Current and future advances in practice: tendinopathies of the hip

Tendinopathy describes persistent tendon pain and loss of function related to mechanical loading. Two common hip tendinopathies seen in practice are gluteal tendinopathy and proximal hamstring tendinopathy. Both conditions can be frustrating for patients and clinicians due to the delay in diagnosis, significant disability caused and lack of response to common treatments. Tendinopathy is a clinical diagnosis and can most often be made using findings from the patient interview and pain provocation tests, without the need for imaging. Specific education and progressive exercise offer a low-risk and effective option for gluteal tendinopathy and result in greater rates of treatment success than corticosteroid injection, both in the short term (8 weeks) and at 1 year. Proximal hamstring tendinopathy is a common, but less researched, and under-recognized cause of persistent ischial pain. As research on proximal hamstring tendinopathy is limited, this review summarizes the available evidence on diagnosis and treatment following similar principles to other well-researched tendinopathies. This review summarizes the diagnosis and management of two common hip tendinopathies, gluteal tendinopathy and proximal hamstring tendinopathy. Gluteal tendinopathy, formerly trochanteric bursitis, is a common source of pain over the side of the hip. This condition is common in postmenopausal women and significantly affects physical function and quality of life. Advances in diagnostic testing and evidence-based treatment programmes have provided clinicians with promising options for the management of gluteal tendinopathy. Education aimed at improving patient understanding of aggravating factors, combined with functional rehabilitation, has been found to have greater treatment success than corticosteroid injection. Proximal hamstring tendinopathy is seen in both athletic and non-athletic populations, with the main symptom being pain at the sitting bone that interferes with sitting and day-to-day athletic function. As research on proximal hamstring tendinopathy is limited, this review summarizes the available evidence on diagnosis and treatment following similar principles to other well-researched tendinopathies.