The psoas is a long muscle located in the lower back area of the spine and extends through the pelvis to the femur or thigh bone. This muscle helps to flex your hips, bend your trunk towards your thighs, rotate your femur, and enable additional movements of the lumbar spine.
The psoas and iliacus muscles join together to constitute one single tendon known as the iliopsoas. Individually, these muscles are commonly referred to as "hip flexors."
Tendons are cords of strong fibrous tissue that attach muscles to bones. Tendonitis refers to inflammation of the tendon. The psoas tendon can become inflamed from overuse, muscle tightness, and muscle weakness, resulting in a painful hip condition known as psoas tendonitis.
Although the condition can affect people of all ages, it is most often noted in athletes participating in sports.
The common causes of psoas tendonitis include an acute injury or overuse injury from repeated bending of an externally rotated hip. It is specifically common in ballet dancers with more than 90 percent reporting a snapping or clicking sensation. The condition may also occur due to activities such as resistance training, gymnastics, soccer, rowing, track and field, and uphill running.
Signs and Symptoms
The common signs and symptoms of psoas tendonitis include:
- Pain in the groin, pelvis, buttocks, and hips
- Pain in the lower back/lumbosacral region
- Audible snap or click in the hip or groin
- Pain that radiates down to the knee
- Shuffling or limping gait while walking
Psoas tendonitis is diagnosed through a review of your medical history and a detailed physical examination of your spine, hip, and leg.
Your doctor will perform the following:
- Inspection of the hip at rest and with flexion
- Palpation of the hip joint to assess for any swelling or unusual tenderness
- Imaging tests such as x-rays, ultrasound, and MRI scans of the hip and pelvis to confirm the diagnosis
Treatment for psoas tendonitis may include:
- Physical therapy and stretching exercises
- Activity modifications and rest
- Osteopathic manipulative treatment/soft-tissue manipulation
- Non-steroidal anti-inflammatory drugs (NSAIDs)for pain and inflammation
- Injection of a corticosteroid with a local anesthetic under ultrasound guidance
Surgery is only recommended to those who have intense symptoms and more severe psoas tendonitis that fails to respond to conservative non-invasive therapy.
Surgery for the treatment of psoas tendonitis may involve either a complete release or a partial release of the psoas tendon, meaning that the tendon is either cut completely or partially to relieve pain and improve range of motion.
Psoas tendonitis is an uncommon condition that usually manifests with refractory lower lumbar pain along with associated symptoms. The condition is best managed with physical therapy for psoas muscle strengthening, which offers significant pain relief, increased mobility, and stronger hip muscles.
People with psoas tendonitis can experiment with different exercises under their physical therapist’s guidance and incorporate them into their daily exercise routine for better management of psoas tendonitis.
With suitable and timely care, most individuals are able to return to their normal activities and occupations.