

• Extracorporeal Shockwave Therapy (ESWT): This uses sound waves to stimulate healing in damaged tendons. It can reduce pain and improve function after a few sessions.
• Dry Needling: Involves inserting fine needles into trigger points or tendon tissue to promote blood flow and reduce muscle tightness.

5. Injections

In some cases where conservative hip tendonitis treatments are not enough, injections may be considered:

• Corticosteroid injections: Can reduce inflammation and pain temporarily but don’t address the underlying tendon health and can weaken tendons if used repeatedly
• Platelet-Rich Plasma (PRP) injections: These involve injecting concentrated growth factors from your own blood to promote tendon repair. Some patients benefit from PRP, especially with chronic hip tendinopathy, but evidence is still evolving

Injections are usually a last resort and should be discussed carefully with a specialist as they temporarily weaken the tendon, risking further damage. Injections should always be used alongside other hip tendonitis treatments rather than in isolation.

6. Surgery

Hip tendonitis surgery is rare and is generally reserved for cases where tendon damage is severe or symptoms fail to improve after 6-12 months of conservative care. Procedures may include:

• Tendon repair or debridement (removal of damaged tissue)
• Release of tight structures compressing the tendon
• Addressing related hip joint problems if present e.g. labral tears

Surgical recovery involves a structured rehab program and can take several months.

Practical Tips to Support Your Recovery

Here are some of our top tips to help you make the best recovery from hip tendonitis:

• Stay consistent with your rehab exercises. This is key to healing and preventing recurrence.
• Avoid “too much too soon.” Gradually increase your activity levels to avoid flares.
• Pay attention to footwear and surfaces, especially if you run or walk a lot. Good support and softer surfaces can reduce impact.
• Maintain overall fitness with cross-training and low-impact activities.
• Address posture and movement habits that might have contributed to the problem.

If you tackle hip tendonitis early with the right treatment and rehab plan, you can expect a good recovery and a return to your normal activities, usually within a few weeks to months depending on severity. If symptoms persist, seeing a physiotherapist or healthcare professional for a personalized assessment is always a good idea.

Hip Tendonitis Summary

Hip tendonitis is a common condition caused by overuse, poor biomechanics, or muscle imbalances. It leads to pain, stiffness, and weakness around the hip, often aggravated by activity.

There are different types of hip tendinopathy, depending on which muscle is affected:

• Hip Flexor Tendonitis: front of hip pain
• Gluteal Tendonitis: outer hip pain
• Hamstring Tendonitis: back of hip pain
• Adductor Tendonitis: inner hip and thigh pain
• ITB Syndrome: outer hip and thigh pain

The good news is that tendonitis of the hip is highly treatable with the right combination of rest, rehab, and movement correction. Early diagnosis and a structured approach can get you back to your normal activities, without any ongoing nagging pain.

If you are experiencing hip tendonitis symptoms, don’t ignore them. The sooner you address the cause, the easier your recovery will be.

You may also be interested in the following articles:

• Front Hip Pain
• Outer Hip Pain
• Inner Thigh Pain
• Groin Strain
• Snapping Hip Syndrome
• Knee Pain Diagnosis Chart

Related Articles

---

Medical & Scientific References

1. Current And Future Advances In Practice: Tendinopathies Of The Hip. Rheumatology Advances In Practice
2. Conservative Management Of Tendinopathies Around Hip. Muscles, Ligaments & Tendons Journal
3. Current Understanding Of The Diagnosis And Management Of The Tendinopathy: An Update From The Lab To The Clinical Practice. Disease A Month Journal

Last Updated: June 17th, 2025
Next Review Due: June 17th, 2027