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Iliopsoas Tendonitis

What is the iliopsoas?

The iliopsoas is the combination of two muscles: the iliacus and the psoas.  These muscles join together to form one single tendon commonly referred to as the iliopsoas or "hip flexors".  

iliopsoas

Can the hip flexors cause hip snapping? Why is my hip snapping?

Yes!  When the muscle is excessively tight, its tendon may rub or even produce an audible snapping sound when passing over the underlying bony landmarks (2-6). When painless, the condition is termed “asymptomatic internal snapping hip”. When accompanied by pain and/or dysfunction, the condition is known by a variety of terms, including; painful internal snapping hip, internal coxa saltans, iliopsoas tendinitis, iliopsoas tendinosis, iliopsoas tendinopathy, iliopsoas bursitis, or ilopsoas syndrome. 

Is it bursitis or tendonitis?

The diagnoses tendinitis and bursitis are essentially synonymous, as inflammation in one inevitably generates inflammation in the neighboring counterpart– with a nearly identical presentation, evaluation, and treatment (7).

How does the iliopsoas get irritated?

The iliopsoas tendon can be irritaed by either acute injury or repetitive micro trauma. Acute injuries involving the hip and pelvis typically result from either direct trauma (11,15).  Like other tendinopathies, chronic injuries occur when repetitive micro trauma exceeds the body’s ability to repair itself (12).

How does iliopasos tendonitis typically occur?

Psoas tendinopathy often arises from  repeated flexion (bending) of an externally rotated hip (think toes pointed out) (9,11). 

What activities or sports contribute to iliosoas tendonitis?

The condition is commonly termed “dancer’s hip” or “jumper’s hip”, as movements associated with these activities predispose participants to injury (9,11). Psoas tendinopathy is particularly common in ballet dancers – with more than 90% reporting clicking or snapping (13). The condition is also seen in athletes who participate in resistance training, rowing, track and field, running (especially uphill), soccer, and gymnastics, and hurdling (11,14). Teens may be at greater risk during growth spurts due to relative inflexibility of the hip flexors (11).

What are the symptoms of hip flexor tendonitis or iliopsoas tendonitis?

Psoas tendinopathy patients complain of deep groin pain that sometimes radiates to the anterior hip or thigh (14,20). Long-standing snapping can lead to weakness or an altered walking and running pattern (14,20).  Problems with the psoas is often associated with a variety of complaints, including difficulty standing fully erect, lower back pain, and possible discomfort into the buttock or thigh (21).

What are the best treatment options for psoas tendonitis?

The evidence supports the use of exercise, friction massage, acupuncture, laser therapy, ice, manipulation, and mobilization (31). 

Modifying activity and relative rest and exercise are also shown to be beneficial for psoas tendonitis (14-20).

Soft tissue manipulation and/or myofascial release may be appropriate to release areas of tightness and/or adhesion within the iliopsoas muscle. Mobilization and/or manipulation may be necessary to restore normal lumbopelvic joint mobility. Stretching and strengthening exercises should be directed at the hip flexors and rotators (14). 

Symptomatic patients should be cautioned to avoid activities that involve repetitive hip bending and to take frequent breaks from seated positions that predispose them to hip flexor shortening or tightening. Patients with fallen arches and those who hyperpronate may benefit from an arch supports or orthotics. Patients with accompanying hip abductor weakness and/or spinal instability will benefit from strengthening of the respective muscles.

What other treatment options are available?

Medical management includes image-guided corticosteroid injections (14).  Rarely utilized, surgical management includes various tendon- lengthening procedures (35-38).

At Creekside Chiropractic & Performance Center, we are highly trained to treat iliopsoas tendonitis.  We are the only inter-disciplinary clinic in Sheboygan county that provides chiropractic, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves. Voted Best Chiropractor in Sheboygan by the Sheboygan Press.

Evidence Based-Patient Centered-Outcome Focused

Sources:

1. HealthScience. Iliopsoas Tendinitis. http://thehealthscience.com/no... 

2. Register B, Pennock AT, Ho CP, Strickland CD, Lawand A, Philippon MJ. Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study. Am J Sports Med. 2012;40: 2720-2724. 

3. Schaberg JE, Harper MC, Allen WC. The snapping hip syndrome. AmJ Sports Med. 1984;12:361-365. 

4. Howse A. Orthopaedists aid ballet. Clin Orthop Relat Res. 1972;89:52-63. 

5. Jacobson T, Allen WC. Surgical correction of the snapping iliopsoas tendon. Am J Sports Med. 1990;18:470-474 

6. Teitz CC. Hip and knee injuries in dancers. J Dance Med Sci. 2000;4: 23-29. 

7. Garry JP. Iliopsoas Tendinitis. http://emedicine.medscape.com/... 

8. Binnie JF. V. Snapping hip (Hanche a Ressort; Schnellende Hufte). Ann Surg. 1913;58:59-66 

9. Laible C, et al. Iliopsoas Syndrome in Dancers. Orthop J Sports Med. 2013 Aug; 1(3) 

10. Walker J, Rang M. Habitual hip dislocation in a child. Another cause of snapping hip. Clin Pediatr (Phila). 1992;31:562-563 11. Garry JP. Iliopsoas Tendinitis. http://emedicine.medscape.com/... accessed: 10/09/15 

12. Micheli LJ, Fehlandt AF Jr. Overuse injuries to tendons and apophyses in children and adolescents. Clin Sports Med 1992;11:713e26. 

