1. Iliopsoas Related Groin Pain

2. 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

3. 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
Hip flexor tear
Hip flexor tendinopathy/tendinitis
Iliopsoas bursitis
Snapping psoas
Post- operative overuse following hip arthroscopy

4. Mechanism of Injury Traumatic Insidious Overstretching
Direct compression
Insidious
Overuse
Kicking
Cycling

5. Subjective Examination
Reports a traumatic or overuse mechanism of injury
Pain over the anterolateral thigh
pain with hip flexion based activities
putting on shoes and socks
sitting for long periods of time
walking up stairs
kicking
jogging
May report snapping or clicking in the hip

6. 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

7. 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

8. 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

9. 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

10. 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

11. Further Investigation
MRI
Ultrasound

12. 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

13. Conservative Reduce Pain Restore Normal Range of Movement
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
Stretching

14. 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

15. 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

16. Plan B
Corticosteroid injection
Arthroscopic release
Debridement

17. 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):
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):
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):
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):