From the Research
Treatment for an intramuscular iliopsoas hematoma typically involves a conservative approach with rest, pain management, and progressive rehabilitation, allowing for return to sport in 4-8 weeks, as supported by the most recent study 1. The initial management includes rest, ice, compression, and elevation (RICE protocol) for 24-72 hours, along with pain management using NSAIDs like ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 5-7 days. Acetaminophen (1000mg every 6 hours) can be used if NSAIDs are contraindicated. After the acute phase, gentle stretching and progressive strengthening exercises should begin, starting with isometric contractions and advancing to concentric and eccentric exercises as pain allows. Physical therapy is crucial, focusing on core stability, hip mobility, and gradual return to sport-specific movements. Some studies suggest that ultrasound-guided aspiration may be considered for large hematomas causing significant pain or functional limitation, though most resolve with conservative management 2. However, the most recent study 1 highlights the importance of a conservative approach, especially in patients with underlying conditions such as diabetes mellitus, where the risk of complications is higher. Return to sport typically occurs in 4-8 weeks depending on injury severity, following a progression from light aerobic activity to sport-specific drills and finally full participation. Athletes should be pain-free with full range of motion and at least 90% strength compared to the uninjured side before returning to competition. It is essential to note that the diagnosis of a psoas hematoma can be challenging, especially in elderly patients, and a high degree of suspicion is necessary to make an accurate diagnosis 3. In general, the treatment approach should prioritize conservative management, with a focus on pain management, rehabilitation, and gradual return to sport, to minimize the risk of complications and ensure optimal outcomes.