An Overview of Iliopsoas Syndrome

Iliopsoas syndrome (also called psoas syndrome) is a vague, “catch-all” name that encompasses several other conditions. The term is often used interchangeably with the iliopsoas tendinitis, snapping hip syndrome, and iliopsoas bursitis—conditions that also affect the iliopsoas muscles, which bend your leg at the hip.

Iliopsoas syndrome syndrome is generally regarded to be an overuse injury and is commonly seen in gymnasts, dancers, track-and-field participants, and other athletes who perform repeated hip flexion movements. ^

Hip snapping usually isn't deemed iliopsoas syndrome until it is accompanied by pain and weakness. This indicates that you're dealing with bursitis, which typically involves hip pain that extends to the thigh area and worsens when lying down or getting up , or tendinitis, which can involve pain that worsens rapidly, along with swelling.

Typically, doing anything that requires the use of the hip worsens pain symptoms. Other symptoms of iliopsoas syndrome include:

• Pain and/or stiffness in the hip and thigh area
• Pain that starts sharp and intense but becomes more dull and aching
• Clicking or snapping in the hip or groin
• Pain that worsens when doing anything that bends the hip (walking, climbing stairs, squatting, sitting, etc.)
• Tenderness in the hip and groin area

The iliopsoas muscles are the anterior hip muscles (muscles on the front of the hip) and are made up of the psoas major, the psoas minor, and the iliacus.

Within the hip joint are several bursae, small, fluid-filled sacs that lie between bones and soft tissues. Bursae reduce friction and provide cushioning to allow tendons, muscles, and other structures to glide over bony prominences effortlessly.

Two of these bursae—the greater trochanteric bursa and the iliopsoas bursa—can become inflamed, setting the stage for iliopsoas syndrome.

• Iliopsoas bursitis, more commonly known as hip bursitis, occurs when the iliopsoas bursa (located between the iliopsoas tendon and the inside of the hip joint) becomes inflamed and irritated
• Iliopsoas tendonitis, or hip tendonitis, occurs when the iliopsoas tendon (the tendon that attaches the thigh bone to the iliopsoas muscle) becomes inflamed and irritated.

Iliopsoas bursitis and tendinitis are most commonly caused by rheumatoid arthritis or psoriatic arthritis, or by an overuse injury caused by intense activity (such as running, rowing, cycling, and strength training).

If a dancer is experiencing snapping hip syndrome, the likelihood of pain and weakness is increased if they are female, under 18 years old, and continuing to perform the repetitive movement causing the hip snapping, and, in turn, their pain.

Other risk factors include:

• Prior hip injury and/or surgery
• Scoliosis, spinal arthritis, and other spinal issues
• Legs that are different lengths
• Bone spurs or calcium deposits

A physician is able to diagnose iliopsoas syndrome based on symptom history and a hip examination. Imaging tests, such as magnetic resonance imaging (MRI) and X-ray, may be used to rule out other injuries or conditions, such as muscle tears.

Your doctor may also opt to administer an anesthetic joint injection to determine if you have internal or external snapping hip syndrome and give you an appropriate treatment plan.

Most cases of hip bursitis and hip tendinitis can be managed with anti-inflammatory medications to alleviate pain and reduce inflammation. Modifications of your activities will also be required, as well proper management of arthritis (if the root cause).

Sometimes, steroid injections are used to relieve symptoms; this can be done right in the doctor's office. If symptoms persist or return, additional steroid injections can be administered as necessary.

After pain and swelling subside, you may need to see a physical therapist or your doctor may start you on a mild exercise program to gradually improve hip strength and flexibility. Canes and crutches can provide additional support.

In severe cases where pain persists despite taking these measures, your doctor may recommend surgical interventions. However, these instances are rare and avoided as much as possible due to the risk of complications such as nerve and muscle damage.

Iliopsoas syndrome is caused by overuse and doing too much, too soon. It's important to start small and build up gradually, whether you are an exercise beginner or trying to amp up your fitness routine. Follow the rule of not increasing volume of activity by no more than 10% each week.