From the Guidelines
Iliopsoas syndrome is a painful condition caused by inflammation or irritation of the iliopsoas muscle group, which consists of the psoas major, psoas minor, and iliacus muscles that connect the spine and pelvis to the femur, as described in the context of hip-related pain by the International Hip-related Pain Research Network 1.
Definition and Classification
Iliopsoas syndrome typically presents as pain in the groin, hip, or lower back that worsens with activities like climbing stairs, running, or bringing the knee to the chest. The classification of hip-related pain, including iliopsoas syndrome, is crucial for proper diagnosis and treatment, and it has been addressed by the International Hip-related Pain Research Network in their consensus recommendations 1.
Diagnosis and Imaging
The diagnosis of iliopsoas syndrome can be supported by imaging modalities such as ultrasound (US), which can evaluate specific questions about superficial structures, such as the abductor tendons, as well as deeper structures like the iliopsoas and adductor tendons, as mentioned in the ACR Appropriateness Criteria for chronic hip pain 1.
Treatment and Management
Treatment usually involves rest, physical therapy focusing on stretching and strengthening exercises, anti-inflammatory medications like ibuprofen (400-800mg three times daily with food) or naproxen (250-500mg twice daily), and occasionally corticosteroid injections for severe cases, as typically recommended for managing pain and inflammation in musculoskeletal conditions.
- Key aspects of treatment include:
- Rest and avoidance of aggravating activities
- Physical therapy for stretching and strengthening
- Anti-inflammatory medications for pain management
- Corticosteroid injections for severe cases
- Ice and heat therapy for symptom relief
Prevention and Rehabilitation
Proper warm-up before exercise and maintaining core strength can help prevent recurrence of iliopsoas syndrome, especially in athletes who perform repetitive hip flexion movements. Recovery typically takes 4-6 weeks with proper treatment, though chronic cases may require longer rehabilitation, emphasizing the importance of a comprehensive treatment plan that includes prevention strategies and rehabilitation exercises.
From the Research
Definition and Pathology
- Iliopsoas syndrome refers to a group of disorders that affect the iliopsoas muscle, which is a deep muscle group connecting the spine to the lower limbs 2.
- The iliopsoas muscle is composed of the iliacus, psoas major, and psoas minor muscles, and functions as the primary hip flexor 2.
- Common pathologic conditions associated with iliopsoas syndrome include iliopsoas bursitis, tendonitis, impingement, and snapping 3.
Symptoms and Diagnosis
- Iliopsoas syndrome can cause significant limitations in daily activities, including sports, due to impairments and pathology associated with the iliopsoas muscle group 2.
- Evaluating pathology associated with the iliopsoas muscle group can be challenging because patient complaints are often vague and difficult to discern from other hip problems 2.
- Diagnosis of iliopsoas syndrome can usually be made by history and physical examination, though real-time ultrasound may be useful in confirming the diagnosis 4.
Treatment Options
- The first-line treatment for iliopsoas disorders is typically conservative, including activity modification, physical therapy, nonsteroidal anti-inflammatory drugs, and corticosteroid injections 3.
- 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 3.
- Iliopsoas injections, including corticosteroid and local anesthetic injections, can also be offered in conjunction with nonoperative management and have been shown to be clinically effective in treating a variety of pathologies, including bursitis, tendinopathy, and snapping hip 5.