Iliopsoas tendonitis is characterized by pain and clicking or snapping in the groin or front of the hip. Because the iliopsoas muscle acts as a hip flexor, symptoms are often worse when bending the hip, especially against resistance. The iliopsoas tendon is fairly close to the skin.
Since the psoas is closely linked to our “fight or flight” mechanism, fear can be over-represented in those with a constricted psoas. It is an emotion that manifests itself in the most unusual ways and can “lock” itself into the body resulting in both physical and emotional tension.
Hip and pelvis injuries represent 2-5% of all sports injuries. Among these injuries, groin pain is the most common finding. The most common sports-related injuries in the hip, pelvis, and thigh area are musculotendinous, (eg, quadriceps strain, adductor tendinitis) and, less commonly, iliopsoas tendinitis. Iliopsoas tendonitis and iliopsoas bursitis are closely interrelated because inflammation of one inevitably causes inflammation of the other, due to their close proximity. Therefore, these 2 conditions are essentially identical in terms of presentation and management.
The iliopsoas is made up of two separate muscles: the iliacus and the psoas major. The iliacus starts at the inner surface of the hip bone known as the ilium and connects to an area on the upper inner surface of the thigh bone (femur) known as the lesser trochanter. The psoas major starts at the bodies of the vertebrae that make up the low back and extends to connect to the less trochanter (same as the iliacus). In approximately 40% of the population, there is an additional muscle called the psoas minor that also belongs to this muscle group. It connects to the body of the L1 vertebrae and extends down to a portion of the pubic bone known as the inferior ramus. Together these muscles assist with lifting the leg into a bent position as when walk up steps, assist with rotating the hip outward and help to bend the trunk at the waist when the legs are in a fixed stationary position as when sitting up from a lying down position.
Now you know what the iliopsoas is made up of, but what is iliopsoas tendonitis? Tendonitis is a term that means inflammation of the tendon; therefore, iliopsoas tendonitis would mean inflammation of the tendons of the iliopsoas muscles. Inflammation can result in pain and discomfort during various hip motions that involve activation of the iliopsoas including walking up steps, sitting up, walking, and running, to name a few. Positions that put the muscle group on a stretch like lying down with the legs straight instead of bent or lunging forward with the painful hip in the back can also be aggravating, especially when symptoms are particularly flared up. The condition can often be associated with a snapping or clicking sound at the hip during movement, which is why it can also be referred to as a “snapping hip.”
Treatment of iliopsoas tendonitis depends on the severity of the condition. The milder the symptoms are, the less invasive the treatment is. When the symptoms are mild, individuals often just need to modify their activities to limit overuse of the iliopsoas and take anti-inflammatory medication. Cortisone injections may also be utilized. If the symptoms persist, however, further intervention may be warranted. Physical therapy can assist with guiding you through recovery and regaining the previous function via an exercise program heavily geared toward stretching and gradual strengthening, as symptoms and strength allow. A less common intervention that is used only when symptoms continue to persist despite conservative treatment is surgery. A surgeon may choose to fully release the tendon, partially release the tendon, remove inflamed tissue, or attempt to lengthen the tendon via small incisions. Once again, surgical intervention is not as common, and typically conservative treatment with physical therapy and relative rest from aggravating activities is all that is needed.
Iliopsoas bursitis can cause pain and limited range of motion in the hip joint. The condition often develops from overuse in athletes or other people who exercise regularly.
- When a person develops iliopsoas bursitis, they may experience painful inflammation.
- Iliopsoas bursitis is often referred to as a repetitive use syndrome.
- As might be expected with swelling around the hip joint, pain is the primary symptom.
Pain is a primary symptom of iliopsoas bursitis. You may experience pain that starts around the front of your hips. The pain may also radiate down your thighs to the knees. Some people also have pain in their buttocks. They may experience stiffness and tightness in the mornings.
Initially, you may notice mild discomfort while doing certain activities, such as:
- walking up a flight of stairs
- extending your leg
- rising from a seated position
The condition can progress and cause more pain over a period of months or weeks. Pain and weakness may also cause limping.
There’s a risk of iliopsoas bursitis if you perform repetitive motions. This injury is sometimes due to overuse of the joints, tendons, and muscles. It can develop in athletes or anyone who’s physically active, such as runners and swimmers.
People with tight hip flexor muscles can also develop iliopsoas bursitis due to increased pressure. This pressure creates friction between the tendons and the bursa.
Arthritic conditions such as rheumatoid arthritis and osteoarthritis can also play a role in iliopsoas bursitis. Rheumatoid arthritis is an autoimmune disease where the immune system mistakenly attacks joints. This attack triggers joint inflammation. Osteoarthritis is a chronic arthritis condition. This form of arthritis causes degeneration of joint cartilage. Degeneration causes bones to rub together and promotes inflammation.
Benefits of Massage for Iliopsoas Pain
- Improve hip joint movement. When you open up the psoas, you increase mobility and joint range of motion in your hip flexors.
- Relieve back pain. I see a lot of clients with back pain. …
- Prevent anterior hip and groin pain. Nobody likes anterior hip and groin pain. …
- Improve posture.
- physical therapy that focuses on hip strength and flexibility.
- corticosteroid injection directly into the bursa.
- anti-inflammatory medications.
- antibiotics when the infection is present.
- walking aids, such as canes, to relieve pressure.
Exercises for iliopsoas muscle
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Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
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