Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Overuse Injury of the Iliopsoas Muscle

The iliopsoas muscle is by far the strongest flexor of the hip joint. It arises from the lumbar vertebrae (psoas) and the inner aspect of the hip bone (iliac muscle) and is inserted into the lesser trochanter (the inner aspect of the femoral shaft). Load on the muscle essentially means load on the insertion. Overuse injury of the iliopsoas muscle can occur during strength training with weights and simultaneous knee-bending, situps, rowing, plowing through snow for conditioning, running uphill, intensive shooting practice in football, badminton, long jump and high jump, hurdling and steeplechasing.

Behind the iliopsoas muscle tendon lies the iliopectineal bursa, which semicircles the tendon and can become the location of inflammation, either in isolation or simultaneously with the tendon of the iliopsoas
muscle. These conditions can be difficult to distinguish, and in the following section they are treated together.

Symptoms and diagnosis

– As a result of this injury the athlete can enter a cycle of pain.
– Tenderness at the insertion of the tendon into the femur may be present but can be difficult to demonstrate in a muscular individual.
– Pain in the groin may occur on flexing the hip joint against resistance.
– When the bursa as well as the tendon of the iliopsoas muscle is inflamed, a sensation of tension and swelling can arise in the groin. In spite of the fact that the bursa is distended with fluid, it can still be
difficult to feel in a muscular individual.

Treatment

The athlete should:

– initially rest; a gradual increase in activity is tolerated;
– apply local heat and use a heat retainer.

The doctor may:
– prescribe anti-inflammatory medication;
– prescribe a muscle training program;
– administer a steroid injection into the muscle insertion to be followed by 1–2 weeks’ avoidance of explosive and strenuous activities;
– aspirate the bursa to confirm the diagnosis. This may be difficult and should therefore be done under fluoroscopic control. After the bursa has been drained 1 ml of a steroid preparation can be injected into it.

Healing and complications

When there are signs of recurring injury in the groin muscles the athlete should rest and avoid painful activities, otherwise the condition can easily become prolonged and chronic.

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