Hip, buttock and thigh tendinopathy

Tendinopathy is the most common cause of pain, instability and disability in the hip, buttock and thigh. While there are over seventeen muscles in this area, anyone of which can be affected by tendinosis, relatively few are frequently a source of pain, and none more common or significant as the rotator cuff muscles of the hip- the gluteus medius and minimus, tensor fascia and hip flexor muscle group.

Tendinopathy of the gluteus medius and minimus is extremely common, reported to affect between 10% and 25% of the general population. But numerous MRI studies indicate it is frequently misdiagnosed.

These muscles, which lie underneath your large buttock muscle (gluteus maximus), extend from almost the entire rim of your pelvic bone to deep into your hip joint.

Pain is often experienced at one or both ends of the muscle, but can be present in the entire muscle deeply across the buttock. Tendinopathy of these muscles are often misdiagnosed as lower back pain, sacro-iliac joint dysfunction, sciatica, bursitis or hip arthritis.

These muscles play a vital role in hip stability, for example, when you place your weight on one leg during walking they keep your pelvis balanced. So weakening and/or pain associated with tendinopathy can lead to a number of symptoms when walking including hip joint stiffness, a painful or non-painful lurching limp, clumsiness or even a fall, which is particularly concerning for frail elderly. A sudden increase in load, for example pulling up from a stumble, on weakened tendon can lead to tearing and sudden giving way with pain.

Over time the tendons can become calcified which makes them brittle. The calcification can spread into the bone from where the tendons attach, making the bone more brittle and vulnerable to break. In fact, studies have shown that many hip fractures in the elderly occur precisely where these tendons attach.

Overuse of these muscles is also associated with hip arthritis.

A muscle at the outer side of your hip- the tensor fascia muscle- is a muscle commonly affected by tendinosis. This muscle is also an important hip stabilising muscle. Tendinosis here can lead to pain, including deep intense pain, and other symptoms in the outer side of your hip which can extend all the way down the outer thigh to your knee. Tendinosis and associated tightening of the muscle can lead to a snapping or clicking sound as its tendon passes over a bony prominence of your upper thigh bone.

Another common group of muscles prone to be habitually overloaded and so affected by tendinopathy are the muscles at the very front of the hip. These are also one of the three groups of muscles most important for hip stabilisation. Intense pain can be localised to the front of the hip or extend all the way down the front of the thigh to your knee, giving rise to knee pain as well.

Because these muscle groups most often work together, all of these muscles can be affected to some degree giving rise to pain all the way around the hip, with pain extending down the thigh and into the knee.