Groin pain can be caused by many different entities, from those as innocuous as a "pulled adductor muscle" to something as serious as a femoral neck stress fracture. Because of the possibility of significant other problems here, prolonged pain in this area should be examined by an orthopedist and at the least x-rays should be taken. Some of the other problems that occur here include Slipped Capital Epiphysis, avulsion fractures, osteitis pubis, osteoarthritis, labral tear, adductor tendonitis, and hernia.

“Iliopsoas tendonitis is an under reported and under diagnosed clinical problem.”

Iliopsoas tendonitis, sometimes called iliopsoas syndrome, is an under reported and under diagnosed clinical problem. A study (Donald J. Rose, MD, department of orthopaedic surgery, Hospital for Joint Diseases)in ballet dancers performed in 1997 and presented at the AAOS Meeting in a poster presentation http://www.aaos.org/wordhtml/97news/dance1.htm showed this to be a significant finding in ballet dancers. Besides ballet dancers iliopsoas tendonitis can occur in runners, hurdlers, high jumpers and many other athletes. The diagnosis is often missed and often no significant therapeutic measures are recommended besides rest. A better strategy will be discussed here.

First let's take a look at this muscle. The iliopsoas is compsosed of two separately identifiable parts the psoas and the iliacus.

Origin:

  • Inner Surface Ilium (Iliacus)
  • Base Of Sacrum
  • Vertebral Column (Psoas) Transverse processes - anterior surface, and inferior surfaces of L1-L5
  • Bodies and Disks of T12-L5

Innervation: L1-L3

Insertion:

  • Femur
  • Lesser Trochanter
  • Femoral Shaft
  • Tendon Psoas Major

Function:

Hip flexion.

Some turning/rotation of the spine.

In gait the iliopsoas becomes active during the terminal portion of stance phase and limits the rate of extension of the hip. During early swing phase the iliopsoas aids in flexion of the hip. In running leaning back while running downhill will aggravate iliopsoas tendonitis, and it will be difficult to take a full stride and also difficult to run uphill.

Image:

Iliopsoas - Gray's Anatomy

 


Diagnosis:

The symptoms most often reported are pain when running or walking in the groin area. Occasionally this is correleated with lower back pain. There is also pain in this area when walking up and down stairs.

Having the patient lie down, flex the knee to 10 - 20 degrees and then have the patient attempt to lift the leg against resistance. Pain occurs with iliopsoas tendonitis. The motion of hip flexion will also be weak and may cause pain even without resistance in severe cases. Tenderness may be present along the course of the tendon and at the insertion.

Treatment:

Rest is usually recommended. A two to three week break from the sports and activities that cause pain can be very helpful. Relative rest, meaning less intense workouts, and fewer miles is also helpful, and should be used during your return to activity. This can be a very difficult problem to get rid of and like achilles tendonitis, can linger for many months.

“This can be a very difficult problem to get rid of and like achilles tendonitis, can linger for many months.”

Two important components to use in treating this problem are stretching the muscle, tendon, and other structures in this region and strengthening muscles that assist the iliopsoas in its work.

Stretching:

The "quad stretch" with your leg held backwards like a bow offers some stretch to the iliopsoas. Another more specific stretch would be lying on your bed, and allow your leg to dangle off the side of the bed from the hip on down. This is uncomfortable, but it does stretch the area. You can do 3 sets of 20 second stretches on each side. Alternatively you can move down towards the bottom of the bed and allow both legs to dangle off the bottom of the bed. To lessen some of the pain you are having you'll also find that when you get up from a lying (supine) position you may want to roll over onto your side first or use your elbows and hands to assist in lifting yourself up. When you are almost completely recoverd. Gentle lunges can help you regain more flexibiltiy and your ability to take a full stride without pain. Don't do this if it causes pain - focus on the other stretches in that case.

Strengthening:

The abdominal muscles need to be strenghtened to aid the hip flexors. This must be approached cautiously or you will aggravate the tendonitis. While ordinarily I believe that no pain equals lots of gain, unfortunately, with this problem, there is some discomfort during the rehabilitation. The abdominals can be strengthened with crunches done on the floor or with an "ab machine" in the gym. If you are doing the ab machine, make sure you use very light weights and perform 2 sets of 25. This should cause a minimum of discomfort. Do not rush to increase the number of sets or the resistance. You will probably find you can not perform the knee up exercise until further in your rehab program.

Alternatively you may do a 5 minute core workout:

Planks 15 to 45 seconds

Bridges - 10-15

Single Legged Bridges - 8-12

Side Planks - 10 to 30 seconds each side

In running, avoid hills. Uphills will be somewhat painful when lifting the leg, and downhills may also aggravate the condition. Curtail your speedwork, and shorten your stride. Also, try a brief rest of a few weeks, while continuuing your stretching and strenghtening exercises. There are a variety of other possible causes of groin pain in athletes which must be taken into consideration when making this presumptive diagnosis.