What is Iliopsoas Tendinitis and Iliopsoas Syndrome?
Discover what causes iliopsoas tendonitis and how to treat it.
by Brad Walker | First Published December 6, 2005 | Updated July 18, 2019
- Iliopsoas tendinitis refers to inflammation of the iliopsoas muscle and can also affect the bursa located underneath the tendon of the iliopsoas muscle.
- Whereas iliopsoas syndrome refers to a stretch, tear or complete rupture of the iliopsoas muscle and / or tendon.
What Causes Iliopsoas Pain?
- Iliopsoas tendinitis is predominately caused by repetitive hip flexion or overuse of the hip area, resulting in inflammation.
- Iliopsoas syndrome, on the other hand, is caused by a sudden contraction of the iliopsoas muscle, which results in a rupture or tear of the muscle, usually at the point where the muscle and tendon connect.
Athletes at risk include runners, jumpers and participants of sports that require a lot of kicking. Also at risk are those who participate in strength training and weight lifting exercises that require a lot of bending and squatting.
Anatomy of the Iliopsoas Muscle
Iliopsoas muscle pain caused by iliopsoas tendinitis and iliopsoas syndrome are conditions that affect the iliopsoas muscle located in the anterior region (or front) of the hip.
The iliopsoas muscle is actually made up of two separate muscles located in the anterior (or front) of the hip area. In the diagram to the right you can see the Iliacus labeled on the left and the Psoas Major labeled on the right (in capitals). These two muscles are responsible for lifting the upper leg to the torso, or flexing the torso towards the thigh (as in a sit-up).
Although the two muscles start at different points (the psoas originates from the spine, while the iliacus originates from the hip bone) they both end up at the same point; the upper portion of the thigh bone. It is at this point; the insertion, that most iliopsoas injury occurs.
Symptom of an Iliopsoas Injury
Pain and tenderness deep in the abdomen are common symptoms of both conditions; however the onset of pain associated with iliopsoas tendinitis is gradual and tends to build up over an extended period of time, whereas the pain associated with iliopsoas syndrome is sudden and very sharp. Weakness is also a common symptom associated with both conditions.
Iliopsoas Muscle Pain Treatment
Iliopsoas tendinitis and iliopsoas syndrome is a soft tissue injury of the iliopsoas muscle and therefore should be treated like any other soft tissue injury.
- Immediately following an injury, or at the onset of pain, the R.I.C.E.R. regimen should be employed. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis. It is critical that the R.I.C.E.R. regimen be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.
- The next phase of treatment (after the first 48 to 72 hours) involves a number of physiotherapy techniques. The most common methods used to do this include ultrasound, TENS, heat and massage. The application of heat and massage is one of the most effective treatments for removing scar tissue and speeding up the healing process of the muscles and tendons.
- Next, start to incorporate some very gentle range of motion exercises for the large muscle groups around your hips. The lower back, buttocks, hamstrings, quadriceps and groin are a good place to start.
- Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your treatment. The main aim of this phase is to regain the strength, power, endurance and flexibility of the muscles and tendons that have been injured.
Beware of false advice
A while ago I came across a website promoting a new product to help with hip pain. I’m always interested to see what other people are doing in the field of stretching & flexibility, so I thought I’d check it out. Click on the video below to see what I found…
Transcript from video (click to open)
Hey everybody, Brad Walker here. I just wanted to do a quick video for you. As most of you know, I’m always on the lookout for new information on stretching and flexibility. And I came across a website the other day that sort of got me interested and I started to have a look around. And this website was promoting a product that was claiming to improve hip flexibility. So I thought, oh, great. I’ll have a look through there. Most new products I come across I purchase just to have a look and see what other people are doing. And anyway, I started reading through some of the material there.
First thing I noticed; very sales-y, very you know, sort of exaggerated claims, you know, you’re going to fix your problems in seven days and you know, you can do this and that and I mean, I’m sure you know the type of websites I’m talking about. Anyway, I came across this part on the website which talked about a very good friend of mine and author Michael Alter. And Michael’s written some great books on stretching and flexibility. If you don’t know his work, I actually list two of his books on my top 10 best stretching and flexibility books of all time. And Michael specializes in the physiology of stretching and his stuff is fantastic for that. The book that he’s most famous for is this one here, The Science of Flexibility and if you’re interested in stretching and flexibility and you haven’t got this book then, you really need to. Michael goes into a heap of detail about what’s going on within the body when you are stretching so, it’s really all the physiology of stretching and flexibility.
Anyway, in this sales material, I was reading, the author of this new product referenced some of Michael’s work. And one of the references he referred to, was the factors that limit flexibility and Michael goes into some detail about different factors that limit or affect flexibility. And one of the things that the author of this new product pointed out was that Michael listed a number of things that affect joint flexibility and one of those things was the joint capsule. So he lists a number of things like muscle and fascia, tendons, skin all these things affect flexibility. And one of the things that he quotes there was that the joint capsule affects flexibility, which is exactly right. The joint capsule does affect flexibility.
Now, when Michael writes about this in his book, what he’s doing is simply listing a number of factors that affect flexibility. He’s not saying that these are necessarily the things you need to work on and this is what the other author was saying. That because Michael lists the joint capsule as one of the limiting factors in flexibility then that’s what you need to stretch. That’s what you should be stretching. So, for anyone who’s not entirely sure about what I’m talking about when I refer to the joint capsule I’m talking about the bones and the ligaments that make up the joint. So the ligaments hold the bones together, they hold the joint in place. So remember ligaments attach bone to bone, tendons attach muscle to bone. So, what this author was saying is that you need to stretch the joint capsule to improve your flexibility, which is absolutely crazy. It’s not what Michael is saying in his book.
