Bursitis is best explained as an inflammation of the bursa; a sac filled with fluid adjacent to the joints that acts like a cushion for the joint. A bursa is a sac that is filled with lubricating fluid situated between tissues like muscles, tendons, skin, and bone that lessens irritation and friction between the tissues. The bursa causes pain in the hip (thus called Iliopsoas bursitis) when subjected to continual trauma resulting in swelling and inflammation. This could strongly affect athletes such as runners, footballers, and soccer players who frequently put the entire weight of their bodies on their hips. The largest bursa of the human body is known as Iliopsoas bursa which is located between the front side of the joint of the hip and the Iliopsoas muscle (hip flexor). Iliopsoas bursa reduces friction between the Iliopsoas muscle and thigh bone. The Iliopsoas is a muscle that runs from the lower back through the pelvis to attach to a small bump on the top portion of the thighbone near the groin. This muscle has the important mission of helping to bend the hip (for example it helps you to lift your leg when going up and down the stairs or when getting out of a vehicle). A bursa then helps to protect and allow the tendon to glide during these movements. The Iliopsoas bursa can also become inflamed or overworked during repetitive activities.
Causes & Symptoms
Iliopsoas bursitis is an overuse injury that results from overloading the hips with repetitive movements. This can lead to a strain of the Iliopsoas muscles and tendons. Patients who participate in sports activities are susceptible to Iliopsoas bursitis. Additionally, this condition may affect those who have loose ligaments. Overuse of the Iliopsoas muscle, changes in equipment or training terrain (e.g. mountain bike to road bike, road running to trail running etc.), or changes in the intensity of the chosen activity (increasing running time or weight lifting poundage without proper preparation) may result in overexertion, which ends in Iliopsoas bursitis injuries.
Overloading the muscles, tendons, and ligaments in the hip with a few specific movements, such as standing and twisting at the waist without moving your feet or rotating your leg outward can cause Iliopsoas injuries. Therefore, others who participate in activities that involve uphill running and / or jumping, lots of kicking, weight training, and heavy lifting are also at risk of Iliopsoas bursitis.
If an individual experiences Iliopsoas bursitis, he / she may experience similar symptoms of inflammation in the tendon or bursa. Symptoms may also include pain, tenderness, swelling, heat, or redness, and loss of normal mobility. Pain and tenderness are the most common symptoms and are co-experienced with Iliopsoas bursitis. The pain is found deep in the groin and radiates around to the front of the hip and upper thigh area, and can follow the length of the tendon down towards the knee; it will often move into the lower back and buttock area as well. Often the reason for the pain is known, such as one specific event, although sometimes there may be no major reason or injury that causes the condition. If the patient has been experiencing Iliopsoas bursitis for a long period of time during the day, he / she may also experience a slow onset of pain and tenderness that continues to build up over time. Hip stiffness and tightness in the groin as well as the knee can result from a tight Iliopsoas muscle. Swelling and increasing amounts of fluid in the bursa may cause added pressure and increased pain and may be accompanied by redness and warmth in the groin. You may experience clicking, snapping, and / or popping hip sounds (crepitus) in the hip. Along with an inflamed Iliopsoas bursa or snapping hip syndrome (caused by the Iliopsoas bursa catching on your pelvis when the hip is flexed), this can result in a severe or complete Iliopsoas tear. If you have a complete tear, it will generally prevent you from walking upstairs.
Who Gets Iliopsoas Bursitis?
Iliopsoas bursitis mainly affects young adults and often presents in more women than men. Additionally, people who participate in sports with repetitive bending at the hip are more likely to develop Iliopsoas bursitis. These include running, skiing, strength training, golf, and swimming. In particular, athletes involved in kicking sports, which place repetitive, one-sided strain on the muscle, are more prone to Iliopsoas injuries, as are people who perform repetitive activities, such as running or swimming. Although overuse is the main cause of Iliopsoas bursitis, a big contributor to the development of this condition is having tight hip flexor muscles. This puts more pressure on the front of the hip and causes more friction between the tendons and the bursa.
How Does It Affect You? How Serious Is It?
Generally, Iliopsoas bursitis isn’t the only hip bursitis in existence. There are two types of hip bursitis, both named for the location of the irritated bursa:
- Trochanteric Bursitis – Occurs when the greater trochanteric bursa is inflamed.
- Iliopsoas Bursitis – Occurs when the bursa tucked under the Iliopsoas become irritated and painful.
