What is Iliopsoas Syndrome?

Iliopsoas 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 after hip surgery.

Treatment

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 bending of your hip (knee to chest). For example cycling or step ups.

You can reduce the overuse of the muscles at the front of the hip by strengthening the muscles at the back of the hip

Pain Relief

Medication (such as simple painkillers or anti-inflammatories) may be useful. A pharmacist or your GP can help advise you what to take if needed. You can find further information here on what medications you could take here:

How and when to take paracetamol for adults – NHS (www.nhs.uk)

Ibuprofen for adults: painkiller which also treats inflammation – NHS (www.nhs.uk)

Exercises

  • Strengthening muscles around the hip has been shown to be very effective in improving this condition
  • There is a link between gluteal muscle weakness (buttock muscles) and irritation of the iliopsoas tendon
  • Gluteal muscle strengthening exercises are helpful in re-balancing muscle strength around the hip
  • Static strengthening exercises of the iliopsoas muscle combined with gentle stretching of iliopsoas can also be helpful
Mini Squat

Exercise 1: 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

Exercise 2: 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

Exercise 3: 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

Exercise 4: 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.

Is your pain coming from somewhere else?

Hip pain may be as a result of ‘referred pain’ from elsewhere, often this is your lower back. If you think that this is the case, please discuss this with a healthcare practitioner for help with management.

Your hip may also cause referred pain into the thigh, knee or lower leg. This referred pain should improve as your hip improves.

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