Iliopsoas bursitis (or tendonitis) is a broad term for symptoms arising from the iliopsoas tendon, which bends your leg at the hip. It’s an overuse condition, common in people who repeatedly flex the hip — runners, cyclists, and sportspeople. Most cases settle with simple treatments such as physiotherapy, but more complex cases benefit from a hip flexor injection. So who benefits from an iliopsoas tendon injection?
Symptoms of iliopsoas bursitis/tendonitis
Any movement that uses the hip can trigger symptoms. The main one is pain at the front of the hip, often worse with repeated bending of the hip — walking upstairs, squatting, and running. In some cases, there’s also an audible click as the hip bends (a snapping hip).
How is iliopsoas tendonitis diagnosed?
Doctors can usually diagnose iliopsoas tendonitis based on symptoms and signs, including tenderness over the iliopsoas tendon and pain with hip flexion.
Imaging — X-ray, ultrasound, or MRI — is often needed to exclude other causes, such as hip joint arthritis, hip impingement, or greater trochanteric pain syndrome.
It’s important to remember that some cases of iliopsoas bursitis/tendonitis stem from problems deeper in the hip joint. Hip impingement, for example, can cause swelling of the iliopsoas tendon, and iliopsoas bursitis/tendonitis is common after a hip replacement or arthroscopy. Occasionally, a local anaesthetic hip joint injection helps work out whether the pain comes from the tendon or the joint.
Iliopsoas bursitis/tendonitis treatment
Most cases settle with simple treatments such as anti-inflammatory tablets and modifying the activity to reduce repeated hip bending. Once the pain subsides, an exercise programme builds strength in the pelvic muscles — the goal is to improve hip strength and flexibility.
Exercises that help with iliopsoas tendonitis include:
- Standing crab walks with a band — great for building the glutes
- Hip bridges — for strengthening the posterior chain
- Step-ups on a box
- Lying lateral leg raises with a theraband
- Copenhagen hip adductor strengthening
In complex cases, we consider an injection into the iliopsoas tendon or the hip flexors.
Iliopsoas tendon injection: who benefits?
Three groups tend to benefit from an iliopsoas tendon injection (a hip flexor injection):
- Runners and triathletes with ongoing hip flexor pain that hasn’t responded to simple treatment.
- People who have had a hip arthroscopy or replacement may develop pain at the front of the hip. We think friction develops between the hip replacement cup and the iliopsoas tendon, causing inflammation and pain — and sometimes the cup is too large, causing hip flexor pain.
- Athletes with pubic overload who develop iliopsoas-related pain. An iliopsoas injection reduces pubic tension and improves pubic overload rehab.
A hip flexor injection should be performed under ultrasound guidance, because the target is the psoas tendon just above the hip joint. Ultrasound makes an iliopsoas tendon injection accurate and helps avoid vital nerves and blood vessels.
What are the options for an iliopsoas tendon injection?
We usually suggest an ultrasound-guided cortisone injection. Studies suggest pain relief from an iliopsoas tendon injection lasts around 12 weeks, and a recent systematic review of psoas injections found that 70% of patients improved.
It’s worth doing your research before any injection — here are the top four questions to ask your practitioner before a hip flexor injection.
How common is iliopsoas tendonitis after labral repair?
More common than you’d think. In one study, about 25% of patients undergoing hip arthroscopy developed at least one symptom of hip flexor tendonitis. We believe excessive hip flexor exercise immediately after surgery raises the risk. Most cases settle with activity reduction and avoiding excessive flexion; a cortisone injection is considered if the pain doesn’t resolve within six weeks.
How much does an iliopsoas tendon injection cost?
Dr Masci performs the iliopsoas injection as a one-stop appointment — consultation, diagnostic ultrasound, and the injection in a single visit. At the Chelsea clinic (the most cost-effective location), a consultation with an ultrasound-guided cortisone injection is £400; other clinic locations cost more. See the full one-stop injection fees here, along with our clinic locations.
Frequently asked questions about the iliopsoas tendon injection
Is there a link between iliopsoas tendonitis and a total hip replacement?
Yes. Some cases of ongoing pain after a total hip replacement are due to the cup pinching against the iliopsoas tendon. In these cases, an iliopsoas injection can reduce the pain — though it should always be followed by more rehab.
Is an arthroscopic iliopsoas tendon release an option?
The iliopsoas tendon and muscle help stabilise the hip joint, so cutting the tendon through a keyhole release can lead to muscle imbalance. We generally recommend avoiding surgery for an irritable iliopsoas tendon unless other treatments have failed.
Does a cortisone injection cure iliopsoas tendonitis?
Not on its own. The injection reduces inflammation and pain, creating a window to rehab — but the lasting improvement comes from the strengthening and load-modification programme. Its other value is diagnostic: a good response confirms the tendon as the source of pain.
Can an iliopsoas injection help a snapping (clicking) hip?
It can, where the clicking comes from the iliopsoas tendon flicking over the hip. The injection reduces the associated inflammation and pain, but rehab to improve hip control remains the mainstay.
How long does an iliopsoas tendon injection take to work, and how long does it last?
Cortisone usually starts working within a week or two, and the studies suggest pain relief of around 12 weeks — enough of a window to make progress with rehab.
Is the injection painful?
Most people tolerate it well. Local anaesthetic is included, and because ultrasound places the needle accurately near the tendon, it tends to be quicker and more comfortable than a blind injection in this deep, complex area.
Final word from Sport Doctor London about the iliopsoas tendon injection
We need to be careful diagnosing iliopsoas bursitis/tendonitis, because many cases of presumed tendonitis have an underlying hip joint problem. See an expert in hip and groin pain for an accurate diagnosis. For genuinely complex cases, a psoas injection is very effective.
To discuss an iliopsoas tendon injection with Dr Masci in London, including uin-clinic ultrasound, contact the team here or call +44 (0) 203 488 0350.
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