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Issues Around the Hip: From Tendonitis to Bursitis

The hip is the largest ball-and-socket joint in the body. Its functions are twofold: it supports and stabilizes the body along with facilitating movement of the upper leg.

To an athlete, the hip is indispensable. Even less active sports, such as golf, depend on a healthy hip for maximum efficiency. Unfortunately, since athletes depend so much on their hips, they are more prone to injuring a hip due to their increased physical activity.

Dr. Hamilton at Beacon Orthopaedics & Sports Medicine is no stranger to hip problems in athletes. He specializes in, among other orthopaedic surgeries, minimally invasive hip repair. The following article contains information from Dr. Hamilton regarding common hip complications and what actions athletes can take to prevent injuries.

Anatomy of the Hip

In the most general sense, the hip joint is a ball-and-socket joint that is formed where the thigh bone (femur) meets the three bones of the pelvis: the ilium, the ischium, and the pubis. The femur has a spherical tip that fits into the socket formed by the hipbone.

Bony Structures:


The trochanter is a spur on the femur just before the ball of the femur forms.


The ischium is the curved bone forming the base of each half of the pelvis.



The iliopsoas muscle is a powerful hip flexor that runs across the top of the hip joint and works to pull the knee up and off the ground. It’s made up of two muscles: the psoas and iliacus. These muscles run from the lower spine and pelvis, join together, then attach by a tendon to the upper thigh.

The iliopsoas is a workaholic muscle. Throughout the day it’s constantly activated by forward motions like walking, running and leg lifting. It also picks up the slack when weaker muscles can’t perform their movements effectively, which lead to overworking and injury.

Rectus femoris

The rectus femoris is of the four quadriceps muscles that attach to the kneecap (patella). It helps to extend the knee and flex the hip.



The sartorius is the longest muscle in the human body. It runs down the entire length of the front of the thigh. It assists with hip flexion, abduction, and lateral rotation of the hip, along with flexion of the knee.


The iliopsoas, rectus femoris, and sartorius are the three biggest/most important muscles of the hip flexors. These muscles, unsurprisingly, are responsible for the action of flexing the hip joint.


The piriformis is a small muscle that runs from the sacrum to the outside of the hip.


Bursae are sacs filled with an egg-white-like substance called synovial fluid. Bursae typically act as lubricators between bones and other structures, such as muscles or ligaments, but they also reduce friction between tendons, ligaments, and muscles. Bursae are named after the bone they envelop.

Trochanteric bursa

It is of the two major bursae of the hip. It is located on the outside point of the femur, called the greater trochanter.

Ischial bursa

It is located in the upper buttock area. It’s a deep bursa located over the ischium and lies between the M. gluteus maximus and the ischial tuberosity.

Common Hip Conditions

Iliopsoas Syndrome

Oftentimes, pain felt in the lower back, hip, and thigh actually has its origin at the iliopsoas muscle, earning the muscle the nickname “hidden prankster.” When either the iliopsoas bursa or the tendon connecting the iliopsoas to the upper thigh get inflamed, it becomes painful to use the muscle, which causes pain to be felt in the front of the hip whenever the leg is raised. A snapping or clicking sensation may also be felt during movement. Iliopsoas syndrome is most likely to affect track and field athletes, cyclists, triathletes, dancers, and tennis players due to their repetitive hip movements.

Hip Bursitis

Hip bursitis is a condition where one or more of the hip’s bursae become inflamed and painful. This pain is typically felt on the outside of the hip and later radiates down into the thigh.

Symptoms of hip bursitis also include joint pain/tenderness. Injured athletes will see swelling and feel warmth around the injured area. The pain is sharp at first, but later dulls and becomes achy. The pain is worst when getting out of a chair or bed, sitting for a long time, or after sleeping on the injured side.

Bursitis can either be acute or chronic. Acute bursitis is fast, flaring up and going away after mere hours (or in some cases, days). Chronic bursitis is slower and lasts longer—anywhere from a few days to several weeks. It can also return unexpectedly after a few weeks or months without any pain.

What Causes Hip Bursitis?

