Transcript Iliopsoas-Related-Groin-Pain-Handoutx

Iliopsoas Related Groin Pain
Normal Anatomy
• Iliopsoas made up of 3 muscles
• Iliacus
• Psoas major
• Psoas minor
• Run inferiorly from the iliac crest
and lumbar spine onto the lesser
trochanter of the femur
• Psoas tendon lies lateral to the
femoral artery
• Iliopsoas bursa between the
musculotendinous junction and the
pelvic brim
Pathology
• Pain and dysfunction of the iliopsoas
and/or structures in close proximity
• Due to a variety of terms and lack of
definitions with the literature the
term “Iliopsoas Related Groin Pain” is
used following Doha agreement to
refer to pain in and around the hip
flexors
• Includes pathologies such as
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Hip flexor tear
Hip flexor tendinopathy/tendinitis
Iliopsoas bursitis
Snapping psoas
Post- operative overuse following hip
arthroscopy
Mechanism of Injury
• Traumatic
• Overstretching
• Direct compression
• Insidious
• Overuse
• Kicking
• Cycling
Subjective Examination
• Reports a traumatic or overuse mechanism of injury
• Pain over the anterolateral thigh
• pain with hip flexion based activities
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putting on shoes and socks
sitting for long periods of time
walking up stairs
kicking
jogging
• May report snapping or clicking in the hip
Objective Examination
• Iliopsoas tenderness
• Lower lateral part of the abdomen
or
• Distal of the inguinal ligament,
medial to the Sartorius, lateral to
the femoral artery
• Pain on resisted hip flexion
• Weakness on resisted hip flexion
• Pain on hip flexor stretching
Objective Examination
• Iliopsoas tenderness
• Lower lateral part of the abdomen
or
• Distal of the inguinal ligament,
medial to the Sartorius, lateral to
the femoral artery
• Pain on resisted hip flexion
• Weakness on resisted hip flexion
• Pain on hip flexor stretching
Objective Examination
• Iliopsoas tenderness
• Lower lateral part of the abdomen
or
• Distal of the inguinal ligament,
medial to the Sartorius, lateral to
the femoral artery
• Pain on resisted hip flexion
• Weakness on resisted hip flexion
• Pain on hip flexor stretching
Objective Examination
• Iliopsoas tenderness
• Lower lateral part of the abdomen
or
• Distal of the inguinal ligament,
medial to the Sartorius, lateral to
the femoral artery
• Pain on resisted hip flexion
• Weakness on resisted hip flexion
• Pain on hip flexor stretching
Objective Examination
• Iliopsoas tenderness
• Lower lateral part of the abdomen
or
• Distal of the inguinal ligament,
medial to the Sartorius, lateral to
the femoral artery
• Pain on resisted hip flexion
• Weakness on resisted hip flexion
• Pain on hip flexor stretching
Further Investigation
• MRI
• Ultrasound
Management
• Similar approach to treating tendinopathy
• Conservative management nearly always considered first and usually
successful
• Treatment aimed at restoring normal hip flexor strength and normal
lumbopelvic and hip stability
Conservative
• Reduce Pain
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Remove the abuse load
Isometrics
Soft Tissue Massage
Joint Mobilisation
Joint Manipulation
Ice
NSAID’s
• Restore Normal Range of Movement
• Lumbar spine, hip and knee
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Stretching
Soft Tissue Massage
Joint Mobilisation
Joint Manipulation
Conservative
• Restore Normal Muscle
Activation and Strength
• Hip flexors, adductors, hip
stabilisers, lumbar spine and
entire kinetic chain
• Isotonic and Isometric Exercise
• Restore Dynamic Stability
• Proprioceptive Exercise
• Report to Sport Specific Training
• Gradual increase of sport specific
drills
Conservative
• Restore Normal Muscle
Activation and Strength
• Hip flexors, adductors, hip
stabilisers, lumbar spine and
entire kinetic chain
• Isotonic and Isometric Exercise
• Restore Dynamic Stability
• Proprioceptive Exercise
• Report to Sport Specific Training
• Gradual increase of sport specific
drills
Plan B
• Corticosteroid injection
• Arthroscopic release
• Debridement
References
• Bui, K. L., H. Ilaslan, M. Recht and M. Sundaram (2008). "Iliopsoas injury: an MRI
study of patterns and prevalence correlated with clinical findings." Skeletal Radiol
37(3): 245-249.
• Daivajna, S. C., A. Hannah and A. S. Bajwa (2014). "The anatomy and relevance of
the iliopsoas in the young adult with hip pain: Role of arthroscopic intervention."
Journal of Arthroscopy and Joint Surgery 1(2): 66-71.
• Holmich, P. (2015). "Groin injuries in athletes--development of clinical entities,
treatment, and prevention." Dan Med J 62(12): B5184.
• Johnston, C. A., J. P. Wiley, D. M. Lindsay and D. A. Wiseman (1998). "Iliopsoas
bursitis and tendinitis. A review." Sports Med 25(4): 271-283.
• Weir, A., P. Brukner, E. Delahunt, J. Ekstrand, D. Griffin, K. M. Khan, G. Lovell, W. C.
Meyers, U. Muschaweck, J. Orchard, H. Paajanen, M. Philippon, G. Reboul, P.
Robinson, A. G. Schache, E. Schilders, A. Serner, H. Silvers, K. Thorborg, T. Tyler, G.
Verrall, R. J. de Vos, Z. Vuckovic and P. Holmich (2015). "Doha agreement meeting
on terminology and definitions in groin pain in athletes." Br J Sports Med 49(12):
768-774.