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Illiopsoas Syndrome

 

What is it?

Illiopsoas syndrome is irritation of the tendon or structures at the front of the hip joint. This can be caused by biomechanical factors such as overload of the tendon at the front of the hip (iliopsoas) combined with weakness of the muscles at the back of the hip (gluteal muscles). This is a similar process to the cause of lateral (outer) hip pain.

What are the common symptoms?

Pain is felt at the front of the hip and the thigh. On occasions you may feel a clicking sensation of the structures at the front of the hip. Pain is often worse with lifting your knee up to your chest as this tends to load the tendon that is irritated.

In a small number of patients, it can be a complication post hip surgery.

How to manage it?

A number of things have been shown to help with anterior hip pain. It is something that typically improves with time but there are lots of things you can to do help.

Modify your activity

This is key to settling down a flare up of anterior hip pain

Limit activities, movements and positions that aggravate the area such as excessive hip flexion (cycling, step ups)

Reduce the overload on the front of the hip by strengthening the muscles at the back of the hip

Strengthening Exercises

  • Strengthening muscles around the hip has been shown to be very effective in improving this condition
  • There has been shown to be a link with gluteal weakness and iliopsoas tendinopathy
  • Gluteal strengthening exercises are very helpful to achieve a muscle re-balance around the hip
  • Static strengthening exercises (isometric) of the iliopsoas muscle combined with gentle stretching of iliopsoas can also be helpful

See below for a few simple exercises to help the hip and improve your symptoms.

Mini squat

In standing with feet apart, hold on to something in front. Keeping your back upright, slowly let your knees bend and return to upright.

Gradually progress to a deeper dip.

Squat

Stand tall with feet slightly wider than hip-width apart. Toes pointing forward or turned a few degrees outwards.

Squat down by sitting back and bring your arms forward. Push back up through the heels, chest up, and straighten your hips.

Note:
– Keep your hips, knees and toes aligned
– Keep your weight evenly on your whole foot

Bridge

Lie on your back with legs bent.

Squeeze your buttock muscles and roll your pelvis off the floor.

In a controlled manner, return to the starting position.

Hip flexor stretch

Stand with one foot in front of the other and take support if needed.

Have your affected hip behind you.

Slightly bend your legs, shift your weight forwards, until you can feel a stretch in front of your affected hip.

Hold for 30 seconds and repeat 3 times.

Isometric hip flexion

Lying down on your back. Place your hand on the affected leg knee,

Apply resistance to your knee and try to lift your leg towards your chest.

Hold for 5 secs and repeat 10 times

Do this as pain allows.

Gradually increase the resistance and the length of hold.

Remember changes to the muscles and tendons takes time, you may need to do the exercises for a number of months to aid recovery.  Be patient and continue to do them regularly.

A mild discomfort during exercise is acceptable but if your get severe pain or increased symptoms stop. Try to return to the exercises again, but at a lower intensity.

If you are having difficulty or need guidance on the right exercises, speak to a physiotherapist.

Pain relief

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Physiotherapy 

If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing hip pain. Click here to self-refer to a physiotherapist.

How to prevent and manage future flare ups? 

Simple advice such as keeping the hip moving, strengthening your muscles, becoming active and keeping your weight under control can often help. If you follow this and the advice above you can make some very positive measures to prevent future problems.

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