From the Guidelines
Hip flexor tendonitis should be initially evaluated with MRI, as it is highly sensitive and specific for detecting soft tissue abnormalities, including tendonitis, and can help guide treatment decisions. When suspecting hip flexor tendonitis, it is essential to consider the patient's symptoms and medical history. The condition is typically caused by overuse or repetitive movements, leading to inflammation of the tendons connecting the hip flexor muscles to the bones.
To manage hip flexor tendonitis, the following steps can be taken:
- Rest and activity modification: Avoid movements that cause pain for 1-2 weeks 1.
- Apply ice to the affected area for 15-20 minutes several times daily, especially after activity.
- Take non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily) for 7-10 days to reduce pain and inflammation.
- Begin gentle stretching exercises for the hip flexors once acute pain subsides, holding each stretch for 30 seconds and repeating 3-5 times daily.
- Gradually strengthen the hip muscles with exercises like straight leg raises and bridges, starting with 10 repetitions and increasing as tolerated.
Some key points to consider when evaluating and treating hip flexor tendonitis include:
- MRI is the preferred imaging modality for evaluating soft tissue abnormalities, including tendonitis, as it is highly sensitive and specific 1.
- Ultrasound (US) can be used to localize fluid collections, such as paralabral cysts, for aspiration and injection, and can also be used to evaluate snapping hip syndrome 1.
- Diagnostic and therapeutic injections, including corticosteroid injections, can be used to confirm the location of pain and help control it for a short period 1.
- Physical therapy may be beneficial for persistent cases, focusing on proper movement patterns and targeted exercises.
It is crucial to prioritize the patient's morbidity, mortality, and quality of life when making treatment decisions, and to consider the most recent and highest-quality evidence available, such as the study published in the Journal of the American College of Radiology in 2017 1.
From the Research
Hip Flexor Tendonitis
- Hip flexor tendonitis is a condition characterized by inflammation of the tendons in the hip flexor region.
- The provided studies do not directly address hip flexor tendonitis, but they do discuss the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on tendon healing and heterotopic ossification after hip arthroplasty 2, 3, 4.
- A study on the effects of NSAIDs on flexor tendon adhesion found that ibuprofen had a more significant effect in limiting adhesion formation compared to rofecoxib after flexor tendon repair 3.
- Another study found that NSAIDs could decrease the incidence of heterotopic ossification after total hip arthroplasty, but increased the risk of gastrointestinal side effects 4.
- A network meta-analysis on the effectiveness of NSAIDs for the treatment of pain in knee and hip osteoarthritis found that all preparations improved point estimates of pain symptoms when compared to placebo, with diclofenac 150 mg/day being the most effective NSAID available 5.
Treatment Options
- NSAIDs may be used to reduce pain and inflammation associated with hip flexor tendonitis, but their effectiveness and potential side effects should be considered 2, 3, 4, 5.
- The choice of NSAID and dosage may impact the treatment outcome, with some studies suggesting that higher doses may be more effective but also increase the risk of side effects 3, 5.