eMedicine Specialties > Sports Medicine > Hip
Hip Tendonitis and Bursitis: Follow-up
Updated: Mar 31, 2008
Follow-up
Return to Play
Patients with chronic hip overuse injuries are often frustrated by the lack of progress and delayed return to play. These individuals must be educated from the first day that a prolonged recovery is usual.
Complete painless ROM needs to return before the patient should start significant strengthening exercises. After strengthening is commenced, endurance needs to be attained again. At this point, eccentric and plyometric exercises are started, and eventually, sport-specific drills that include cutting and cross-overs can begin. At any point if significant pain or stiffness returns, the athlete's progress needs to be slowed down and a step backward taken. Team athletic trainers or physical therapists can provide supervision and education to the athlete.
Complications
Other than worsening or returning pain, few complications of the overuse injury exist. Educating the athletes will remind them of the long-term nature of these injuries. As we age, our tendons age and degenerate, making recovery from these injuries more difficult.
If the patient's injury is not responding to treatment as quickly as expected, the physician should reconsider the diagnosis (see Differentials and Other Problems to Be Considered). Of paramount importance is reconsidering whether intra-abdominal, intrapelvic, or spinal pathology is responsible for the patient’s symptoms. Further imaging may be necessary to help rule out more worrisome diagnoses.
Prevention
Downplay the role of stretching, particularly in rapidly growing adolescents or mature weekend warriors because each, in their own way, needs short periods of light cardiovascular workouts, followed by several minutes of stretching of the lumbar, hip, and knee areas.
Most hip overuse syndromes occur not at the beginning of the athletic event, but after considerable time; this mechanism suggests a repetitive-use etiology or eventual microtears that are associated with aging and stiffened tendinous structures. Therefore, ask most patients to continue their warm-up and stretching programs, but athletes should not assume that warm-up and stretching programs, in themselves, are effective. Instead, these patients should attempt to exercise under the threshold that results in repetitive microtears and persistent hip pain. Athletes are well advised to develop programs of cross-training to maintain hip strength and flexibility if the slightest amount of hip tendinitis pain occurs.
Prognosis
Adolescents who present with pain around the hip joint by traction apophysis are expected to recover within a matter of months. Recurrence can be avoided if the intensity and volume of the sports activity is limited modestly until skeletal maturity occurs.
Aggressive athletes in their 20s or 30s may need ongoing physical therapy so that they can ascend the ladder of progressive exercise and return to their sports. Recurrence in this group is high, given the innate desire of these individuals to return to play too quickly. Fortunately, the tendinous structures in this group are pliable, and the chance for repetitive microtearing is lower than that in an older group.
Active athletes older than 40 years have the added burden of a decreasing tendinous pliability and a lower threshold of tendinitis recurrence. Their return to sports must be calculated with great care to slowly ramp up the level and intensity of their activity. A good rule of thumb is to not increase activity more than 10% per week until the patient has progressed back to reasonable exercise levels. In this active group, the reality of abandoning long-distance running or jumping sports may need to be addressed. The treatment team is encouraged to promote the patient's participation in new activities that provoke less hip pain, such as cycling.
Related Medscape topics:
Resource Center Adolescent Medicine
Resource Center Exercise and Sports Medicine
Miscellaneous
Medicolegal Pitfalls
- Failure to eliminate other serious pathologies that could cause pain in the hip area
Related Medscape topic:
Resource Center Medical Malpractice and Legal Issues
More on Hip Tendonitis and Bursitis |
| Overview: Hip Tendonitis and Bursitis |
| Differential Diagnoses & Workup: Hip Tendonitis and Bursitis |
| Treatment & Medication: Hip Tendonitis and Bursitis |
 Follow-up: Hip Tendonitis and Bursitis |
| References |
| « Previous Page |
References
Segal NA, Felson DT, Torner JC, et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil. Aug 2007;88(8):988-92. [Medline].
Browning KH. Hip and pelvis injuries in runners. Phys Sportsmed. 2001;29(1):23-34. [Full Text].
DeAngelis NA, Busconi BD. Assessment and differential diagnosis of the painful hip. Clin Orthop Relat Res. Jan 2003;406:11-8. [Medline].
Anderson K, Strickland SM, Warren R. Hip and groin injuries in athletes. Am J Sports Med. Jul-Aug 2001;29(4):521-33. [Medline].
Adkins SB 3rd, Figler RA. Hip pain in athletes. Am Fam Physician. Apr 1 2000;61(7):2109-18. [Medline]. [Full Text].
Johnston CA, Wiley JP, Lindsay DM, Wiseman DA. Iliopsoas bursitis and tendinitis. A review. Sports Med. Apr 1998;25(4):271-83. [Medline].
Garrick JG, Webb DR. Sports Injuries: Diagnosis and Management. 2nd ed. Philadelphia, Pa: WB Saunders; 1999.
