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.
tendonitis is an under reported and under diagnosed clinical
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
First let's take a look at this muscle. The iliopsoas is compsosed
of two separately identifiable parts the psoas and the iliacus.
- 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
- Lesser Trochanter
- Femoral Shaft
- Tendon Psoas Major
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.
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
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.
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.
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.
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
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.
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.