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.