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Iliopsoas Syndrome (Hip Flexor Muscle Strain) Injury Guide

What is Iliopsoas Syndrome?

Pain at the front of the hip may be due to a hip flexor muscle strain. The iliopsoas muscle is most commonly affected. The iliopsoas muscle is comprised of the Iliacus and psoas muscles.

The iliopsoas muscle lies in front of the hip joint and sits quite deeply, below the surface of the skin. Its main job is to flex the hip (bringing the leg out in front of the body) as when kicking a ball. The iliopsoas attaches to the thigh bone via the iliopsoas tendon (a tendon is a structure which attaches muscle to bone).

In between the tendon and the hip joint lies the iliopsoas bursa (a small sac of fluid). Bursae are present wherever moving parts occur, and help to reduce friction. They are normally found around joints and where tendons, muscles or ligaments pass over bony prominences.

Iliopsoas syndrome is the name given to a condition in which a person has iliopsoas bursitis (irritation and inflammation of the iliopsoas bursa) and/or iliopsoas tendonitis (irritation and inflammation of the iliopsoas tendon). The condition occurs primarily in gymnasts, dancers and track athletes and is caused by repetitive hip flexion.

Iliopsoas Syndrome Signs & Symptoms

A person suffering from iliopsoas syndrome may have pain in the hip and thigh region, as well as hip stiffness and in some cases a clicking or snapping hip. The physiotherapist should be able to diagnose the condition through manual tests, but it can be confirmed by an ultrasound or MRI scan.

Iliopsoas Syndrome Treatment

What you can do

  • Consult a sports injury expert
  • Apply ice packs to relieve pain and reduce bleeding
  • Use resistance bands for muscle strengthening exercises
  • Use a swiss ball for core strengthening exercises

The initial aim in the treatment of iliopsoas syndrome is to allow the condition to settle down and pain to decrease through rest, electrotherapy and anti-inflammatory medications. Ice packs can be applied for periods of twenty minutes every couple of hours (never apply ice directly to the skin as it can cause an ice burn). The ice packs relieve pain and reduce bleeding in the damaged tissue. This can significantly reduce the total rehab time.

Once the acute pain has settled down, a 6 week programme of flexibility and strengthening exercises for muscles around the hip can begin, followed by a gradual return to full activity. Resistance bands are ideal for strengthening the muscles around the hip.

As with all overuse injuries, iliopsoas syndrome can be caused by doing too much, too soon. When beginning or stepping up any exercise, gradual progress must be made. For example, it is impossible to increase from running 2 miles per day one week to running 10 miles per day the next week, without the body being put at risk of various problems.

As well as progressing gradually, your body has to be prepared for increased physical demands. Core strength exercises to help improve the stability of the trunk and pelvis are an important component of the rehab programme, as well as the prevention of overuse problems in the pelvis and groin. More advance mat based and swiss ball exercises can help to develop core strength for sports.

Iliopsoas Syndrome Prevention

  • Wear compression shorts for injury prevention
  • Warm up before sporting activities
  • Cool down following sporting activities
  • Use a Swiss Ball for core strengthening exercises
  • Stretch regularly to maintain muscle length

Warm up prior to sporting activity is thought to decrease muscle and tendon injuries because the tissues are more extensible when the tissue temperature has been increased by one or two degrees. Compression shorts are extremely good at maintaining muscle temperature in the groin and pelvic region, even in cold conditions. They provide warmth and support and are very effective at preventing muscle injuries.

A good warm up should last at least 20 minutes – starting gently and finishing at full pace activity. Practicing sport specific activities helps tune coordination and prepare mentally for competition.

Maintaining good muscle strength and flexibility may help prevent overuse injuries. Core strength exercises using a swiss ball are ideal. Tight muscles are associated with injury and stretching on a gym mat should also be practiced to maintain muscle length and prevent injury.