Tendinitis of the Iliopsoas Muscle and Pelvic Pain

Injuries to the pelvis and hip constitute a small percentage of sporting injuries with groin pain being the most common presentation. Muscular and tendinous problems (especially where the tendon and the muscle meet) are the typical areas of complaint. The iliopsoas, a hip muscle deep in the pelvis, can be irritated by a traumatic event or by overuse from repeated hip flexion (bending). This condition is not well diagnosed and may often be missed, with young persons more likely to present and females somewhat more often.

The two muscles, iliacus and psoas, have their origin respectively from the pelvis and lumbar spine, coming together to make the combined iliopsoas muscle which becomes a tendon and inserts into a small area of bone on the inside of the upper thigh, the lesser trochanter. The bursa between the musculo-tendinous junction of the iliopsoas and the nearby pelvic bone is the largest in the body and in some cases runs into the hip joint itself. Acute trauma may cause damage to the tendon resulting in inflammation which can then be termed tendinitis and this can be longer term or chronic. Inflammation may occur around the tendon instead or the tendon fibres themselves may show degenerative changes due to overuse, known as tendinosis.

The most common traumatic event usually involves a contraction of the muscle while it is trying to lengthen and overuse occurs where hip flexion is repeatedly performed such as running, dancing, rowing and many sports. The iliopsoas muscle may become tight which increases the forces exerted on it and tilts the pelvis anteriorly, with other negative effects in the leg during activity. Typical onset is slow and gradual and people note that the pain comes on with the problem activity and eases off soon as they get warmed up. As it gets worse the pain will remain during the active period as ease after the activity is stopped, progressing to continuous pain if no action is taken. Pain will be in the groin area but can radiate down the front of the thigh.

Physiotherapy acute management involves rest, ice and gentle movements to allow the pain and inflammation to settle. Stretching can be gradually introduced, starting with very gently techniques and steadily progressed to return full range of movement, strength and endurance. Gradual return to the low intensity sport related hip flexion should allow the iliopsoas to tire without overstraining.