Iliopsoas bursitis exercises: Causes, symptoms, diagnosis, and treatment

Iliopsoas bursitis refers to inflammation of a bursa found near the iliopsoas muscles. This musculature is formed by the joining of the psoas and iliacus muscles, making up the strongest of the hip flexor muscles. The iliopsoas is important for standing, walking, and running.

A bursa is a thin, lubricated cushion located at points of friction between bones and surrounding soft tissue, such as ligaments, tendons, muscles, and skin. It can be visualized as a tiny water balloon that has a few drops of fluid in it, wedged between two surfaces, aiding in friction reduction for moving joints.

When a bursa is subjected to continual trauma or friction, it can result in inflammation and swelling, which leads to the development of hip pain. Iliopsoas bursitis is more often seen in those who overuse their hip flexor muscles, such as when lifting weights or doing excessive amounts of squatting.

What are the causes and symptoms of iliopsoas bursitis?

Causes

Iliopsoas bursitis causes are often the result of injury due to repetitive motions, which can put stress on joints, tendons, and muscles. This is why the symptoms of iliopsoas bursitis are more often seen in physically active individuals. However, the condition may also be appreciated in arthritic conditions such as rheumatoid arthritis and osteoarthritis. Both of these conditions lead to the degeneration of protective cartilage within joints, causing bones to rub against each other, promoting inflammation.

Symptoms

Iliopsoas bursitis symptoms often present when performing activities such as walking or crossing the legs, as these actions stretch and contract the iliopsoas muscle during hip flexion, extension, internal rotation, and adduction. Pain and weakness are often felt on the front side of the hip for a short period, which may result in a slight limp in your step. As the iliopsoas muscle becomes tighter, the hip joint may experience stiffness in its movements. Pain may eventually radiate down into the groin, lower back, buttocks, and knee.

How to diagnose iliopsoas bursitis?

Your doctor will first take a detailed medical history of your presenting symptoms to get a better idea of how your hip pain may have developed. Considerations for age, occupation, and various other risk factors for joint pain will all be taken into account to better pinpoint the cause. Next, a physical exam of your hip joint will be done to assess various motions and to what degree you experience pain. Deep palpation or pressure will be applied to the bursa of the iliopsoas to see if it elicits pain. Other signs of symptoms of other joint diseases such as osteoarthritis and rheumatoid arthritis will be examined to help rule them out.

Once the physical exam has concluded, imaging studies will likely be ordered to provide definitive evidence of iliopsoas bursitis or other joint conditions. These may include:

• X-ray of the pelvis
• Bone scan
• MRI
• Hip musculoskeletal ultrasound

Treating iliopsoas bursitis

Iliopsoas bursitis treatment will often be comprised of conservative measures. This will include:

• Getting rest from aggravating activities
• Avoiding repetitive activities
• Apply ice packs to the area to relieve pain and inflammation
• Using anti-inflammation medication such as ibuprofen, aspirin, or naproxen to help relieve pain and inflammation
• The use of corticosteroid injection if all other conservative options fail
• The use of crutches or canes during recovery

Physical therapy and exercises for iliopsoas bursitis

Strengthening exercises in combination with other conservative treatment methods can be a great way to ease symptoms and promote recovery. While the performance of sports that may aggravate the iliopsoas muscle is discouraged, the following rehabilitation program is often recommended as an initial form of physical therapy to improve the hip rotators, hip flexors, buttocks, quadriceps, and hamstrings.

Rehabilitation Program for Iliopsoas Syndrome (adapted from Johnston et al. 1998)

Stage	Exercise	Prescription
Stage 1 (0-2 weeks)	Hip rotations with resistance band in setting with knees flexed	3 sets, 20 reps daily
Stage 2 (2-4 weeks)	Side lying external rotation and abduction, knees flexed, with resistance band	3 sets, 20 reps daily (injured side) 3 sets, 20 reps daily (uninjured side)
	Continue exercise from the first stage
Stage 3 (4 weeks onwards)	Standing mini-squats with external rotation of opposite leg	3 sets, 20 reps daily (injured side) 2 sets, 20 reps daily (uninjured side)
	Gait retraining focused on hip stability using concentration of the deep gluteal muscles on stance	10 to 15 reps, 2-3 times a day

The following are some additional iliopsoas bursitis exercises you can try at home today.

Hip flexor stretch

Improves stiffness of the hip joint

• Being by placing your injured leg on the ground, with the entire lower leg lying directly on the ground
• Bend your other knee and lean forward slightly
• You should feel a stretch in your front thigh
• Hold this position for 30 seconds and repeat three times

Straight leg raises

Strengthens the iliopsoas and quadriceps muscles of the thigh

• Begin by lying down on your back, straightening out your injured leg
• Bend your opposite leg and place your foot flat on the ground
• Contract the muscle of the thigh lying flat and raise it to the level of the bent knee
• While in midair, hold out the thigh for a couple of seconds, then gently lower it back to the ground
• Perform this exercise 10 times on both sides. You may add ankle weights for added resistance

Sitting hip flexion

Strengthens the iliopsoas muscle

• While in a seated position, raise your right knee up as high as possible
• Hold this position for a second then lower it back to starting position
• Perform this exercise 10 times for each leg, adding extra resistance using ankle weights if you desire

While iliopsoas bursitis pain can be quite bothersome, symptoms are quite manageable on your own. With the adequate amount of rest and avoidance of aggravating factors, you will be back to normal within a couple of weeks. If you feel that your symptoms are getting worse instead of improving, it may be a good time to visit your doctor to get more insight on your condition.

Related:

Hip effusion: Causes, symptoms, treatment, and exercises

Hip pain in women: Causes and pain relief tips

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