What is Iliopsoas Tendonitis?

More frequently lately I have been seeing patients with injuries to their iliopsoas muscle group.  This muscle area is a good one to discuss because it is not as commonly known as areas like the quadriceps and hamstrings and can be confusing for people to understand because it involves both the hip and the back.  Let’s delve a little further into what makes up this muscle group.

The iliopsoas is made up of two separate muscles: the iliacus and the psoas major.  The iliacus starts at the inner surface of the hip bone known as the ilium and connects to an area on the upper inner surface of the thigh bone (femur) known as the lesser trochanter.  The psoas major starts at the bodies of the vertebrae that make up the low back and extends to connect to the less trochanter (same as the iliacus).  In approximately 40% of the population there is an additional muscle called the psoas minor that also belongs to this muscle group.  It connects to the body of the L1 vertebrae and extends down to a portion of the pubic bone known as the inferior ramus.  Together these muscles assist with lifting the leg into a bent position as when walk up steps, assist with rotating the hip outward, and help to bend the trunk at the waist when the legs are in a fixed stationary position as when sitting up from a lying down position.

Now you know what the iliopsoas is made up of, but what is iliopsoas tendonitis?  Tendonitis is a term that means inflammation of the tendon; therefore, iliopsoas tendonitis would mean inflammation of the tendons of the iliopsoas muscles.  Inflammation can result in pain and discomfort during various hip motions that involve activation of the iliopsoas including walking up steps, sitting up, walking, and running, to name a few.  Positions that put the muscle group on stretch like lying down with the legs straight instead of bent or lunging forward with the painful hip in the back can also be aggravating, especially when symptoms are particularly flared up.  The condition can often be associated with a snapping or clicking sound at the hip during movement, which is why it can also be referred to as “snapping hip.”

Treatment of iliopsoas tendonitis depends on the severity of the condition.  The milder the symptoms are, the less invasive the treatment is.  When the symptoms are mild, individuals often just need to modify their activities to limit overuse of the iliopsoas and take anti-inflammatory medication.  Cortisone injections may also be utilized.  If the symptoms persist, however, further intervention may be warranted.  Physical therapy can assist with guiding you through recovery and regaining previous function via an exercise program heavily geared toward stretching and gradual strengthening, as symptoms and strength allow.  A less common intervention which is used only when symptoms continue to persist despite conservative treatment is surgery.  A surgeon may choose to fully release the tendon, partially release the tendon, remove inflamed tissue, or attempt to lengthen the tendon via small incisions.  Once again, surgical intervention is not as common and typically conservative treatment with physical therapy and relative rest from aggravating activities is all that is needed.

In first addressing this topic we noted that the iliopsoas can be confusing because it may involve both the hip and the back.  Our next blog will discuss the effects of the iliopsoas muscle group on the low back.  We hope this blog was informative.  If you have any questions on this topic or any others in which you are interested, feel free to leave any questions, comments, or suggestions. Thank you for reading and stay active.







Obesity and Health Risks

Now that the New Year is here, many people have made resolutions to lose that excess weight that was gained over the holidays or as an accumulation over the years.  When weight loss is necessary, this is a wonderful goal.  One key factor to understand, though, is that having healthy weight is more important than just your outward appearance.  Sure, you may want to look good and feel good in your own skin; but there are also MANY health problems that you can escape by losing weight and avoiding obesity.

The following list may seem long, but ALL of these are conditions that can result from obesity.

  • Coronary Artery Disease (CAD) – plaque builds up in the arteries which is why this condition is also referred to as blocked arteries; heart attack or heart failure can result from the condition
  • High Blood Pressure – damage can occur to the body in many ways when the force of the blood pushing against the walls of the arteries increases as the heart pumps
  • Stroke – plaque built up in the arteries can cause a break off resulting in a clot; if the clot is close to the brain then it can block oxygen and result in a stroke
  • Type 2 Diabetes – an increase in intra-abdominal fat is correlated with a decrease in the effective use of insulin which is required to convert glucose (sugar) in the body to energy; obesity has also increased the risk of type 2 diabetes in children
  • Abnormal Blood Fats – obesity can result in high levels of triglycerides and LDL (“bad”) cholesterol and low levels of HDL (“good”) cholesterol which increases the risk of developing CAD
  • Metabolic Syndrome – this group of risk factors increases your chances of having heart disease, diabetes, or a stroke; risk factors include: a large waistline, higher than normal triglyceride level, lower than normal HDL level, higher than normal blood pressure, higher than normal fasting blood sugar level, or if you are on medications for any of these conditions
  • Cancer – obesity increases the risk for colon, breast, endometrial, and gallbladder cancers
  • Osteoarthritis – excess weight increases pressure through the joints, thus increasing the risk of developing arthritis especially in the knees, hips, and low back
  • Sleep Apnea – greater fat around the neck can narrow the airway and make pauses in breathing or shallow breathing while sleeping more likely
  • Reproductive problems – menstrual issues and infertility can occur with obesity
  • Gallstones – obesity can increase the risk of developing gallstones which are mostly made of cholesterol and can cause back pain; obesity can also increases the risk of an enlarged gallbladder which does not function

In order to know your risk for these conditions, it is improtant to know how to check if you are overweight or obese.  The best measures come from devices that can calculate body composition.  Certain devices can measure air or water displacement while in a testing apparatus in order to assess the amount of muscle versus fat in your body.  Due to the fact that these measurement devices are not always readily available to most people, measuring your waistline, the ratio of your waistline to your hips, and your body mass index (BMI) may be a quicker and more feasible option.  These measurements are not as accurate; however, they do have statistical correlations with health risks. 

