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Iliopsoas pain-Lisamarie and PT's help please

post #1 of 7
Thread Starter 
Anyone ever have an iliopsoas injury? I believe that I do. It hurts to ride the lift! Here are my Sx: Pain on hip flexion with the knee 'locked'. When I lie down and try to lift my leg, it barely goes up. I am a competitive cyclist (100+ miles/wk) and this has went on for 2 months after my last race. 1 week off with NSAIDs did nothing. The pain is sharp and does not radiate. Icing helps a bit. It occurs only after biking or skiing, and doing situps.

Localization of pain: lateral to the femoral pulse palpation point inferior-medial to the ASIS. No palpable bulges.

So to my next question: What should I look for when I go to the doc? I don't want to be sent home with RICE orders for a week. Should I request that I be sent to a PT? Any ideas of how long I will be off my skis and bike?
post #2 of 7
The iliopsoas muscle is a strong muscle that lifts the knee up. It starts at the lower back and inserts into the thigh. It lies in front of the hip joint and sits quite deeply below the surface of the skin. Its main job is to flex the hip (bringing the leg out in front of the body) as when kicking a ball. The iliopsoas attaches to the thigh bone via the iliopsoas tendon (a tendon is a structure which attaches muscle to bone).

In between the tendon and the hip joint lies the iliopsoas bursa which are small sacs of fluid. Bursae are present wherever moving parts occur, and help to reduce friction. They are usually found around joints and where tendons, muscles or ligaments pass over bony prominences.

Iliopsoas Syndrome is a condition where a person either has iliopsoas bursitis (irritation and inflammation of the iliopsoas bursa) and/or iliopsoas tendinitis (irritation and inflammation of the iliopsoas tendon). Although illiopsoas bursitis is more common than teninitis, because of their proximity, inflammation of one may lead to inflammation of the other. These conditions occur in athletes who use a good deal of hip flexion. Many runners or cyclists, who engage in a good deal of uphill training, sometimes develop some sort of illiopsoas syndrome. You also say you do sit ups. Often, if the deep abdominal muscles are not proprely engage, the hip flexors will take over, causing strain on the psoas. If you are having too much movement in the legs while performing sit -ups, this may be the case.

Iliopsoas bursitis happens when the iliopsoas bursa becomes irritated. This is sometimes the result of excessive friction of the bursa on the underlying bone. Sometimes, a tight iliopsoas muscle is the cause. The iliopsoas bursa works to allow the iliopsoas muscle to slide smoothly and without friction over the underlying bone. If the muscle is too tight it places too much pressure and friction on the bursa. This increases wear and tear on the bursa causing microtrauma which can eventually cause bursal thickening, inflammation and bursitis.

A tight illiopsoas can also have a negative effect on biomechanics. Inflexibility of the of the iliopsoas, tensor fascia lata, or rectus femoris can lead to inhibition of the gluteus maximus, which in turn causes an anterior pelvic tilt. This can lead to to adverse affects on the kinetic chain. Excessive anterior tilt causes increased lumbar lordosis which results in stress on the lower lumbar discs, facet joints, and sacroiliac joints and may cause increased knee flexion at heel strike. The increased flexion can lead to inflammation.

Since you are a competitive cyclists, it is VERY important that you ask the doctor to refer you to a PT! Since much of the cause of this sort of injury is due to flexibility and alignment, a PT can help. Time away from sport generally lasts from 2-6 weeks, but you need your doc to give the final okay. When you return, you may want to avoid bumps for awhile!
Good Luck!

<FONT COLOR="#800080" SIZE="1">[ January 20, 2002 09:11 AM: Message edited 2 times, by Lisamarie ]</font>
post #3 of 7
Thread Starter 
Thanks sooo much! I will keep you posted on my progess here once I get my Dx. Of course I am a med student so I am already thinking of the Differential!
post #4 of 7
Something else occured to me. If Gonzo or one of the other bikers can comment on how seat height and handle bars would relate to psoa/hip flexor pain, it may also be helpful!
post #5 of 7
I noticed that when I had my saddle adjusted too high on my road bike, I would get very sore in that area after long rides. I refused to believe my saddle was too high and just assumed it was because my hip flexors were not accustomed to the added milage.

I finally lowered my saddle (only a quarter inch or so) and that has made all the difference in the world. I did a 60 mile ride a week or so ago and no pain at all. I guess I was stressing the area on the "up" or "pull" part of the pedal stroke. With my saddle too high, I was putting more stress on this area.
post #6 of 7
wonder if this pertains to the lovely CLICK sound/feel i get in my hip sometimes when flexing the joint. no pain, but a CLICK. girlfriend's bro-in-law, a chiropractor, surmises that it's the bursa sac THING.
post #7 of 7
Thread Starter 
Well I went to the sports med doc at the Univeristy here. He did a whole bunch of range of motion type tests on me and surmised that it was a strained iliopsoas. Much to my surprise he is letting me work out still. I got Vioxx though and some new stretches to do as well. And if it still hurts in 2 weeks the next step is ultrasound, PT then local steroid injections after that. Thanks and I'll keep everyone posted! As far as seat height I played with that before. I really think I strained it doing situps and aggrivated it on the bike.
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