Although we often associate bad hips with getting old, hip tendonitis can begin as early as your teens, according to Sydney-based Orthopaedic Surgeon Dr Sunny Randhawa.

“Groin pain, or pain on the outside of the hip is a classic symptom,” the Hip and Knee Surgeon said. “The pain can get up to a 10 out of 10, but it can also just be a dull ache – a constant two or three out of 10.”

Weak hip flexion is another red flag. This might be felt during everyday movement like walking, sitting, or squatting to lift the groceries. “You may get the sensation that your hip is dislocating,” said Dr Randhawa.

Tendo-what?

While the term ‘itis’ indicates an inflammatory condition, “tendonitis involves a tightening of the tendons, and is not an inflammation,” Dr Randhawa confirmed.

“If you pull a bowstring to release the arrow, the tightening of the string is the same kind of tightening you get with hip flexor tendonitis.”

This tightening occurs around the anterior hip muscle called the iliopsoas muscle (‘ileo-so-ahs’), responsible for flexing your hip, moving your torso towards your thigh, and rotating your thighbone.

Are you a candidate?

“The first group of candidates are young females who are very flexible, and so the tendon rubs over the hip joint,” Dr Randhawa said.

A Femoroacetabular Impingement (FAI) can also increase risk. In FAI, the head of the thighbone prohibits a regular range of motion, or rubs in a way it shouldn’t in its hip socket.

“This causes the tendons around the muscle to shrink and stiffen,” Dr Randhawa said.

A hip replacement can be another cause. “The tendons are unbalanced due to a new position of the hip, and they can rub on the edge of the prosthesis,” he explained.

An exercise injury, or simply missing a step can also make you a fast candidate. “All you have to do is fall or twist wrong,” Dr Randhawa said.

Treatment

Physiotherapy is the first line of treatment, along with rest and anti-inflammatories – ibuprofen or meloxicam (Mobic), Dr Randhawa said.

A cortisone injection is the second line of treatment.

“If this doesn’t work, the final option is keyhole surgery,” Dr Randhawa said. “This involves an arthroscopy (which examines the inside of the hip joint), and a tendon release. “But only about 20 per cent of patients will require surgery.”

And they’re likely to be female. “In young active females, tendonitis and a labral tear of the hip can occur simultaneously.” The latter involves a MRI-detected tear to the labrum; this is a protective ring of cartilage that holds the top of the thighbone securely within the hip socket. “If you have this as well as tendonitis there’s a high chance you’ll need keyhole surgery,” Dr Randhawa said.

“You can’t really avoid being young, active and flexible, so there are no preventative measures.” But treated appropriately, tendonitis “usually resolves well.”

“The first two treatment options can take a long time, maybe six months,” Dr Randhawa acknowledged. So compliance is key, as is seeking medical advice in the first place.

“The surgery is like a magic wand,” Dr Randhawa said. “Combined with simple physio, the patient will be better about six weeks later.”