To measure your waistline, find the smallest point around your abdomen and measure the circumference in centimeters.  Most women are at a higher risk for heart disease when their waistline is greater than 80-88 cm, whereas most men are at a higher risk when their waistline is greater than approximately 94-102 cm.  Asian men and women are at a higher risk with even smaller waistlines. 

To calculate your waist to hip ratio, measure the smallest point of your waistline and the widest point of your hips, then divide the waist measurement by the hip measurement.  Your hips should always be wider than your waistline.  Women with a ratio of 0.80 or below have a low health risk, those with a ratio of 0.81-0.85 have a moderate health risk, and those with a ratio greater than 0.85 are at a high health risk.  For men, the low range is 0.95 or below, medium is 0.96-1.0, and high is greater than 1.0. 

BMI is a measure of your weight compared to your height.  It is calculated by dividing your weight in kilograms by the square of your height in meters.  For a more information on BMI and an easier means of calculating this measure, check out our past blog BMI and Cholesterol.  A BMI of greater than 25 is considered overweight for most people and a BMI of 30 is considered obese.  Women are at a greater risk for heart problems when their BMI is over 21 and the risk for heart disease in both men and women is greatly increased once their BMI reaches 30 or above.

If, after testing yourself, you have discovered that you are overweight or obese; then refer to our past blogs Exercise for Health or Exercise for Weight Loss?, What Form of Exercise is Best for Your Goals?, and How to Lose Weight…Even Around the Holidays for good tips on healthy exercise and weight loss.  We hope this blog was informative.  If you have any questions on this topic or any others in which you are interested, feel free to leave any questions, comments, or suggestions. Thank you for reading and stay active.                                                                                                       







How to Lose Weight…Even Around the Holidays

The holidays are an amazing time to enjoy the company of family and friends.  Typically one of the key components to holiday celebrations is the food.  It becomes a time that we splurge on treats that we may not often consume during the rest of the year.  This can take a particular toll on the waist line.  So how do we keep the weight off, even during those tempting holiday feasts?

The most obvious choice for preventing weight gain is avoiding overeating.  Note that 1 lb is the equivalent of 3,500 calories.  If you plan on not only avoiding weight gain, but possibly losing some weight during this challenging winter timeframe, your caloric intake will need to be reduced by 500-1000 calories per day in order to lose 1-2 lbs per week.  “But the food is so tempting!” you may think.  I’m not disagreeing with you.  If at all possible, limiting caloric intake will help you avoid gaining weight; however, there is an alternative.  If you plan on consuming those extra calories over the holidays, then you have to expend more calories.  In other words, you’re going to need to burn off those calories with activity. 

Activity does not have to be a particular structured exercise program like lifting weights or running on the treadmill, but you have to expend enough energy to burn off the extra calories that you have consumed.  You may choose to play in the yard with your children or grandchildren, go on a brisk walk and look at Christmas decorations, or even shovel snow off the driveway (depending on the accumulation this year).  The important thing is to balance how many calories you bring in compared to the amount you expend.  Just because you have been active for the afternoon does not necessarily mean that you have been active enough to consume everything that you may desire.  Keep that in mind when you are loading your plate; and especially if you are not particularly fond of exercise or being active, you may want to rethink the extra helping of mashed potatoes.

If losing weight and keeping it off are your goal, then both diet and exercise/activity should become a more regular part of your daily routine.  30-60 minutes of moderately intense activity at least 5 days a week will make maintaining or losing weight more sustainable.  The dieting portion of the program can be more challenging during the holidays; but if you find yourself falling off of the bandwagon, then don’t be afraid to hop back on.  Weight loss is not an overnight venture.  It takes time and commitment.  You may falter, but that does NOT mean give up ENTIRELY.  Also note that GRADUAL changes in diet and reducing calories will be more effective and sustainable than trying to keep a very strict reduction in calories right away.  Reducing your caloric intake to TOO low of a level may actually result in your body losing muscle rather than fat, decrease the likelihood of you getting all of the proper nutrients that your body needs from food, and may leave you more prone to binging when you feel starved.

The health benefits to losing excess weight are definitely worth the struggle.  If your goal is to lose 20% of excess body weight, that’s great; but even a 5% loss will begin to demonstrate health benefits.  These benefits may include improvements in blood pressure, cholesterol levels, and blood sugar.  In addition to these health benefits, weight loss can also assist in your energy level, mobility, mood, and self-confidence.  For more blogs related to weight loss and exercise, check out the following links: exercise for health or weight loss, different forms of exercise, childhood obesity, and obesity continued.

If you have any questions on this topic or any others in which you are interested, feel free to leave any questions, comments, or suggestions. Thank you for reading and stay active.







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