13. Winston P, Awan R, Cassidy JD, Bleakney RK. Clinical examination and ultrasound of self-reported snapping hip syndrome in elite ballet dancers. Am J Sports Med. 2007;35:118-126. 

14. Morelli V, Smith V. Groin injuries in athletes. Am Fam Physician 2001 Oct 15;64(8):1405-14. 

15. Bencardino JT, Palmer WE. Imaging of hip disorders in athletes. Radiologic Clinics of North America, Volume 40, Issue 2, March 2002, Pages 267-287 

16. Puddu G, Ippolito E, Postacchini F. A classification of Achilles tendon disease. Am J Sports Med 1976;4:145-50. 

17. Khan KM, Cook JL, Kannus P, Maffull N, Bonar SF. Time to abandon the “tendinitis” myth. BMJ 2002;324:626-7. 

18. Sharma P, Maffulli N. Biology of tendon injury: healing, modeling and remodeling. J Musculoskelet Neuronal Interact 2006;6:181-90. 

20. Laible C et al. Iliopsoas Syndrome in Dancers The Orthopaedic Journal of Sports Medicine, Aug 2013 1(3) p1-6. 21. Diagnosis and manipulative treatment: thoracic region. In: Kuchera WA, Kuchera ML. Osteopathic Principles in Practice. 2nd ed. Columbus, OH: Greyden Press; 1994:480-488. 

23. Garry JP. Iliopsoas Tendinitis. http://emedicine.medscape.com/... accessed: 

24. Reider B, Martel J. Pelvis, hip and thigh. In: Reider B, Martel J, eds. The orthopedic physical examination. Philadelphia: Saunders; 1999:159– 1199. 

25. Poultsides LA, et al. An Algorithmic Approach to Mechanical Hip Pain. HSS Journal 2012 Oct; 8(3): 213–224. 

26. Sutherland WG. Teachings in the Science of Osteopathy. Portland, OR: Rudra Press; 1990:279-281. 

27. Kuchera WA. Lumbar region. In: Ward RC, ed. Foundations for Osteopathic Medicine. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003:747-748. 

28. Chapter 11. Posterior abdominal wall. In: Morton DA, Foreman KB, Albertine KH. The Big Picture: Gross Anatomy. New York, NY: McGraw-Hill Medical; 2011. 

30. Wunderbaldinger P, et al. Imaging features of iliopsoas bursitis. 2002 Feb;12(2):409-15. Eur Radiol. Epub 2001 Sep 15. 

31. Pfefer MT, Cooper SR, Uhl NL. Chiropractic Management of Tendinopathy: A Literature Synthesis Journal of Manipulative and Physiological Therapeutics, Volume 32, Issue 1, January 2009, Pages 41-52 

32. Janda V (1987) Muscles and motor control in low back pain: assessment and management. In: Twomey LT (ed) Physical therapy of the low back. Churchill Livingstone, New York, pp 253–278 

33. Pettman E (2007) Lecture presented for the NAIOMT Lecture Series. Andrews University, Berrien Springs, Michigan 

34. Gracovetsky SA, Iacono S (1987) Energy transfers in the spine engine. J Biomed Eng 9(2):99–114 

35. Flanum ME, Keene JS, Blankenbaker DG, DeSmet AA. Arthroscopic treatment of the painful ‘‘internal’’ snapping hip results of a new endoscopic technique and imaging protocol. Am J Sports Med. 2007;35: 770-779. 

36. Gruen GS, Scioscia TN, Lowenstein JE. The surgical treatment of internal snapping hip. Am J Sports Med. 2002;30:607-613. 

37. Ilizaliturri VM, Chaidez C, Villegas P, Brisen A, Camacho-Galindo J. Prospective randomized study of 2 different techniques for endoscopic iliopsoas tendon release in the treatment of internal snapping hip syndrome. Arthroscopy. 2009;25:159-163. 

38. Ilizaliturri VM Jr, Villalobos FE Jr, Chaidez PA, Valero FS, Aguilera JM. Internal snapping hip syndrome: treatment by endoscopic release of the iliopsoas tendon. Arthroscopy. 2005;21:1375-1380 

39. Page P (2007) The Janda approach to musculoskeletal pain 40. Edelstein J. Rehabilitating Psoas Tendonitis: A Case Report. HSS Journal. 2009 Feb; 5(1): 78–82.

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