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Iliopsoas Tendonitis Symptoms Causes Treatment Preventions & More All you need to know

December 28, 2021

The iliopsoas muscle is one of the flexor muscles of the hip. It is responsible for the external rotation of the femur, the thigh bone.

The muscle is the strongest flexor of the hip and contributes to maintaining the strength and integrity of the hip joint besides stabilizing the lumbar spine and pelvis.

Injury to the iliopsoas results in hip pain. Asymptomatic snapping hip syndrome, tendonitis, bursitis, and impingement all arise from its dysfunction.

Iliopsoas tendonitis means inflammation of the tendon or area surrounding the tendon. Inflammatory changes almost always accompany acute cases. However, chronic cases may present without any inflammation, so they are often designated as tendinopathy. Chronic cases result from improper healing and degenerative changes in the tendon.

Repetitive hip flexion results in chronic degenerative changes of the tendon. The inflammation of the iliopsoas bursa often accompanies iliopsoas tendonitis. When the tendon gets inflamed, so does the bursa.

Iliopsoas Tendonitis Symptoms Causes Treatment Preventions

Anatomy of the iliopsoas tendon

The iliopsoas muscle comprises of three muscles;

  • iliacus
  • psoas major
  • psoas minor

The iliacus arises from the iliac fossa of the hip bone and attaches into the psoas tendon extending and attaching to the femur.

The psoas major also follows the same route; inserting via the psoas tendon onto the femur after arising from the transverse processes of the lumbar vertebrae, the intervertebral discs, and margins of vertebral bodies T12 to L5.

The psoas major and the iliacus muscles join each other at the level of L5 to S2.

The psoas minor arises from the vertebral bodies of T12 and L1 and gets attached to the iliac bone.

The iliopsoas tendon travels into the pelvis, the thigh and passes under the inguinal ligament.

The iliopsoas bursa is the largest bursa of the hip joint and is situated deep to the iliopsoas junction of muscle and tendon.

The iliopsoas functions to allow;

  • Flexion of the thigh and trunk
  • External rotation of the femur
  • Lateral flexion of the lower vertebral column

Causes of iliopsoas tendonitis

Injury to the iliopsoas is commonly referred to as "dancer's hip" or "jumper's hip." The biomechanics involves repetitive hip flexion in an externally rotated position.

Acute trauma or repetitive movement that results in overuse of the tendon resulting in the subject condition.

Acute trauma may result in an injury to the musculotendinous unit of the iliopsoas or in an avulsion fracture of the lesser trochanter of the femur.

Movements involving eccentric contraction of the muscle or quick flexion against an opposing extension force result in such an injury. The force surpasses the capacity of the tendon and results in damage.

Overuse injuries involving the iliopsoas arise from any activity requiring

  • repetitive hip flexion
  • repetitive external rotation
  • repetitive flexion of both the hip and trunk

Examples of such activities include dancing, ballet, cycling, rowing, inclined running, track and field, soccer, and gymnastics.

Signs and symptoms of iliopsoas tendonitis

Iliopsoas tendonitis is characterized by;

  • Deep groin or anterior hip pain in the early days
  • Intermittent pain in the groin or the front of the hip area is described as a deep ache.
  • Clicking or snapping in the groin
  • Symptoms worsen movements like bending, especially against resistance, tying shoelaces, rising from a seated position after extended sitting, and inclined walking.
  • The front hip and the groin are tender to touch.
  • Pain relief by rest progresses to a constant complaint.
  • Radiating pain along the front of the thigh that extends to involve the knee
  • Low back pain
  • Discomfort in the gluteal region or thigh
  • Inability to stand straight

On examination, there is a palpable and audible snap upon flexion and extension of the hip. Additionally, the iliopsoas junction area in the femoral triangle may be tender to touch.

The patient's appearance reveals signs of psoas hypertonicity, holding the affected hip in a mildly flexed and externally rotated position. The patient walks in short strides on the affected side.

The patient shows pain on passive hip extension and active or resisted hip flexion.

Treatment and management of iliopsoas tendonitis

  1. Immediately after the injury to first few days
  1. RICER

Rest accompanied by gentle stretching along with icing helps in reducing muscle spasms.

Whichever iliopsoas stretch is selected, it should be held for 20-seconds, followed by 30-seconds of rest. The stretch is repeated at least five times. No pain should occur during the stretch. Deep breaths are encouraged during stretch exercises.

  • Medication
    • TENS

The TENS application helps alleviate pain and muscle stiffness.

  • After a few weeks, when the symptoms start resolving
  • Massage

Soft tissue techniques such as myofascial release are applied in the acute phase of recovery. They help in speedy recovery.

The main aim of acute-phase massage therapy is to alleviate pain, reduce muscle spasms and decrease any swelling.

Massage helps the patient to return to activities of daily life.

  • Therapeutic ultrasound

Therapeutic ultrasound improves the pain of chronic iliopsoas tendonitis.

  • Active rehabilitation

Increased lumbar lordosis and anterior pelvic tilt are often associated with iliopsoas tendonitis. Active rehabilitation includes manual therapy aimed at mobilizing the hip capsule, lumbar spine, and pelvis. In addition, strengthening and stretching hip muscles (flexors and extensors) help achieve a neutral posture.

The rehabilitative approach should also include a range of motion, stretching, and strengthening exercises to target the hip flexors and antagonistic muscle groups. These are adopted in the recovery phase of the iliopsoas tendonitis.

The stretching routine must follow proper warm-up and cool-down and should be continued throughout the therapy.

Strengthening exercises are performed daily in sets of four with 10-15 reps.

Once the injury has healed, endurance exercises to improve iliopsoas muscle strength should be adopted. Some examples include cycling, walking, machine stair climbing.

Gradually increase the resistance with strengthening exercise to maintain and upgrade the strength of the subject muscle.

Some of the rehabilitative exercises for iliopsoas tendonitis include;

Lunge Stretch

Start in a lunge position

  • Keep your hip to be stretched at the back.
  • Move your hips and upper body forward till you are comfortable.
  • Make sure your back knee does not slide forwards.
  • Keep your upper body upright, back straight, and chest forwards.

Thomas Stretch

  • Lie on the edge of a bed or table with your legs hanging down from the knees.
  • Pull your healthy knee towards your chest.
  • Relax the other affected knee and let it hang from the edge of the bed. Again, the stretch is for the hanging leg.
  • You should feel a pulling effect at the front of your hip or thigh.

Straight Leg Raise

  • Lie on your back. Make sure the surface is flat. Lift your right leg. Make sure to keep the knee straight. Take it high as far as comfortable.
  • Slowly lower the leg back on the ground.
  • Make sure not to arch your lower back while performing the exercise.

Prevention of iliopsoas tendonitis

Some preventive tips for iliopsoas tendonitis pain include;

  • Modify equipment or sitting positions
  • Take extended rests
  • Learn new routines for repetitive activities
  • Prepare the muscle with a thorough and correct warm-up before any activity
  • Take some time for rest and recovery after athletic activity
  • Strengthen and condition the muscles of the hips, buttocks and lower back with regular exercise
Abdur Rashid
Medically Reviewed By Abdur Rashid
MSC Public Health, MCSP, MHCPC
BSC (Hon) Physiotherapy
Consultant Neuro-spinal & Musculoskeletal Physiotherapist

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