What is the treatment for left hip tendinosis?

Treatment for Left Hip Tendinosis

Begin with relative rest, NSAIDs for short-term pain relief, and eccentric strengthening exercises as the cornerstone of treatment, while avoiding complete immobilization. 1, 2

Initial Conservative Management

First-line therapy should include:

• Relative rest to decrease repetitive loading on the damaged tendon while maintaining activities that don't worsen pain 1, 2
• NSAIDs (oral or topical) for short-term pain relief, though they provide no long-term benefit 1, 2, 3
  • Naproxen 500 mg twice daily is appropriate for tendinosis, with initial doses up to 1250 mg/day if needed 4
  • Topical NSAIDs offer similar pain relief with fewer gastrointestinal side effects 1, 2
• Cryotherapy applied through a wet towel for 10-minute periods provides short-term pain relief 1, 2
• Avoid complete immobilization as this leads to muscular atrophy and deconditioning 2, 5

Exercise-Based Rehabilitation (Primary Treatment)

Eccentric strengthening exercises are the cornerstone of tendinopathy treatment and may reverse degenerative changes:

• Eccentric exercises have proven beneficial across multiple tendinopathies and should be initiated early 1, 2, 3, 6
• Deep transverse friction massage reduces pain 1
• Stretching exercises for the affected muscle-tendon complex are generally helpful 1

For gluteal tendinopathy specifically (a common hip tendinosis), education and progressive exercise offer greater treatment success than corticosteroid injection at both 8 weeks and 1 year 7

Advanced Interventions (If Conservative Treatment Fails)

Consider these options if symptoms persist beyond 3-6 months:

• Corticosteroid injections may provide better acute pain relief than oral NSAIDs but don't improve long-term outcomes and may inhibit healing 1, 2, 3, 6
• Extracorporeal shock wave therapy (ESWT) is a safe, noninvasive option for chronic tendinopathies, though expensive 1, 2, 5
  • Eccentric training combined with ESWT shows higher success rates than either therapy alone 6
• Sclerotherapy and nitric oxide patches show promise but require larger trials for confirmation 3
• Therapeutic ultrasonography has limited evidence for consistent benefit 1, 5

Surgical Consultation

Refer for surgical evaluation if:

• Symptoms persist after 6 months of appropriate conservative management 1, 5
• Surgery remains the last option due to morbidity and inconsistent outcomes 3

Critical Pitfalls to Avoid

• Do not use corticosteroid injections as first-line treatment - they may inhibit healing and reduce tendon tensile strength despite providing short-term relief 2, 3, 6
• Joint effusions are uncommon with tendinopathy and suggest intra-articular pathology requiring different evaluation 1
• Complete immobilization is contraindicated - maintain some activity to prevent deconditioning 2, 5
• Most patients (80%) fully recover within 3-6 months with appropriate outpatient treatment 5

Monitoring Strategy

• Track pain levels and functional improvement during conservative treatment 1, 5
• Adjust exercise intensity based on pain response - some discomfort during exercise is acceptable but should not persist beyond the session 7
• If multiple tendons are symptomatic, evaluate for possible rheumatic disease 2