Iliopsoas bursitis/tendonitis is a vague term relating to symptoms arising from the iliopsoas tendon, which bends your leg at the hip. It is an overuse condition common in people who repeatedly perform hip flexion movements, such as runners, cyclists, and sportspeople. Most cases will get better with simple treatments such as physiotherapy. However, more complex issues need a hip flexor injection. So, who benefits from an iliopsoas tendon injection?
Symptoms of iliopsoas bursitis/tendonitis
Typically, doing any movements that use the hip triggers symptoms. These symptoms include pain in the front of the hip. Pain often worsens with repeated hip bending, such as walking upstairs, squatting, and running. In addition, there might be an audible click with bending of the hip. in some cases.
How to diagnose iliopsoas tendonitis?
Generally, doctors can diagnose iliopsoas tendonitis based on symptoms and signs. Common signs include tenderness at the iliopsoas tendon and pain in bending the hip.
Usually, imaging with X-ray, ultrasound, or MRI is necessary to rule out other causes, such as hip joint arthritis, hip impingement, or greater trochanteric syndrome.
We must remember that some causes of iliopsoas bursitis/tendonitis are due to problems deeper in the hip joint. For example, hip impingement can cause swelling of the iliopsoas tendon. Also, iliopsoas bursitis/tendonitis is common after a hip replacement or arthroscopy. Occasionally, a local anaesthetic hip injection is helpful to find out whether the pain is coming from the tendon or the hip joint.
Iliopsoas bursitis/tendonitis treatment
Generally, we manage most cases with simple treatments such as anti-inflammatory tablets. The activity needs to be modified to reduce repeated hip bending. Once the pain subsides, an exercise program is essential to build strength in the pelvic muscles. Overall, the goal is to improve hip strength and flexibility.
Overall, some of the exercises that help iliopsoas tendonitis include:
- Standing crab walks with a band – great for building glutes
- hip bridges – fantastic for strengthening your posterior chain
- Step-ups on a box
- lying lateral leg raises with a therband
- Copenhagen hip adductor strengthening
In complex cases, we consider an iliopsoas tendon or hip flexor injection.
Iliopsoas tendon injection: Who benefits?
We think two types of people benefit from an iliopsoas tendon injection, also known as a hip flexor injection.
Firstly, runners or triathletes experience ongoing hip flexor pain and fail simple treatments.
Secondly, people who have had a hip arthroscopy or replacement. We think friction forms between the hip replacement cup and the iliopsoas tendon, causing inflammation and pain. Sometimes, the cup might be too big, causing hip flexor pain.
In general, a hip flexor injection should be done with ultrasound. This is because we target the psoas tendon just above the hip joint. Ultrasound makes an iliopsoas tendon injection accurate and helps doctors avoid vital nerves and blood vessels. In addition, studies suggest ultrasound makes injections much more accurate.
What are the options for an iliopsoas tendon injection?
In general, we suggest an injection of cortisone directed by ultrasound. Studies suggest that pain relief from an iliopsoas tendon injection lasts 12 weeks. This pain-free period provides a window to strengthen the hip and pelvis.
We suggest you do your research before having an ultrasound-guided injection. These are the top four questions for your practitioner before a hip flexor injection.
How common is iliopsoas tendonitis after labral repair?
It’s more common than we think.
In a recent study, approximately 25% of hip arthroscopy patients developed at least one symptom of hip flexor tendonitis. We believe that too much hip flexor exercise in the initial time after surgery may increase the risk of iliopsoas tendonitis. Most settle with activity reduction, avoiding too much flexion. A cortisone injection is recommended if the pain does not resolve within six weeks.
Other frequently asked questions about iliopsoas tendon injection:
Iliopsoas tendonitis after total hip replacement: Is there a link?
Yes. Some cases of ongoing pain after a total hip replacement relate to pinching the cup against the iliopsoas tendon. In these cases, a psoas injection might help reduce pain.
Arthroscopic iliopsoas tendon release: Is it an option?
The iliopsoas tendon and muscle are essential to stabilize the hip joint. Generally, we recommend you avoid surgery for an irritable iliopsoas tendon unless you’ve failed other treatments.
Final word from Sportdoctorlondon about iliopsoas tendon injection
Overall, we need to be careful about diagnosing iliopsoas bursitis/tendonitis. Many cases of presumed tendonitis have underlying hip joint problems. We suggest you see an expert in hip and groin pain for the correct diagnosis. Psoas injection is very effective for complex cases.
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