What is hip tendinosis and how is it treated?

Tendinosis of the hip joint (tendinosis of the hip joint) is atrophic changes and subsequent degeneration of the fibers within the tendon. The pathology is non-inflammatory in nature and is associated with chronic tendinitis. Violation provokes partial or complete rupture of the tendon. The cause of the disease is prolonged arthritis and arthrosis, previous injuries. The most vulnerable age category is elderly and elderly people; social – people with heavy physical and/or monotonous loads, athletes. Calcium deficiency in the body is an aggravating condition that must be taken into account when planning treatment.

Symptoms and diagnosis of iliopsoas tendinitis

Symptoms of iliopsoas muscle tendonitis include: pain when palpating the inflamed area, swelling, crackling of the joints during movement. Pain may occur during movement, limited range of motion and redness of the skin over the inflamed area appear.

Often pain occurs at the tendon insertion site. At the same time, the patient’s pain intensifies, for example, when he tries to pull his knee to his chest. With iliopsoas tendinitis, the bursa often becomes inflamed, which can cause a feeling of tension and swelling in the groin area.

If left untreated, calcific tendonitis may develop. This inflammation is associated with the deposition of salts in the connective tissue. Carpal tunnel syndrome may also develop. This inflammation is associated with thickening of the articular ligaments and compression of the nerve trunks. To make a diagnosis, computed tomography, magnetic resonance imaging, and ultrasound are used.

Diagnostics

Determining the fact of joint pathology involves interviewing the patient, examination, and performing functional tests. Endoscopic verification of pathology is relevant only if necessary. Laboratory methods are secondary.

Informative sources of the condition of the hip joint are x-ray examination, MRI and ultrasound.

Dr. Epifanov about hip joint testing:

The specialist can also expand diagnostic prescriptions based on the expected stage of the disease and associated disorders.

Conservative treatment of iliopsoas tendinitis

Conservative treatment of iliopsoas muscle tendonitis includes the following procedures: immobilization, cryotherapy, anti-inflammatory medications, vitamin and mineral complex, laser and magnetic therapy. Mineral, wax and mud applications help well. In addition, iliopsoas tendonitis can be successfully treated with physical therapy. It includes the following procedures: ultrasound treatment, heat therapy and massage. Physiotherapy improves range of motion, improves the quality of metabolic processes in tissues, relieves inflammation, restores elasticity of structures and normalizes joint function.

When there is inflammation, rest is important. It is needed in order to avoid actions that could make the pain worse. Sometimes novocaine blockade is used to reduce pain.

Causes of tendinitis and mechanisms of development

The main cause of tendinitis of the thigh tendons is chronic microtrauma of the ligament tissues received during their functional overload. As a rule, if such microtraumas occur systematically and regularly, the body is not able to restore damaged tissue. An aseptic inflammatory process develops at the site of damage. Over time, the normal structure of tendon tissue is disrupted, and its elasticity and strength decreases. Changes in tendon tissue are accompanied by limited mobility and painful sensations that increase with movement.

Other causes of hip tendonitis include:

• autoimmune disorders that cause systemic damage to connective tissue (rheumatoid arthritis, etc.);
• reactive arthritis (Reiter's syndrome);
• metabolic disorders (gout, diabetes);
• degenerative changes in joint tissue;
• infection caused by a bacterial or viral agent;

• long-term use of glucocorticoid drugs;
• long-term antibiotic therapy;
• diseases of the hematopoietic system;
• chronic hypertension;
• chronic renal failure and other kidney diseases;
• age-related changes in the tissues of ligaments, tendons and joints;
• hereditary predisposition;
• general decrease in immunity.

A number of studies prove that a predisposing factor in the development of tendinitis is the excessive presence in the diet of foods containing purine bases: red meat and red fish, coffee, cocoa bean products.

Surgical treatment of iliopsoas tendinitis

Surgical intervention is prescribed if conservative treatment is ineffective. During the operation, the affected tissue is excised. If we are talking about calcific tendinitis, then calcium deposits are destroyed with a needle. The operation is performed under anesthesia, then the inflamed area is absorbed.

If a tendon rupture occurs, a transplant is performed using one's own or donor tissue. After the operation, painkillers, antibiotics, and vitamins are prescribed. After surgery, a rehabilitation course is prescribed.

Treatment

It is important to confirm with diagnostic methods the stage of hip tendinosis - treatment is carried out conservatively (in 80% of cases) only because patients seek medical help in a timely manner. You should not rely on self-destruction of the disease - this will lead to loss of time and the need for surgical intervention. The same applies to attempts to treat tendinosis with traditional medicine.

Conservative

The main goal is to relieve the patient's pain and restore his motor activity. To achieve the assigned tasks, the following are prescribed:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs) - Ibuprofen, Voltaren, Diclofenac. Use strictly under constant monitoring of the gastrointestinal tract. Complaints of stomach pain, nausea and lack of appetite are grounds for canceling the prescription.

