Logan Steele
The iliopsoas muscle is a group of two muscles located towards the front of the inner hip. It is essential for the movement of the back, pelvis, legs, and hips. Iliopsoas tendinopathy, also referred to as snapping hip syndrome, is an inflammation of the iliopsoas tendon or the surrounding area. It is often caused by repetitive use, such as running, and is common among athletes and physically active people. Treatment for iliopsoas tendinopathy includes relative rest, activity modification, and gentle stretching and strengthening exercises. This article will provide an overview of the iliopsoas muscle, the causes and symptoms of iliopsoas tendinopathy, and effective treatment options.
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Rest and gentle stretching
Rest is an important part of the recovery process. Relative rest involves the avoidance of activities that stress the iliopsoas muscle. This includes running, jogging, kicking, and other sports-related activities. It is recommended that individuals with an iliopsoas injury limit their activity during the recovery period, which typically lasts between 6 to 8 weeks.
Gentle stretching can help reduce muscle spasms in the iliopsoas complex. It is important to avoid overstretching, especially after icing, as this can increase an individual's pain threshold, making them less sensitive to pain and potentially leading to overstretching. A gentle stretch for the iliopsoas muscle can be held for 20 seconds, followed by a 30-second relaxation period, and repeated five times. This stretch should be pain-free, and individuals should be mindful of their breathing while holding the stretch, ensuring they do not hold their breath.
Stretching the rectus femoris can help bring an anteriorly rotated pelvis into a more neutral position, reducing strain and spasm in the iliopsoas muscles. Additionally, strengthening the hamstrings provides a posterior force on the pelvic girdle, combating the stress of the iliopsoas pull on the anterior pelvis. Abdominal strengthening exercises, such as sit-ups with knees and hips flexed at 90 degrees, allow the iliopsoas to relax and preserve a neutral pelvic position.
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Hip exercises
To heal the iliopsoas muscle, it is important to first understand the muscle itself and its role in the body. The iliopsoas is a group of two muscles, the psoas and the iliacus, that meet and share a common tendon, attaching to the thighbone. This muscle group is essential for the movement of the back, pelvis, legs, and hips.
An injury to the iliopsoas can occur when the muscle fibers or tendons in either the psoas or the iliacus get damaged or torn. This can happen due to repetitive use or trauma, and athletes and physically active people are more at risk. The injury can cause pain in the hip joint, and conditions such as iliopsoas tendonitis or bursitis may develop.
To heal the iliopsoas muscle, rest and limited activity are important in the initial stages. Icing the injury can help reduce pain and inflammation. Once the acute phase of healing is complete, gentle stretching can aid in reducing muscle spasms and improving range of motion. It is important to avoid overstretching, especially immediately after icing, as this can lead to potential overstretching.
Specific stretches that target the iliopsoas muscle can help in the healing process. One stretch is to hold the position for 20 seconds, relax for 30 seconds, and repeat this cycle 5 times. This can be done in various positions, such as lying on the back with one knee to the chest and the other leg extended, or in a kneeling lunge position.
In addition to stretching, strengthening exercises for the hip flexors and antagonistic muscle groups are beneficial. Exercises such as hip flexion or femoral external rotation with low resistance can improve iliopsoas function. Cycling with low resistance, stair climbing on a machine with minimal settings, or walking are recommended. As endurance improves, resistance can be gradually increased.
For more severe cases of iliopsoas tendonitis that do not respond to conservative treatment, surgery may be considered. This involves the release of the iliopsoas tendon, either partially or completely, to relieve pain and improve function.
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Physical therapy
In addition to stretching, physical therapy may include endurance exercises and resistance training. As the muscle recovers, endurance exercises can be performed daily, with gradual increases in resistance over time. It is important to stretch the iliopsoas after any strengthening or resistance exercises to prevent injury.
Another important aspect of physical therapy is activity modification. This involves modifying activities to reduce strain on the iliopsoas tendon and promote healing. For example, avoiding sit-ups or crunches that can aggravate the iliopsoas strain, and instead opting for exercises with knees and hips flexed at 90 degrees allows the iliopsoas to relax and maintains a neutral pelvic position.
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Surgery
The two surgical techniques that have been described are:
- Complete release of the iliopsoas tendon
- Partial release by transection of the posteromedial aspect of the iliopsoas tendon
The exact surgical procedure will depend on the extent of the patient's injury. The surgeon may surgically release the iliopsoas tendon or lengthen the muscle itself.
Gruen et al. reported that 73% of patients returned to previous athletic activities following surgery, with 45% also returning to their previous level of athletic participation. Hoskins et al. reviewed their experience with surgical correction by iliopsoas tendon fractional lengthening in 92 cases, noting complications in one-third of patients, including persistent hip pain, sensory deficits, and hip flexor weakness.
While short courses of analgesics may be required during the recovery phase, surgery may result in residual weakness in patients. There is also limited information on the long-term effects of surgical iliopsoas release, with major concerns about the impact on the underlying hip joint and lumbar spine.
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Prevention
Iliopsoas injuries are common among athletes and physically active people, especially runners, skiers, swimmers, and those who play sports that are intensive for the thighs, like hockey and soccer. Iliopsoas injuries can also be caused by underlying health conditions, such as arthritis, or by tight hips.
To prevent iliopsoas injuries, it is important to stretch and strengthen the appropriate muscle groups to achieve a neutral posture. Stretching the rectus femoris, for example, helps to bring an anteriorly-rotated pelvis into a more neutral position, reducing the likelihood of strain or spasm in the iliopsoas muscle. Additionally, strengthening the hamstring muscle group increases the posterior force on the pelvis, reducing the stress of the iliopsoas pulling on the pelvis anteriorly. Abdominal strengthening exercises, such as sit-ups or crunches, should be performed with knees and hips flexed at 90 degrees to allow the iliopsoas to relax and preserve a neutral pelvic position. Exercises that strengthen the gluteus maximus also help to achieve a neutral pelvic position.
It is recommended to begin all strengthening exercises with a weight that the individual can comfortably lift, gradually increasing resistance as the weight becomes easier to lift. Endurance is gained through movement with low resistance over time. Exercises requiring repeated hip flexion or femoral external rotation can improve iliopsoas function if resistance is kept low. Examples of such exercises are cycling with low resistance, stair climbing on a machine with the lowest resistance setting, or walking. Stretching the iliopsoas should occur following any strengthening and/or resistance exercises.
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Frequently asked questions
The iliopsoas muscle is a group of two muscles located towards the front of the inner hip. Pain in this area is often caused by iliopsoas bursitis, an inflammatory response in the bursa located under the iliopsoas muscle. The bursa is a liquid-filled sack that sits between muscles, ligaments, and joints, providing cushioning and reducing irritation from rubbing and friction.
Pain in the iliopsoas muscle can cause an achy feeling in the inner thigh, as well as pain in the lower back, pelvis, groin, or buttocks. In some cases, pain may spread down the legs or get worse when standing up straight.
Treatment for iliopsoas muscle pain includes rest, physical therapy, and pain-relieving medication. A doctor may also recommend gentle stretching and strengthening exercises to reduce muscle spasms and restore range of motion. In more severe cases, surgery may be required to release the iliopsoas tendon.
