Pain at the front of the hip is a common condition in elite athletes and active individuals. More common causes of anterior hip pain include hip arthritis, hip impingement, and stress fractures of the femoral neck. A less common cause is rectus femoris tendonitis, which causes pain in the rectus femoris tendon, typically felt in the front of the hip or upper thigh. What is rectus femoris tendonitis, and how do we treat it?
What is the Rectus Femoris Tendon?
The rectus femoris is a component of the quadriceps muscle, which is involved in the movement of the hip and knee. Toward the hip, the muscle forms into two tendons – direct and indirect heads – attaching to the front of the pelvis above the hip joint.
Causes of Rectus Femoris Tendonitis
Rectus femoris tendonitis develops when excessive load causes swelling and inflammation in the rectus femoris tendon. Common contributing factors include:
- Overuse from activities such as sprinting, kicking, or cycling.
- Tight hip flexors and weak gluteal muscles place excessive strain on the tendons.
- Direct trauma or strain from an explosive movement, such as a sudden acceleration or jump.
Symptoms
Individuals with rectus femoris tendon pain often describe pain in the front of the hip and upper thigh. Pain is usually gradual in onset, although damage can occur with sudden explosive movements such as turning or twisting. Often, athletes report pain with sprinting, kicking or sudden acceleration or deceleration. Other symptoms include reduced leg power and stiffness or discomfort upon waking in the morning.
Differential Diagnosis of Rectus Femoris Tendon Pain
Because rectus femoris tendon pain can mimic other hip and thigh conditions, it’s essential to exclude other causes of pain in this region.
- Iliopsoas Tendonitis
- Hip Impingement (FAI)
- Hip Apophysitis or avulsion fracture of the AIIS: more common in adolescents; occurs with a sudden, forceful contraction of the rectus femoris.
- Osteoarthritis of the hip
- Referred Pain from Lumbar Spine (L2-L4 Nerve Roots) – may cause similar anterior thigh pain with associated back symptoms.
Diagnosis
Your doctor will conduct a thorough clinical assessment to confirm the diagnosis and rule out other potential conditions. Generally, your doctor will find tenderness upon palpation of the rectus femoris tendon. Resisted muscle manoeuvres such as resisted hip flexion and knee extension reproduce rectus femoris tendon pain.
Imaging helps to confirm the diagnosis. X-ray images reveal calcification of the tendon, ruling out hip joint problems, such as hip impingement or arthritis. Ultrasound identifies tendon thickening, inflammation and partial tear. MRI provides a detailed view of the tendon and surrounding structures.
Management of Rectus Femoris Tendonitis
Most cases of rectus femoris tendonitis can be treated conservatively with:
- Activity Modification, including reducing high-impact activities and incorporating low-impact exercises such as swimming or cycling.
- Pain Management with regular ice therapy (10 minutes 3- 4x/day) and oral NSAIDS such as oral ibuprofen.
- Physiotherapy incorporating manual therapy and hip and pelvic strengthening
Advanced treatments can be used alongside conservative management and include:
- Shockwave therapy – useful in chronic cases with calcification to encourage calcification resorption and tendon healing
- Ultrasound-guided barbotage in cases of calcific rectus femoris calcification
- Ultrasound-guided PRP may promote tendon healing and be utilised in the treatment of tendonitis and partial or full-thickness tendon tears.
Surgical Treatment
- Surgery is rarely required but may be considered for tendon tears or avulsions of greater than 1cm involving both heads of the rectus femoris tendon – direct and indirect heads.
Final Word from Sportodctorlondon about Rectus Femoris Tendonitis
Rectus femoris tendonitis is an uncommon cause of pain at the front of the hip in athletes and active individuals. Early recognition, activity modification, and targeted rehabilitation are essential for successful recovery. If symptoms persist despite conservative treatment, advanced therapies such as PRP injections or shockwave therapy may be considered.
If you are struggling with persistent rectus femoris tendon pain, seek evaluation from a sports medicine specialist to develop an effective treatment plan and safely return to your sport or daily activities.
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