Iliopsoas Tendinopathy

Iliopsoas tendinopathy is an overuse injury of one of the tendons at the front of the hip (the psoas, also known as the hip flexor). This tendon attaches to the lower back, pelvis, and the front of the thigh, and runs through the groin, often resulting in groin pain.

The psoas has two main functions: hip flexion and stabilising the front of the hip. When the psoas is overused, you may experience pain in the groin, which can sometimes radiate to the knee.

How does iliopsoas tendinopathy develop?

Iliopsoas tendinopathy usually develops gradually. Whether a tendon becomes overloaded depends on the balance between load and load capacity of the tissue. Simply put, if the load is greater than what the tendon can handle, the risk of injury increases.

With repetitive loading of the iliopsoas, this stress can accumulate. The tendon tries to adapt to this pressure, but this is only possible if the tissue is strong enough and there is sufficient recovery time. If one of these factors is missing, the body reacts with an inflammatory response in the tendon. This is a protective mechanism that indicates the tendon is overloaded.

To promote recovery, it is crucial to adjust the load and work specifically on strengthening the tendon. This improves the load capacity and reduces the risk of recurring symptoms.

When a tendon becomes overloaded, it typically goes through three phases:

• Reactive phase

With a sudden and heavy load, the tendon reacts by becoming thicker and painful. In this phase, it is important to temporarily reduce the load so the tendon can recover.

• Phase of structural change

If the load continues, the structure of the tendon changes. It remains thickened and can feel stiff. Specific exercise therapy combined with reduced load is essential in this phase to make the tendon stronger and more functional.

• Chronic phase

With prolonged overuse, the tendon can suffer severe damage. This is often accompanied by scar tissue and an increased risk of tears. Treatment in this phase is more extensive and may include targeted exercises, injections, or even surgery.

Accurate diagnosis and a targeted approach for each phase are crucial for effectively treating symptoms and preventing further damage.

Typically, iliopsoas-related groin pain is experienced when flexing the hip, lifting the leg, driving, getting in/out of a car, getting up from a sitting position, walking, etc.

Treatment for iliopsoas tendinopathy may include the following elements:

• Specific exercise therapy
• Lifestyle modification
• Injection
• If you experience psoas tendinopathy after a total hip arthroplasty: psoas interposition capsuloplasty
• If you experience psoas tendinopathy after an arthroscopy: capsuloplasty

We will discuss with you which treatment option is most suitable based on your specific situation and needs.