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.
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.
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.
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:
Iliopsoas bursitis treatment will often be comprised of conservative measures. This will include:
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 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
3 sets, 20 reps daily
|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
2 sets, 20 reps daily
|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.
Improves stiffness of the hip joint
Strengthens the iliopsoas and quadriceps muscles of the thigh
Strengthens the iliopsoas muscle
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.