Introduction
Iliopsoas Syndrome is a condition caused by inflammation and overload of the iliopsoas muscle (M. iliopsoas) in the hip and inflammation of the bursa. It is accompanied by pain in the lumbar spine, hip and thigh area. It is mainly a disease of the young athletically active person.
Iliopsoas syndrome is mainly the result of overloading the iliopsoas muscle and the associated inflammation of its tendons (iliopsoas tendinitis) and bursa (iliopsoas bursitis). Iliopsoas syndrome therefore mainly affects athletes who put a lot of strain on the hips. Typical examples are dancers, track and field athletes and footballers.
Often repetitive, powerful movements in the hip joint, such as when shooting a ball, or fast, reflex-like movements ultimately lead to chronic irritation of the muscle fibers. In the groin area, these run close to the hip bone. The resulting friction is absorbed by the bursa located there, which can lead to an inflammation of the bursa in case of chronic strain.
Ignoring the disease, abrupt, rapid movements can eventually cause the muscle to tear. Finally, an iliopsoas syndrome can also result from a blockage of the vertebral bodies in the area of the lower thoracic spine and the upper lumbar spine. This causes a reflex defensive tension of the muscle, which can lead to symptoms of iliopsoas syndrome.
Symptoms
The classic symptoms of iliopsoas syndrome include pain in the lumbar spine and hip area, often radiating to the thigh, especially when stretching the thigh and tightening it over 90°. A localization of pain in the lower abdomen, near the appendix, is common because the iliopsoas muscle runs under the appendix. The pain typically has a stabbing, suddenly shooting character. This sometimes results in severe restrictions of movement with gentle limping on the affected side. When lying down, the patient takes a flexor position of the hip joint.
Therapy
Acute therapy of the iliopsoas syndrome focuses on symptomatic treatment with relief of the muscle and effective pain and inflammation therapy. Drugs such as ibuprofen or diclofenac are particularly suitable for this. These have both analgesic and anti-inflammatory effects.
Paracetamol, on the other hand, is less effective because it lacks the anti-inflammatory effect. Cooling with cold packs in the area of the hip joint can also achieve an alleviation of the symptoms. Sport should never be done during this time.
After the pain has largely subsided, a follow-up treatment in the form of physiotherapy with movement training and special stretching exercises can be carried out. Once this phase of treatment has been completed, patients can perform their own stretching exercises as part of their sports activities in the future. For a functional M. iliopsoas, both its strengthening and stretching exercises are important.
A number of stretching exercises are available to stretch the iliopsoas muscle independently:
- One of the best known and most effective is probably the so-called “Thomas Stretch”. To do this, you lie on your back on a raised surface, for example a table or even a bench, with your coccyx resting on the edge. While one leg is pressed to the ground by gravity, the other leg is pulled towards the chest.
A training partner can support this movement by applying light pressure on the knees. Just as in strength training, you should not act too impatiently, as this can lead to injuries. Muscle building and stretching take time.
- Another very simple stretching exercise is to pull the foot of the leg to be stretched against the buttocks while standing upright.
Even at this stage, a slight pulling sensation can be felt in the thigh, which can be further intensified by pushing the hip forward.
- Finally, stretching of the iliopsoas muscle is also possible through a pronounced pacing position. The feet standing almost in a line should be about two shoulder widths apart. If the back is straight, the hips should now be carefully pushed forward.
A pull in the area of the thigh should be clearly felt.
Physiotherapy is an important treatment component in the presence of iliopsoas syndrome.After the end of the acute pain phase, which as already mentioned can be treated with the help of pain-relieving and anti-inflammatory drugs and cooling, an active exercise and especially stretching should follow quickly. A professionally conducted physiotherapy has several advantages: On the one hand, physiotherapists who know their trade well instruct all stretching and strengthening exercises, which are correct and important for the patient at that moment, precisely and carefully. This means that they not only explain what the patient should do, but also show him, are present while he tries out the exercises on his own and correct possible mistakes.
In addition, the physiotherapist gives clear guidelines on the number of repetitions of an exercise and the frequency of training. This is the only way to guarantee a perfect execution of the exercises and an effective training process, which does not lead to incorrect loading and renewed overloading. Secondly, a physiotherapist, who usually works with only one patient at a time, can adjust to the same patient throughout the entire training session and adapt the program individually.
If there is severe pain on one day, he can suggest a combination of relaxation massage and light stretching exercises. If he is dealing with a patient who is very ambitious in terms of sports, demanding strength exercises may be on the agenda more quickly. Not to forget the great motivation factor that comes from a fixed appointment with a certain physiotherapist. Due to the commitment that most people feel after making an appointment, the training – and especially the often rather unpopular stretching – becomes a fixed point that is cancelled or postponed less quickly than stretching at home on your own.
