What are the treatment options for iliopsoas (iliospoas) muscle strain or injury?

From the Guidelines

Treatment for iliopsoas muscle strain or injury should prioritize a combination of rest, physical therapy, and pain management, with a focus on gentle stretching exercises and strengthening exercises, as supported by the most recent evidence 1. When managing iliopsoas muscle strain or injury, it is essential to reduce activities that aggravate the pain and apply ice to decrease inflammation. Over-the-counter NSAIDs like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily) can help manage pain and inflammation, as noted in general guidelines for tendon problems 1. However, the most recent and highest quality study 1 emphasizes the importance of imaging techniques such as MRI and US for evaluating soft tissue abnormalities, including iliopsoas or subiliacus bursitis.

Key components of treatment include:

• Reducing aggravating activities and applying ice to decrease inflammation
• Using over-the-counter NSAIDs for pain and inflammation management
• Engaging in physical therapy with gentle stretching exercises, such as the kneeling hip flexor stretch, and strengthening exercises like bridges and core stabilization work
• Considering corticosteroid injections for severe cases, as mentioned in the context of treating tendon problems 1
• Gradually returning to normal activities as pain subsides, typically after 2-4 weeks of consistent treatment, as supported by the general principles of managing overuse tendinopathies 1

It is crucial to address both the symptoms and underlying causes of iliopsoas muscle strain or injury for effective recovery and preventing recurrence. The most recent evidence 1 highlights the value of advanced imaging techniques in diagnosing and managing hip pain, including iliopsoas-related issues, but the fundamental approach to treatment remains focused on conservative management with rest, physical therapy, and pain management.

From the Research

Treatment Options for Iliopsoas Muscle Strain or Injury

The treatment options for iliopsoas muscle strain or injury can be categorized into conservative and surgical approaches.

• Conservative treatment includes:
  • Activity modification
  • Physical therapy
  • Nonsteroidal anti-inflammatory drugs
  • Corticosteroid injections 2
  • Hip rotation strengthening program 3
  • Manual therapy and active exercises 4
• Surgical treatment can be considered if the patient fails conservative measures and typically involves:
  • Arthroscopic lengthening of the musculotendinous unit
  • Treatment of concomitant intra-articular abnormality 2
  • Tendon release in the central compartment, in the peripheral compartment, or at the lesser trochanter 2

Specific Conditions

For specific conditions such as iliopsoas abscess, the treatment options include:

• Broad-spectrum antibiotics
• Percutaneous drainage
• Surgical intervention 5 For iliopsoas haematoma, treatment approaches include:
• Conservative therapy (bed rest, restoration of circulating volume, and drug discontinuation)
• Transcatheter arterial embolisation
• Surgical intervention 6