Shbeeb MI, Matteson EL. Trochanteric bursitis (greater trochanter pain syndrome). Mayo Clin Proc. Jun 1996;71(6):565-9. [Medline].
Kujala UM, Orava S, Karpakka J, Leppävuori J, Mattila K. Ischial tuberosity apophysitis and avulsion among athletes. Int J Sports Med. Feb 1997;18(2):149-55. [Medline].
Margo K, Drezner J, Motzkin D. Evaluation and management of hip pain: an algorithmic approach. J Fam Pract. Aug 2003;52(8):607-17. [Medline]. [Full Text].
Jacobson T, Allen WC. Surgical correction of the snapping iliopsoas tendon. Am J Sports Med. Sep-Oct 1990;18(5):470-4. [Medline].
Mozes M, Papa MZ, Zweig A, Horoszowski H, Adar R. Iliopsoas injury in soccer players. Br J Sports Med. Sep 1985;19(3):168-70. [Medline].
Lequesne M, Mathieu P, Vuillemin-Bodaghi V, Bard H, Djian P. Gluteal tendinopathy in refractory greater trochanter pain syndrome: diagnostic value of two clinical tests. Arthritis Rheum. Feb 15 2008;59(2):241-6. [Medline].
Kingzett-Taylor A, Tirman PF, Feller J, et al. Tendinosis and tears of gluteus medius and minimus muscles as a cause of hip pain: MR imaging findings. AJR Am J Roentgenol. Oct 1999;173(4):1123-6. [Medline]. [Full Text].
Brucker PU, Imhoff AB. Functional assessment after acute and chronic complete ruptures of the proximal hamstring tendons. Knee Surg Sports Traumatol Arthrosc. Jul 2005;13(5):411-8. [Medline].
Clanton TO, Coupe KJ. Hamstring strains in athletes: diagnosis and treatment. J Am Acad Orthop Surg. Jul-Aug 1998;6(4):237-48. [Medline].
Bencardino JT, Kassarjian A, Palmer WE. Magnetic resonance imaging of the hip: sports-related injuries. Top Magn Reson Imaging. Apr 2003;4(2):145-60. [Medline].
Akermark C, Johansson C. Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes. Am J Sports Med. Nov-Dec 1992;20(6):640-3. [Medline].
Aksoy B, Oztürk K, Ensenyel CZ, Kara AN. Avulsion of the iliac crest apophysis. Int J Sports Med. Jan 1998;19(1):76-8. [Medline].
Birrell F, Lunt M, Macfarlane GJ, Silman AJ. Defining hip pain for population studies. Ann Rheum Dis. Jan 2005;64(1):95-8. [Medline]. [Full Text].
Brinks A, van Rijn RM, Bohnen AM, et al. Effect of corticosteroid injection for trochanter pain syndrome: design of a randomised clinical trial in general practice. BMC Musculoskelet Disord. Sep 19 2007;8:95. [Medline]. [Full Text].
Chung CB, Robertson JE, Cho GJ, et al. Gluteus medius tendon tears and avulsive injuries in elderly women: imaging findings in six patients. AJR Am J Roentgenol. Aug 1999;173(2):351-3. [Medline]. [Full Text].
Craig RA, Jones DP, Oakley AP, Dunbar JD. Iliotibial band Z-lengthening for refractory trochanteric bursitis (greater trochanteric pain syndrome). ANZ J Surg. Nov 2007;77(11):996-8. [Medline].
Emery CA, Meeuwisse WH, Powell JW. Groin and abdominal strain injuries in the National Hockey League. Clin J Sport Med. Jul 1999;9(3):151-6. [Medline].
Gilmore J. Groin pain in the soccer athlete: fact, fiction, and treatment. Clin Sports Med. Oct 1998;17(4):787-93, vii. [Medline].
Lacroix VJ. A complete approach to groin pain. Phys Sportsmed. 2000;28(1):66-86. [Full Text].
Metzmaker JN, Pappas AM. Avulsion fractures of the pelvis. Am J Sports Med. Sep-Oct 1985;13(5):349-58. [Medline].
Ruane JJ, Rossi TA. When groin pain is more than 'just a strain': navigating a broad differential. Phys Sportsmed. 1998;26(4):2678-103. [Full Text].
Walker P, Kannangara S, Bruce WJ, Michael D, Van der Wall H. Lateral hip pain: does imaging predict response to localized injection?. Clin Orthop Relat Res. Apr 2007;457:144-9. [Medline].
Further Reading
Keywords
trochanteric bursitis, gluteus medius tendonitis/tendinitis, rectus femoris tendonitis/tendinitis, adductor strain/tendonitis/tendinitis, quadriceps tendonitis/tendinitis, hamstring tendonitis/tendinitis, groin injury, groin pull, sports hernia, iliopsoas tendonitis/tendinitis/bursitis, apophysitis, avulsion fracture, tendinopathy
