Iliopsoas Syndrome
Overview:
- characterized by musculoskeletal pain in the hip, anterior thigh, or groin regions involving conditions such as bursitis, tendonitis/osis, snapping tendon, muscle strain, or avulsion injury
- Iliopsoas tendinobursitis is synonym involving inflammation of both iliopsoas bursa and tendon
Pathogenesis:
- synovial inflammation and hypertrophy of the bursal wall and/or irritation of iliopsoas tendon sheath
- excessive friction or compression of the ilipsoas tendon irritates the underlying bursa
- “Snapping Hip Syndrome” or the iliopsoas tendon rubbing over the anterior inferior iliac spine, iliopectineal eminence, or bony ridge of lesser trochanter may also lead to irritation
Causes/Risk Factors:
- direct trauma to inguinal area
- insidious secondary to overuse of hip flexors during eccentric activities
- ilipsoas impingement
- Inflammatory conditions promoting effusion of the hip joint
- Tight iliopsoas unit
- Running hills or climbing stairs regularly
- Leg length discrepancy, tight iliotibial band, weak abductors and hip rotators, subtalar hyperpronation, and lumbopelvic dysfunction
Clinical Presentation:
- MOI of aggravating or overuse activity
- exercise-induced pain in the inguinal area possibly radiating from anterior thigh to knee
- episodic discomfort when putting on socks and shoes
- increase in pain with running or climbing stairs but quickly subsides when stopping activity
- possible “snapping” sensation in affected hip
- point tenderness of femoral triangle
Contraindications/Precautions:
- hip or pelvic deformity, swelling, redness/warmth, palpable mass in inguinal area, capsular pattern of restriction, lumbar or SI dysfunction, groin pain radiating to the hip, and partial weight bearing
- screen for underlying fracture if trauma was present
Differential Diagnosis:
- imaging if underlying fracture is suspected from trauma or palpable mass indicating a neoplasm
- Screening to rule out:
- hip pointer - femoral nerve compression
- groin strain - meralgia parethetica
- ischiofemoral impingement - referred hip pain
- sports hernia - DVT
- femoral stress fracture - Aseptic necrosis
- neuritis - labral tear
Outcome Measures:
- VAS
- MMT
- Goniometer
- Posture and gait analysis
Clinical Bottom Line:
- treat with possible referral if underlying fracture is suspected or palpable mass is present
- Interventions should focus on relative rest, activity modification, patient education, pain management, manual therapy or stretching of iliopsoas unit, therapeutic exercise, and postural correction
References:
See “Illiopsoas Syndrome” section of References page
- characterized by musculoskeletal pain in the hip, anterior thigh, or groin regions involving conditions such as bursitis, tendonitis/osis, snapping tendon, muscle strain, or avulsion injury
- Iliopsoas tendinobursitis is synonym involving inflammation of both iliopsoas bursa and tendon
Pathogenesis:
- synovial inflammation and hypertrophy of the bursal wall and/or irritation of iliopsoas tendon sheath
- excessive friction or compression of the ilipsoas tendon irritates the underlying bursa
- “Snapping Hip Syndrome” or the iliopsoas tendon rubbing over the anterior inferior iliac spine, iliopectineal eminence, or bony ridge of lesser trochanter may also lead to irritation
Causes/Risk Factors:
- direct trauma to inguinal area
- insidious secondary to overuse of hip flexors during eccentric activities
- ilipsoas impingement
- Inflammatory conditions promoting effusion of the hip joint
- Tight iliopsoas unit
- Running hills or climbing stairs regularly
- Leg length discrepancy, tight iliotibial band, weak abductors and hip rotators, subtalar hyperpronation, and lumbopelvic dysfunction
Clinical Presentation:
- MOI of aggravating or overuse activity
- exercise-induced pain in the inguinal area possibly radiating from anterior thigh to knee
- episodic discomfort when putting on socks and shoes
- increase in pain with running or climbing stairs but quickly subsides when stopping activity
- possible “snapping” sensation in affected hip
- point tenderness of femoral triangle
Contraindications/Precautions:
- hip or pelvic deformity, swelling, redness/warmth, palpable mass in inguinal area, capsular pattern of restriction, lumbar or SI dysfunction, groin pain radiating to the hip, and partial weight bearing
- screen for underlying fracture if trauma was present
Differential Diagnosis:
- imaging if underlying fracture is suspected from trauma or palpable mass indicating a neoplasm
- Screening to rule out:
- hip pointer - femoral nerve compression
- groin strain - meralgia parethetica
- ischiofemoral impingement - referred hip pain
- sports hernia - DVT
- femoral stress fracture - Aseptic necrosis
- neuritis - labral tear
Outcome Measures:
- VAS
- MMT
- Goniometer
- Posture and gait analysis
Clinical Bottom Line:
- treat with possible referral if underlying fracture is suspected or palpable mass is present
- Interventions should focus on relative rest, activity modification, patient education, pain management, manual therapy or stretching of iliopsoas unit, therapeutic exercise, and postural correction
References:
See “Illiopsoas Syndrome” section of References page