With over 150 bursars throughout the body, most patients experience them at some point in their lives. However, because the hip is a highly mobile and weight-bearing joint, hip bursitis is the most common type of bursitis that people experience. Trochanteric bursitis is more common in older adults, but Iliopsoas bursitis is seen more often in adolescents and young adults. Therefore, it is recommended to not ignore any symptoms linked to any of these two types of bursitis. If left untreated, the pain may become worse. Additionally, the Iliopsoas bursa may rupture and become infected. Infections are rare, but signs of this infection include:
- Fever or chills
- Joint pain
- Red, warm skin
- Feeling sick
Recommended Treatment & Rehabilitation
Throughout the diagnosis for Iliopsoas bursitis, your doctor may ask about your symptoms. He / she may also ask about medical history and past conditions that you have experienced before. To diagnose Iliopsoas bursitis, your doctor may complete a full physical examination that includes putting stress onto your bursa.
Bursitis in general can mimic other medical conditions, such as tendonitis, so your doctor cannot diagnose the condition through a physical exam alone. The doctor will perform imaging tests to help rule out other types of conditions and confirm a diagnosis. Imaging tests capture detailed images of the inside of your body and allow doctors to identify abnormalities with the hip joint. These tests include the following:
- MRI, which uses a magnetic field and radio waves to create images
- Hip ultrasound
- Bone scan, a medicine procedure to identify changes in bones
Treatment for Iliopsoas bursitis depends on the cause and the severity of the condition. When diagnosed early, at-home remedies are often enough. In more severe cases, a person may need to seek medical advice in order to treat the pain.
Mild cases often require little more than just rest and icing to eliminate the inflammation. Some people might also benefit from over-the-counter anti-inflammatory medications. Patients experiencing mild episodes of Iliopsoas bursitis should consider stopping or at least reducing the activity. In more severe cases, a person may seek additional therapies. Some therapies include:
- Physiotherapy that focuses on hip strength and flexibility.
- Corticosteroid injection directly into the bursa.
- Anti-inflammatory medications.
- Antibiotics when infection is presented.
- Walking aids, such as canes, to relieve pain and pressure.
If a person is currently living with arthritis, the doctor will treat the underlying condition. Medications designed to target the arthritis symptoms will likely help relieve the bursitis. A person should talk to his / her doctor if experiencing Iliopsoas bursitis associated with arthritis.
Stretching and exercise
This can be used to help prevent Iliopsoas bursitis. One of the primary causes is friction and rubbing that can occur when the hips are too tight. Stretching can help alleviate the tightness. There are many stretch exercises on the hips including the following:
Hip flexor stretch
This exercise stretches the Iliopsoas muscle and improves stiffness of the hip joint. To perform this exercise, place the knee on the injured leg on the ground. The entire lower leg should lie directly on the ground. Bend the other knee and lean forward slightly. You should then feel a stretch in the front of your thigh. Hold this position for 30 seconds and repeat the exercise three more times.
Straight leg raises
Straight leg raises focus on strengthening the iliopsoas and quadriceps muscle in your thigh. To perform this exercise, lie down on your back and straighten your injured leg. Bend your opposite leg and place your foot flat on the ground. Contract the muscles in your thigh and slowly raise your leg up until it is level with your opposite thigh. Pause for a few seconds and then finally lower it back down to the ground. Perform 10 repetitions and then repeat the same procedure on your opposite leg. If you want to increase the difficulty of this method, try wrapping an ankle weight around your lower leg.
Sitting hip flexion
This exercise is also beneficial for strengthening the iliopsoas. Sit down on a table or chair. Bend your knee and slowly raise your right knee up as high as possible. Hold for a second and then lower your leg back down to the starting position. Do 10 more repetitions after finishing the first rep. An ankle weight may be placed around your lower leg to make this exercise harder.
Standing resisted hip flexion
Similar to the sitting hip flexion, this exercise also improves the strength of your iliopsoas. For this exercise you will need a rubber resistance band – tie the ends of the band together to create a loop. Place the band in a door jam or around the leg of a table. Put your foot into the loop and stand with your body facing away from the band. The band should be looped around the front of your ankle. Contrct your hip muscles and slowly pull your foot forward. Do three sets of 10 more repetitions.
Alternative & Homeopathic Treatment
Fortunately, most causes of iliopsoas bursitis will heal with simple home at-home treatments and surgery is often not needed. Some at-home treatment methods recommended includes:
This is important for initial healing because without proper rest you are at risk for increased pain and inflammation. If you are not resting your hip, the condition will probably worsen, possible becoming chronic.
Avoid activities that caused iliopsoas bursitis
While resting your hip, it is also important to avoid all activities that may have caused your iliopsoas bursitis, including any repetitive hip or leg movement. Continuing with regular activities can increase the severity of bursitis, turning a mild or moderate case of injury into serious damage or leading to injuries in other areas due to overcompensation.
Apply a cold compress or ice pack for the inflammation
Immediate cold therapy at the onset of your injury will help you combat the pain and inflammation of bursitis and tendonitis. Immediate pain relief and reduced inflammation can also relieve some of the pressure that’s being placed on soft tissue in the hip and stop your injury from getting worse.