Iliopsoas tendinopathy or bursitis is mainly caused by overuse. Repeated compression can result from pinching the iliopsoas tendon as it crosses the front of the hip joint. This ongoing compression triggers inflammation, called tendinitis, which is typically temporary and often gets better with rest in a few weeks. It’s structure can, however, weaken if the tendon encounters recurrent bouts of tendinitis without sufficient recovery.
Over time, the tendon may thicken, and undergo degenerative changes due to an impaired healing process, resulting in tendinopathy. Sometimes, this condition may also cause a snapping or clicking feeling at the front of the hip and can be painful or painless.
Symptoms
Pain: Usually a sharp, deep pain in the front of the hip.
Clunking or clicking sensation: When hip flexion (raising the knee towards the chest) or hip extension occurs, a clicking or clunking sensation is frequently felt deep within the hip.
Pain when getting up from a seated position: Moving from a seated to a standing position might cause discomfort.
Pain with prolonged sitting: Sometimes, symptoms may get worse during or after prolonged sitting.
Discomfort during activity: Exercises, running, and walking might make the discomfort worse.
Weakness: A sensation of weakening in the thigh and hip muscles.
Causes
Iliopsoas tendinopathy is usually caused by repetitive strain or hip overuse. Factors that can contribute to the development of this condition are:
Overuse in sports and activities: Activities involving repeated hip flexion, like cycling, running, or dancing, can place excess pressure on the iliopsoas tendon.
Poor biomechanics: Poor posture, abnormal motion patterns and muscle imbalances are likely to exert more strain on the iliopsoas tendon.
Inadequate recovery: Not allowing enough rest between intense physical activities can lead to repetitive microtrauma, which contributes to tendinopathy.
Snapping hip syndrome: When the iliopsoas tendon “snaps” above the hip bone, it can lead to inflammation and irritation.
Age and degeneration: As people age, the iliopsoas tendon naturally deteriorates, thus making it more vulnerable to overuse damage.
Diagnosis and Tests
Clinicians at The Joint Pain Clinic often diagnose iliopsoas tendinopathy by combining clinical evaluation and imaging tests.
Clinical evaluation:
Patient history: A detailed discussion concerning the start of symptoms, contributing factors and general medical history review.
Physical examination: This involves assessing muscular strength, flexibility and hip joint range of motion. In addition to performing functional tests like evaluating walking and squatting, the physician may palpate the hip and lower back to find sensitive spots.
Diagnostic imaging:
Ultrasound imaging: Ultrasound is a crucial diagnostic tool that shows tendon thickening or iliopsoas bursa inflammation.
MRI: In more complicated situations, MRI scans can be used to evaluate structures of the soft tissue and rule out other disorders.
Treatment
The goals of treatment are to lessen inflammation, boost recovery as well as stop more damage. The strategy could combine conservative treatment along with less invasive techniques in some situations.
Conservative management:
Rest and activity adjustment: It’s important to cut back on activities that make symptoms worse. High-impact exercises like running and jumping can be temporarily stopped to allow the tendon to heal.
Physical therapy: In order to manage the condition, specific exercises that strengthen and stretch the hip flexors as well as methods to enhance hip biomechanics, are essential.
Anti-inflammatory drugs: Non-steroidal anti-inflammatory drugs (NSAIDs) are used to alleviate pain and reduce inflammation.
Ice therapy: Using ice packs to reduce discomfort and swelling in the affected area can be helpful.
Ultrasound-guided cortisone injections:
Corticosteroid injections can be given under ultrasound guidance when conservative treatment is insufficiently effective. This method makes it possible to precisely administer anti-inflammatory drugs to the irritated tendon or bursa.
Surgical procedure:
Although rarely required, surgery could be taken into consideration if conservative options don’t work. The iliopsoas tendon is usually released during the operation, and any structural problems causing the condition are addressed.
