Do Steroids and NSAIDs Delay Psoas Tear Healing?
There is no quality evidence demonstrating that either corticosteroids or NSAIDs delay healing of psoas muscle tears, and in fact, image-guided steroid injections have shown long-term efficacy for psoas tendinopathy with 8 of 23 patients achieving lasting pain relief without requiring surgery. 1
Evidence for Corticosteroid Use in Psoas Injuries
The available research on psoas tendinopathy specifically contradicts concerns about delayed healing with corticosteroids:
Image-guided steroid injections provided lasting pain relief in 35% of patients (8/23) over an average follow-up of 77 months, with no evidence of impaired healing or progression to surgical intervention. 1
Patients who responded to steroid injection maintained their improvement long-term with average NAHS scores of 76.08, suggesting no detrimental effect on tissue integrity. 1
For patients requiring subsequent psoas tenotomy after temporary relief from injection, 67% (10/15) reported pain relief after surgery, indicating that prior steroid exposure did not compromise surgical outcomes. 1
Absence of Evidence for Delayed Healing
Multiple high-quality guidelines addressing musculoskeletal injuries acknowledge the lack of evidence regarding corticosteroid effects on tendon healing:
The American Academy of Orthopaedic Surgeons states there is "no quality evidence to guide recommendations" regarding potential adverse effects of corticosteroid injection on tendon biology and healing capacity, despite logical clinical concerns. 2
A systematic review found "no clinical data that supported or refuted a negative or positive effect of subacromial corticosteroid injections or NSAIDs on tendon healing or outcomes after rotator cuff repair." 2
NSAIDs and Muscle Healing: Mixed Evidence
The evidence on NSAIDs and muscle healing is limited and conflicting:
One animal study showed that corticosteroids caused irreversible damage to healing muscle in the long term (14 days), with totally degenerated muscles showing disorganized fiber architecture, though short-term benefits (2 days) were observed. 3
However, this animal model used high-dose methylprednisolone acetate (25 mg/kg) for muscle contusion, which differs substantially from clinical psoas tear management. 3
The British Journal of Sports Medicine notes that "NSAIDs may delay the natural healing process as the inflammation suppressed by NSAIDs is a necessary component of tissue recovery," but this is a theoretical concern without direct clinical evidence in muscle tears. 2
Clinical Application Algorithm
For acute psoas muscle tears:
Consider image-guided corticosteroid injection as first-line intervention for patients with confirmed psoas tendinopathy causing significant pain and functional limitation. 1
NSAIDs can be used for pain relief without strong evidence of healing impairment, though topical formulations are preferred when feasible to minimize systemic effects. 4
Monitor response at 6-8 weeks: If lasting relief occurs, continue conservative management; if only temporary relief, consider surgical consultation for psoas tenotomy. 1
Avoid prolonged high-dose systemic corticosteroids based on animal data showing potential long-term muscle degeneration, though this extrapolation from contusion models to human psoas tears is uncertain. 3
Important Caveats
The evidence base for psoas-specific injuries is extremely limited, with only one retrospective case series directly addressing this question. 1
Extrapolation from rotator cuff and other tendon literature suggests theoretical concerns about corticosteroid effects on healing, but these have not been substantiated in clinical outcomes studies. 2
The distinction between acute inflammatory tendinitis and chronic degenerative tendinopathy matters: corticosteroids may be more appropriate for inflammatory conditions, while their role in degenerative tears remains unclear. 2
Local injection technique is critical—peritendinous injection is preferred over intratendinous injection to minimize potential structural damage. 2