2. Painkillers. Dexalgin, Ketanov, Ketorol are prescribed additionally only in cases where the administration of NSAIDs did not provide an analgesic effect. As the main treatment (pain relief according to the regimen) it is prescribed when the use of NSAIDs is basically impossible (for gastropathy).

3. Vitamin complexes (to improve tissue trophism, eliminate neurological disorders, normalize blood supply).
4. Antibiotics (if tendinosis is caused by an infection).

When treating hip tendinosis, doctors are careful when prescribing hormone therapy.

Corticosteroid injections reduce the tensile strength of the tendon, leaving it susceptible to rupture, especially if the procedure is performed incorrectly or too frequently. In this regard, the use of hormones in the form of injections is justified only in the acute period and no more than once every 3 weeks.

It is necessary to limit the mobility of the hip joint - immobilization is achieved by using elastic bandages, bandages, orthoses. Plaster is rarely applied.

Surgical

Tendon repair with autografts is a complex and quite expensive operation. It assumes a healthy heart condition, since to ensure an adequate depth of anesthesia, doctors widely use Diprivan and narcotic analgesics in their practice (68.3%). This combination puts a strain on the heart, so on the eve of the intervention, special attention is paid to ECG readings. Considering the high risk of complications and the long (more than 3 months) recovery period after surgery, doctors try to prescribe surgery only in severe cases, when long-term administration of NSAIDs and antibiotics is ineffective or contraindicated.

Physiotherapeutic

A competent specialist never limits himself to drug treatment if the goal is to eliminate the disease. Simultaneous use of physiotherapeutic methods makes it possible to quickly improve the patient’s well-being.

Dr. Epifanov about the benefits of physiotherapy:

Among these areas, UVT is used. Tendinosis can be easily eliminated by shock wave therapy.

The technique provides the following long-term effects:

• promotes loosening of calcium crystals and fibrosis segments formed due to acute or chronic damage;
• improves the degree of blood supply to areas of damaged tissue, stimulates their recovery;
• helps normalize the structure and elasticity of ligaments;
• eliminates pain for a long time.

A separate advantage of the procedure has been established - the ability to form a new capillary network - neoangiogenesis. The process improves metabolism in the hip joint, which is insufficiently supplied with blood due to the development of tendinosis. The formation of a new network of capillaries occurs within 95 hours after exposure to UVT.

Despite the multiple advantages of the technique, there are contraindications to its implementation:

1. Impaired blood clotting ability.
2. The presence of confirmed oncological processes in the hip joint (if the tumors are malignant).
3. The period of gestation and lactation.
4. Presence of a heart pacemaker.
5. Suppuration in the hip joint.

Piezoson 100.

To have a positive effect on hip tendinosis, it is enough to carry out 2 procedures of exposure to shockwave therapy with a Piezoson 100 device from the German company Richard WOLF. It is recognized as an effective equipment, patented and aimed at wide practice. The device meets the safety requirements of physiotherapy equipment. Piezoson 100 has been approved by members of the German Society for Shock Wave Therapy.

A course consisting of 2 procedures should be carried out no more than every 3 days. The shock wave should be generated at a frequency of 4 blows per second - 1 procedure involves impacting the joint with 2000 blows.

It is important to increase the shock energy level from 1 to 3 gradually, taking into account the patient’s sensations. For effective but safe manipulation, a special silicone gasket is used. With it, the doctor determines the depth of penetration of the impulse, which in the treatment of hip tendinosis should be no more than 1 cm. For high-quality impulse transmission, a gel is placed between the pad and the patient’s skin. The therapeutic head directs the wave to the site of pathology.

Immediately after the treatment procedure, the patient notes the absence of typical pain inside the joint, and there is a feeling of a rush of warmth. On the 2nd day there is a relapse of pain, gradually decreasing in the evening. After 2 manipulations, unpleasant sensations are significantly reduced. The pain syndrome is relieved within 7 days from the start of physiotherapeutic treatment.

Tendinosis of the hip joint is treated with shock wave therapy for the following reasons:

• the technique can be carried out on an outpatient basis;
• the effect is non-invasive;
• case of side effects – 1 in 1000, minimal risk;
• the effect does not require preliminary anesthesia;
• improvement in well-being occurs quickly;
• the achieved therapeutic effect is long-term.

The shock waves activate the body's own repair mechanisms for healing.

Rehabilitation after iliopsoas tendinitis

Rehabilitation is a recovery period prescribed after the main course of treatment. Courses of massage, physiotherapy and physical therapy are prescribed. Physiotherapy is also used in the postoperative period, which helps speed up the recovery process.

