Iliopsoas Syndrome:

Basically Iliopsoas syndrome is a collection of conditions relating to the area, which is down to overuse of the Iliopsoas muscle, weakness, disuse, shortening and/or tightness of the Iliopsoas. These issues can give rise to bursitis, tendinopathy, vascular issues and back pain.

Firstly you need to know a little about the anatomy of the area. If you take a look at  “The case of the clicky hip (AKA: Snapping hip syndrome)” article this will give you a rundown of the anatomy of the hip:

http://mathewhawkesphysiotherapy.blogspot.co.uk/2014/04/the-case-of-clicky-hip-aka-snapping-hip.html

What causes Iliopsoas Syndrome?

It is often caused by repetitive hip flexion in a sport that demands this movement frequently. The excessive use basically causes chronically shortened hip flexors:

Iliopsoas syndrome is the result of repetitive active hip flexion in abduction (Laible et al 2013).

Other factors include:

Performing speed/track work without proper ramp up phase or correct training techniques.

Shortened hip rotators.

Poor Core stability and strength.

Excessive lumbar lordosis (arch of lower back).

Pelvic asymmetry and leg length discrepancy.

Overpronation of the foot.

Shortening quadriceps (rectus femoris is a hip flexors).

Hip joint restrictions (stiffness: soft tissue related or osteoarthritis),

What sports commonly get it?

It is very common in Cyclists and Ballet Dancers secondary to excessive turn out demands but it can of course occur in anyone if the above issues are present. Research shows that 85% of athletes engaged in the cycling will suffer from an overuse injury (Linder et al 2014) and 20% of all lower extremity overuse injuries in competitive cyclists are of a vascular source (Linder et al 2014). A vascular impairment can be responsible for the occurrence of early fatigue and reduced performance in cycling (Alencar et al 2013). This is due to iliopsoas hypertrophy and compression from the cycling position.

What are the symptoms?

It can depend so you don’t have to have all of these symptoms but generally the following can be felt:

Lower abdominal pain.

Inguinal/Groin pain.

Buttock pain.

Thigh and leg pain.

Hip pain.

Sacroiliac Joint pain.

Stiffness or snapping/clicking in hip.

Lower Back pain: Research highlights that Psoas syndrome may manifest as low back pain & often poses a diagnostic challenge (Tufo et al 2012) and results suggest increased activity of the Psoas Major in Lower Back pain patients (Arbanas et al 2013).

How do you diagnose Iliopsoas Syndrome?

It is quite often misdiagnosed due to its pain referral patterns to the hip, lower back and thigh so it is important to perform a thorough examination.

Physiotherapy assessment:

Static hip extension flexibility (Thomas test) does not appear to be reflective of functional dynamic movements (Schache et al 2000). This is due to the fact that anterior pelvic tilt & hip extension are coordinated movements during running (Schache et al 2000). So rather than just using the Thomas test you need to look at pelvic tilt motion and actually look at movement patterns  (Applied Kinesiology and Biomechanics) as a whole to work out dysfunctions that could be causing the pain.

However an MRI is the most accurate way to assess iliopsoas bursitis but Ultrasound is the more cost-effective, easier and faster (Wunderbaldinger et al 2002).

How do you treat Iliopsoas Syndrome?

Conservative treatment with nonsteroidal anti-inflammatory medication, activity modification, and Physiotherapy specific to the iliopsoas should be the primary treatment for patients with iliopsoas syndrome (Laible et al 2013). So you should avoid aggravating factors for a few of weeks to allow for the inflammation to subside.

Techniques such as soft tissue release, muscle energy and PNF (Proprioceptive Neuromuscular Facilitation) stretching can be used but some of these are limited due to the depth of the structure.

Exercise with hip rotation improves function & reduces pain for patients with iliopsoas syndrome (Johnston et al 1999).

The biomechanical problems must be addressed otherwise it may not improve or if it does it will come back again in the future. 

Surgery:

If conservative treatment is ineffective then surgery may be needed.

Lengthening of the iliopsoas tendon. Surgical lengthening of the iliopsoas tendon has an 85% success rate (Jacobson & Allen 1990).

Resection of the bony prominence of the lesser trochanter.

Complete release of the iliopsoas tendon.

So there it is, everything that you need to know about Iliopsoas Syndrome. But as you can see it is extremely difficult to accurately diagnose and everyone’s causes are different, which means that the treatment needed will be very specific to the individual. If you think that you may have iliopsoas syndrome then get in touch for a physiotherapy assessment.

If you need any further information or would like to book an appointment then call Hawkes Physiotherapy on 01782 771861 or 07866195914

WWW.HAWKESPHYSIOTHERAPY.CO.UK