From the Guidelines
Treatment for iliopsoas bursitis typically begins with conservative measures, including rest, activity modification, and over-the-counter NSAIDs, with the goal of reducing inflammation and pain, as supported by the American College of Radiology's guidelines for chronic hip pain 1. The initial approach to managing iliopsoas bursitis involves a combination of non-pharmacological and pharmacological interventions. Non-pharmacological methods include:
- Rest and activity modification to reduce stress on the hip joint
- Physical therapy focusing on gentle stretching exercises for the hip flexors, strengthening of surrounding muscles, and correction of biomechanical issues
- Application of ice to the affected area for 15-20 minutes several times daily, especially after activity Pharmacological interventions may include:
- Over-the-counter NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to reduce inflammation and pain For persistent cases, a corticosteroid injection (typically methylprednisolone 40-80mg mixed with lidocaine) directly into the bursa under ultrasound guidance may provide significant relief, as suggested by the use of diagnostic and therapeutic injections in the evaluation of hip pain 1. This injection should be limited to 2-3 times yearly to avoid tissue damage. In rare severe cases that don't respond to conservative treatment after 3-6 months, surgical intervention to remove the inflamed bursa may be considered, highlighting the importance of a multidisciplinary approach in the management of iliopsoas bursitis 1. Recovery typically takes 4-8 weeks with proper management. Iliopsoas bursitis occurs when the bursa between the iliopsoas muscle and hip joint becomes inflamed, often due to repetitive hip flexion movements, overuse, or trauma, making proper treatment essential to prevent chronic pain and functional limitations.
From the FDA Drug Label
For the treatment of dermatomyositis, polymyositis, and systemic lupus erythematosus Intra-Articular The intra-articular or soft tissue administration of KENALOG-40 Injection and KENALOG-80 Injection are indicated as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, epicondylitis, rheumatoid arthritis, synovitis of osteoarthritis. Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and Bursitis Because the sodium salt of naproxen is more rapidly absorbed, naproxen sodium is recommended for the management of acute painful conditions when prompt onset of pain relief is desired.
The treatment for iliopsoas (ilacus and psoas major muscle) bursitis may include intra-articular corticosteroid injection with triamcinolone, as it is indicated for the treatment of acute and subacute bursitis 2. Additionally, naproxen may be used for the management of acute bursitis 3.
From the Research
Treatment Options for Iliopsoas Bursitis
- Conservative management strategies for iliopsoas bursitis include a home-based rehabilitation program with hip rotation exercises and stretching 4
- Activity modification, physical therapy, nonsteroidal anti-inflammatory drugs, and corticosteroid injections are also considered first-line treatments for iliopsoas disorders 5
- Ultrasound-guided corticosteroid injections (US-CSIs) can be effective in managing iliopsoas tendonitis after total hip arthroplasty 6
- Iliopsoas injections, including corticosteroid and local anesthetic injections, can be offered in conjunction with nonoperative management and have been shown to improve patient outcomes and reduce the need for surgery 7
Surgical Treatment
- Surgical treatment can be considered if the patient fails conservative measures and typically involves arthroscopic lengthening of the musculotendinous unit and treatment of concomitant intra-articular abnormality 5
- Tendon release has been described as a surgical option, with similar outcomes observed between different techniques 5