Iliopsoas bursitis and Iliopsoas tendon inflammation have similar symptoms of gradual onset pain, deep in the groin. The bursa is a small sack of fluid that reduces friction between the tendon and bone.
Symptoms
Iliopsoas bursitis and iliopsoas tendon inflammation share similar symptoms, making it difficult to distinguish between the two.
The key symptoms associated with these conditions include:
- Deep pain in the groin and front of the hip.
- Radiating pain that can extend down to the knee or even into the buttocks.
- Occasional snapping sensation in the hip.
- Morning stiffness and pain improve with warm-up but worsen as activity increases.
Differentiating iliopsoas pain from other groin conditions like a groin strain or ‘Gilmore’s groin’ involves specific techniques:
- Muscle Palpation: Probe the iliopsoas muscle for tenderness and tightness. Its deep location in the abdomen makes this process challenging.
- Iliopsoas Stretching: During stretching exercises, observe for pain and tightness.
Despite the difficulty of palpating the deep-seated muscle, an experienced therapist can find it by elevating the patient’s leg passively while probing. This practice helps differentiate iliopsoas pain from other types of groin pain.
Thomas test
The Thomas test is a useful tool for evaluating tightness or pain in the Iliopsoas muscle.
Here’s how the test is conducted:
- The patient lies on their back and raises one knee as high as possible.
- The thigh of the opposite leg should be kept horizontal.
- If the thigh of the raised leg rides up, it suggests potential tightness in the hip flexor muscles, such as the Rectus femoris or Iliopsoas.
- The shin of the raised leg should hang vertically. If it deviates from a vertical position, it may indicate tight Quadriceps muscles.
By performing the Thomas test, healthcare professionals can gain insights into the tightness and potential issues with the hip flexors and Quadriceps muscles.
Iliopsoas bursitis causes & anatomy
The iliopsoas muscle, a strong hip flexor lifting the knee, originates from the lower five lumbar vertebrae and inserts into the thigh bone. A fluid-filled sack called a bursa, sits between a tendon and bone, lubricating movement and reducing friction. Overuse can inflame the tendon (Iliopsoas tendonitis) or bursa (Iliopsoas bursitis) due to repetitive tendon-bursa rubbing.
Athletes, particularly those in kicking sports, and individuals in repetitive activities like running or swimming, face a higher risk of iliopsoas injuries. Tight hip flexor muscles, adding pressure to the hip front and increasing tendon-bursa friction, can significantly contribute to the development of Iliopsoas bursitis.
Treatment of Iliopsoas bursitis & tendonitis
What can the patient do?
The patient can manage their condition with these strategies:
- Rest: Take breaks from activities that worsen pain, particularly repetitive ones. Ignoring discomfort and continuing activities can delay healing and possibly worsen the condition.
- Ice: Use ice to reduce pain and swelling, but wrap it in a moist towel or use a cold compression wrap. This method can also provide compression.
- Gentle Exercise: Start hip flexor stretches when pain eases. These should be gentle to gradually improve flexibility and strength without further injury.
What can a sports injury specialist do?
A sports injury specialist can conduct diagnostic tests such as CT scans or MRIs, prescribe anti-inflammatory medications for pain management, and assess muscle imbalances. They often focus on hip flexor stretching and strengthening of abdominals and glutes to correct imbalances and prevent further injury, particularly in one-sided sports.
These experts can perform biomechanical assessments to identify the need for orthotic inserts. When necessary, they collaborate with Chiropractors or Osteopaths who apply spinal manipulations for joint alignment and nerve pressure relief. If traditional approaches don’t work, they can administer corticosteroid injections. As a last resort, they might recommend iliopsoas tendon release surgery.