  • Rheumatoid arthritis
  • Gout
  • Pseudo gout
  • A sudden hip injury
  • Diabetes
  • Bone spurs (bony growths on top of normal bone) on the hip
  • Spine problems (like scoliosis)

Trochanteric bursitis

Trochanteric bursitis occurs near the top of the femus, and it causes pain and tenderness of the outer hip and thigh. One of the more unfortunate side effects of trochanteric bursitis is that those who have it have a hard time laying on the afflicted side, which makes sleep very difficult. Excessive walking, exercise, or stair climbing often makes the painful symptoms worse. The most common causes of trochanteric bursitis are sudden hip injuries, bad posture, or extra stress (typically caused by arthritis, excess weight or uneven leg lengths)

Ischial bursitis

The ischial bursa is located in the upper buttock area. Ischial bursitis can cause dull pain in this area that is most noticeable when climbing uphill. The pain sometimes occurs after prolonged sitting on hard surfaces, which has earned the condition the nicknames “weaver’s bottom” and “tailor’s bottom.” Ischial bursitis is most commonly caused by sitting on a hard surface for a long time. The hard surface presses against the ischial bursa, causing irritation and eventually bursitis.

Piriformis Syndrome

Despite being such a small muscle, the piriformis can cause massive problems when inflamed or overused. Because the piriformis runs over the sciatic nerve, it tends to put pressure on the nerve, which causes extreme pain around the gluteus and posterior hip area when the piriformis swells or spasms. Long distance running and prolonged sitting are the two most common reasons one develops piriformis syndrome.

Hip Flexor Injuries

A hip flexor injury occurs when one (or more) of the hip flexor muscles are torn. The iliopsoas is the one that is most commonly injured, though. The amount of pain felt and how much functionality is lost depends entirely on how many muscle fibers are torn. When a small number of fibers get torn, function mostly stays the same (despite it still being painful). If enough fibers are torn, though, the injury becomes much more painful and is accompanied by a severe loss of function in the leg.

Pain from hip flexor injuries is typically felt in front of the hip/groin area and might also be accompanied by bruising, muscle spasms, and tenderness. Hip flexor injuries often make it difficult to walk normally.

While any athlete (or nonathlete) can wind up with a hip flexor injury, they are most common in athletes who do a lot of kicking, running, or jumping (which are all activities that engage the hip flexors).

Another common contributor to hip flexor injuries is weakness of the supporting muscles. When someone sits for long periods of time every day, the hip flexor muscles stay contracted for long periods of time, shortening and weakening them, making injuries far more likely.

Hip Flexor Tendonitis

Hip tendonitis is the inflammation of any tendon that’s a part of the hip flexors. It is typically accompanied by degeneration. The most common symptom of hip flexor tendonitis is pain that gradually develops over time. Often this pain will decrease after activity as the tendons get more blood and stretch out, though the pain frequently returns worse later.

Ways to Prevent Hip Injury

Because of the diversity of hip injuries and possible causes, it is impossible to completely prevent hip injuries, however, there are three actions that drastically reduce an athlete’s risk of developing a hip injury:

  • Stop when fatigue sets in
  • Take care to use proper biomechanics
  • Warm up and stretch. (stretching isn’t effective at preventing injury unless a warm up routine is also present)

Exercises to Prevent Hip Pain

Because of the complexity of the hips and the different ways that different sport athletes use their bodies, it’s important to note that there is no catch-all hip pain prevention technique. But exercises, such as the following, can help relieve hip pain:

  • Bridge with alternating hip flexion
  • Abdominal crunches
  • Single and double knee to chest (supine) figure four piriformis stretch
  • Seated butterfly stretch

Dr. Hamilton is Your Local Hip Expert

If you’re an athlete who is concerned about their hips, reading this article was an important first step towards understanding and ultimately preventing hip damage. The next step, whether you’ve been injured or not, is to schedule an appointment with Dr. Hamilton at Beacon Orthopaedics & Sports Medicine. If you’re injured, Dr. Hamilton and his team of experts will walk you through exactly what needs to happen for you to get back to the field (or court, green, or ice). Dr. Hamilton can help you prevent future injuries so you can stay in the game longer and achieve your personal best in whatever sport you specialize in.