Therapeutic taping of inflamed tendons is used. Tape is an adhesive tape that is used to support joints. As a rule, it is prescribed by physiotherapists and rehabilitation specialists. The main task of taping is to relieve pain and create an anti-inflammatory effect. When applied correctly, the patient's pain decreases and range of motion increases. The tape can be used during exercise therapy.

Physical therapy consists of performing certain exercises that will speed up the recovery process of the iliopsoas muscles. The exercises must be performed under the supervision of a doctor. You can increase the load gradually. It is worth avoiding sudden exercises, but it is important to do them smoothly and follow the correct technique. A set of exercises is compiled by a rehabilitation specialist individually, depending on the characteristics of the course of the disease.

Therapeutic massage helps restore blood supply to muscle fibers, increases their elasticity, promotes the delivery of oxygen and nutrients, thereby eliminating muscle discomfort. As a rule, a massage course consists of 10-15 sessions. Massage is often done before exercise therapy, as a result of which the muscles warm up well and become more elastic, or after exercise - to relieve tension.

Therapy methods

Treatment tactics for quadriceps tendinitis depend on the cause of this pathology. In the case of traumatic tendonitis, treatment will consist primarily of immobilization of the affected limb and pain relief. In other cases, therapy is aimed at eliminating the root cause of its appearance. Treatment of tendinitis of the adductor muscle of the thigh, as well as the rectus and vastus muscles, is predominantly conservative.

Surgical intervention is necessary only in late stages of diseases accompanied by severe pain.

With timely diagnosis and adequate treatment, the prognosis in the vast majority of cases is favorable.

Drug treatment

Non-steroidal anti-inflammatory drugs are used to stop the inflammatory process and relieve pain. They can be used either orally or in ointment, cream or gel format. In case of severe pain, glucocorticoids are prescribed by injection.

Physiotherapeutic methods

At the recovery stage, physiotherapeutic procedures are prescribed to speed up rehabilitation:

• electrophoresis with lidase;
• UHF heating;
• magnetic therapy;
• massage;
• physiotherapy.

Traditional methods of treatment

Alternative therapy can be used as an adjuvant in line with general therapy and only after consultation with the attending physician.

• A compress of raw potatoes and onions will help relieve inflammation and swelling in the area of ​​the affected tendon. Finely grated raw vegetables are mixed with cosmetic clay and applied to the affected area overnight.
• Turmeric helps reduce pain. It is added to food; the daily dose should not exceed 0.5 grams.
• Rubbing with castor oil infused with grated garlic helps relieve pain and improve blood circulation.
• Ginger tea will help reduce inflammation and strengthen overall immunity.

A set of exercises for tendonitis of the iliopsoas muscle

• Hip exercises for iliopsoas tendinitis

Conclusion

Iliopsoas tendinitis usually occurs in athletes or people whose jobs involve physical activity. If the inflammation is minor, then conservative therapy is prescribed. For severe inflammation, surgery may be required at the discretion of the physician. Timely contact with a specialist reduces the risk of relapse. Also, to prevent re-inflammation, it is necessary to follow preventive measures, eat well, avoid muscle overload, and undergo a massage course 1-2 times a year.

Prevention

A set of measures to prevent the development of traumatic tendonitis of the hip tendons include:

• mandatory warm-up and warm-up exercises for muscles and ligaments before each workout;
• choosing loads and types of activity that are adequate to your physical fitness;
• gradual increase in the pace and intensity of the load;
• avoiding performing monotonous exercises for a long time, changing the type of activity;
• compliance with the rest regime.

General prevention rules also include:

• timely and adequate treatment of any infectious diseases;
• compliance with the principles of healthy and rational nutrition and drinking regime;
• moderate exercise and regular physical activity to strengthen the musculoskeletal system.

Types of pathology

Tendinosis is caused by inflammation in the joints.
According to the nature of its occurrence, tendinosis occurs:

• Aseptic. Occurs as a result of external influence on the tendon, such as injury.
• Infectious. Develops due to infection of the connective tissue or joint.

In addition, when making a diagnosis, the localization of the pathological process is taken into account. Tendinosis can occur in the following areas:

• adductor longus tendon;
• connection of the iliopsoas muscle;
• abductor tendon.

Causes of tendinosis

The pathology is expressed by an inflammatory process in the tendons that connect the muscles and joints of the hips.

As a result of the development of the disease, motor function is impaired, ligaments are stretched or torn, cartilage tissue is erased, joints are destroyed and bones are deformed. Tendinosis affects people over 40 years of age, professional athletes and those whose work involves constant physical activity. The following are the reasons for the development of tendinosis:

• advanced age;
• arthritis and arthrosis of the joints;
• congenital anatomical anomalies of the skeleton;
• infectious inflammation of the joint;
• frequent injuries;
• metabolic disorders in the body;
• hormonal imbalance;
• incorrect posture;
• frequent wearing of high-heeled shoes.