So the first thing I did was grab Michael’s book and find the reference to where this new author got this information from. And sure enough, you know, it’s right here in Michael’s book. You know, he talks about these factors that limit flexibility; muscle and fascia, tendons, skin, and joint capsule and he actually says that the joint capsule is one of the biggest limiters in flexibility or range of motion. But as I said before…
He’s NOT saying you should stretch the joint capsule, he’s simply listing these factors that need to be taken into consideration when you’re assessing range of motion.
In fact, Michael actually says (I’ve just highlighted this passage here which I’m going to read to you), and you know, Michael actually warns against stretching the joint capsule. In fact, he says…
“As a general rule lay people should NOT direct their stretching exercises towards elongating the joint capsule and normal length ligaments, should NOT direct their stretching, because stretching these structures may destabilize the joint and increase the likelihood of injuries.“
So what we have here, is someone taking research from someone else and using that research to promote their own product. And this is what you’ve got to be really careful of on the Internet especially because anyone can write whatever they want. So has this author, I think his name is Eric Wong and I’m not criticizing him specifically, he seems to be a bodybuilder or strength and conditioning coach I think, so he’s probably very good at what he does but obviously doesn’t have the knowledge as far as stretching and flexibility is concerned.
So what he’s doing is he’s taking someone’s research and he’s either misinterpreted, or, and I can’t be the judge of this, maybe he’s manipulated the research to support the product he’s selling. But either way, he’s misused the research. So he’s saying now, that you should stretch the joint capsule and his product specifically shows you how to stretch this joint capsule.
So what’s my point? My point is, that you need to be very careful about what you read and what you see on the Internet. And just because someone is an expert in one field doesn’t make them an expert in other fields and this is a clear example of what goes on all the time on the Internet. I’ve seen this all the time, people misinterpreting or purposely, you know, manipulating the research to support their own argument or support their own product or whatever.
So anyway, I just wanted to bring that to your attention. Again, if you’re really into stretching and flexibility and you want to know more about the physiology of stretching and flexibility then I can’t recommend this book highly enough. It’s great; Science of Flexibility by Michael Alter. You can find it on Amazon. Well and truly worth every penny. So thanks again. Great to catch up with you again. Take care. And we’ll see you next time. Bye-bye for now.
Preventing Iliopsoas Pain
There are a number of preventative techniques that will help to prevent both iliopsoas tendinitis and iliopsoas syndrome, including modifying equipment or sitting positions, taking extended rests and even learning new routines for repetitive activities. However, there are a few preventative measures that I feel are far more important and effective.
- A thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons will be tight and stiff. There will be limited blood flow to the hip area, which will result in a lack of oxygen and nutrients for the muscles. This is a sure-fire recipe for a muscle or tendon injury. Before any activity be sure to thoroughly warm up all the muscles and tendons that will be used during your sport or activity.
- Rest and recovery are extremely important; especially for athletes or individuals whose lifestyle involves strenuous physical activity. Be sure to let your muscles rest and recover after heavy physical activity.
- Strengthening and conditioning the muscles of the hips, buttocks and lower back will also help to prevent iliopsoas tendinitis and iliopsoas syndrome.
- Flexible muscles and tendons are extremely important in the prevention of most strain or sprain injuries. When muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement. When this happens, strains, sprains, and pulled muscles occur. Get videos and photos of quad and hip flexor stretches here.
Research and References
- Walker, B. (2018). The Anatomy of Sports Injuries, 2nd Edition (ISBN: 978-1623172831)
- Bahr, R. Maehlum, S. (2004) Clinical Guide to Sports Injuries, 1st Edition (ISBN: 978-0736041171)
- Wikipedia contributors. (2019, February 6). Iliopsoas, In Wikipedia, The Free Encyclopedia.
- Sajko, S. Stuber, K. (2009). Psoas Major: a case report and review of its anatomy, biomechanics, and clinical implications. Journal of the Canadian Chiropractic Association, 53(4): 311–318.
- Rauseo, C. (2017). The rehabilitation of a runner with iliopsoas tendinopathy using an eccentric-biased exercise: A case report. International Journal of Sports Physical Therapy, 12(7): 1150–1162.
- Johnston, C. Wiley, J. Lindsay, D. Wiseman, D. (1998). Iliopsoas bursitis and tendinitis. Sports Medicine, 25(4), 271-283.
- Thorborg, K. Bandholm, T. Zebis, M. Andersen, L. Jensen, J. Hölmich, P. (2016). Large strengthening effect of a hip-flexor training programme: a randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy, 24(7):2346-52.
About the Author: Brad Walker is often referred to as the "Stretch Coach" and has even been called the Stretching Guru. Magazines such as Runners World, Bicycling, Triathlete, Swimming & Fitness, and Triathlon Sports have all featured his work. Amazon (author page) has listed his books on five Best-Seller lists. Google cites over 100,000 references to him and his work on the internet. And satisfied customers from 122 countries have sent 1,000's of verified customer reviews. If you want to know about stretching, flexibility or sports injury management, Brad Walker is the go-to-guy.
Disclaimer: The health and fitness information presented on this website is intended as an educational resource and is not intended as a substitute for proper medical advice. Please consult your physician or physical therapist before performing any of the exercises described on this website, particularly if you are pregnant, elderly or have any chronic or recurring muscle or joint pain.