What is the treatment for hip overuse injury?

From the Guidelines

Exercise therapy is the most effective treatment for hip overuse injuries, reducing pain and improving physical function, and should be prioritized over oral non-steroidal anti-inflammatory drugs and paracetamol. Treatment for hip overuse injuries typically involves a combination of rest, medication, physical therapy, and gradual return to activity. Initially, reduce or stop activities that cause pain for 1-2 weeks while using NSAIDs like ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily) to manage pain and inflammation, as supported by the network meta-analysis of randomised controlled trials 1. Apply ice to the affected area for 15-20 minutes several times daily.

Key Components of Treatment

• Physical therapy is crucial for recovery, focusing on strengthening hip muscles, improving flexibility, and correcting movement patterns that contributed to the injury
• Exercises often include hip bridges, clamshells, and gentle stretching of hip flexors and rotators, with consideration of load magnitude, number of repetitions and sets, duration of whole programme, and rest duration between exercise sessions 1
• As pain decreases, gradually reintroduce activities at about 50% of previous intensity, increasing by 10-15% weekly if pain doesn't worsen

Important Considerations

• For persistent pain lasting more than 4-6 weeks, consult a healthcare provider as corticosteroid injections or further imaging may be necessary
• Overuse injuries occur when repetitive stress exceeds the body's ability to repair itself, so proper recovery time and addressing biomechanical issues are essential for preventing recurrence
• The Consensus on Exercise Reporting Template (CERT) and Template for Intervention Description and Replication (TIDieR) checklist should be used to improve reporting of exercise-based interventions 1

From the Research

Overuse Injury Hip Treatment

• The treatment of overuse injury hip pain can be managed through various non-operative methods, including patient education, activity modification, limitation of aggravating factors, an individualized physical therapy protocol, and use of a home exercise program 2.
• Rehabilitation interventions should focus on addressing biomechanical deficiencies with neuromuscular training of the hip and lumbopelvic regions 2.
• Intraarticular corticosteroid injections have been shown to provide pain relief and functional improvement in hip osteoarthritis, with benefits lasting up to 12 weeks 3.
• Platelet-rich plasma (PRP) injections may be beneficial and safe for patients with hip osteoarthritis, although their superiority over other procedures such as hyaluronic acid remains unclear 4.
• A systematic review and network meta-analysis found that intra-articular saline injection is as effective as corticosteroids, platelet-rich plasma, and hyaluronic acid for hip osteoarthritis pain 5.

Non-Operative Management

• A literature review identified 49 studies that described non-operative management for individuals with non-arthritic hip pain, including rehabilitation recommendations such as patient education, activity modification, and individualized physical therapy protocols 2.
• Higher-quality guidelines consistently recommend education, exercise, and weight management, as well as non-steroidal anti-inflammatory drugs and intra-articular corticosteroid injections (knee) for the management of hip and knee osteoarthritis 6.
• Arthroscopy is consistently recommended against in higher-quality guidelines, while the use of hyaluronic acid and stem cell injections is not consistently recommended 6.

Treatment Options

• Intraarticular corticosteroid injections are a commonly used treatment for hip osteoarthritis, with evidence showing they provide pain relief and functional improvement 3.
• Platelet-rich plasma (PRP) injections are another treatment option, although their effectiveness and superiority over other procedures are still being researched 4.
• Intra-articular saline injection has been shown to be as effective as other injectable treatments for hip osteoarthritis pain 5.
• Non-operative management, including patient education, activity modification, and individualized physical therapy protocols, is a recommended approach for managing non-arthritic hip pain 2.