Iliopsoas Syndrome

introduction

The iliopsoas syndrome is a disease that is based on the inflammation and overloading of the muscle of the same name in the hip (M. iliopsoas) and an inflammation of the associated bursa.
It is accompanied by pain in the lumbar spine, hips, and thighs. It is primarily a disease of young, physically active people.

causes

The iliopsoas syndrome is mainly the result of an overload of the iliopsoas muscle and an associated muscle inflammation or its tendons (Iliopsoas tendinitis) and his bursa (Iliopsoas bursitis). Iliopsoas syndrome therefore mainly affects athletes who put a lot of stress on the hips. Examples are typically dancers, track and field athletes, and soccer players.

Repetitive, powerful movements in the hip joint, such as when shooting a ball, or even quick, reflex-like movements ultimately lead to chronic irritation of the muscle fibers. In the area of ​​the groin, these run close to the hip bone. The resulting friction is absorbed by the bursa located there, which can lead to inflammation in the case of chronic stress. If the disease is ignored, sudden, abrupt movements can ultimately tear the muscle.

Finally, iliopsoas syndrome can also be the result of a blockage of the vertebral bodies in the area of ​​the lower thoracic spine and the upper lumbar spine. This creates a reflex defense tension in the muscle, which can lead to symptoms of an iliopsoas syndrome.

Symptoms

The classic symptoms of iliopsoas syndrome include pain in the lumbar spine and hip area, often radiating to the thigh, especially when stretching the thigh and pulling it more than 90 °.
A localization of the pain in the lower abdomen, near the appendix, is common because the iliopsoas muscle runs under the appendix. The symptoms typically have a stabbing, suddenly shooting character. This sometimes leads to severe restrictions on movement, with limps on the affected side. When lying down, the patient assumes a flexion-free position of the hip joint.

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The hip joint is one of the joints that are exposed to the greatest stress.
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therapy

In acute therapy for Iliopsoas syndrome, the focus is on symptomatic treatment with relief of the muscle and effective pain and inflammation therapy. Medicines such as ibuprofen or diclofenac are particularly suitable for this. These have both pain-relieving and anti-inflammatory effects. Paracetamol, on the other hand, is less effective as it lacks anti-inflammatory properties.
Cooling with ice packs in the area of ​​the hip joint can also alleviate the symptoms. Sports should not be practiced during this time.

After the pain has largely subsided, a follow-up treatment in the form of physiotherapy with movement training and special stretching exercises can take place.Once this phase of treatment has been completed, you can do stretching exercises on your own as part of sporting activities.

stretching

For a properly functioning M. iliopsoas, both strengthening it and training its flexibility is important. A number of stretching exercises are available for independent stretching of the iliopsoas muscle:

• One of the best known and most effective is probably the so-called "Thomas Stretch". To do this, lie on your back on an elevated surface, for example a table or a bench, with your tailbone on the edge. While one leg is pushed to the ground by gravity, the knee of the other is pulled towards your chest. A training partner can support this movement by applying light pressure on the knees. As with strength training, you shouldn't be too impatient here, as this can lead to injuries. Building muscle and exercising flexibility take time.
• Another very simple stretching exercise is pulling the foot of the leg to be stretched against the buttocks while standing upright. A slight pulling in the thigh can already be felt at this point, which can be intensified by pushing the hip forward.
• Finally, stretching the iliopsoas muscle is also possible with a pronounced step position. The feet, which are almost in a line, should be about two shoulder widths apart. With your back straight, your hips should now be carefully pushed forward. Pulling in the thigh area should be clearly felt.

physical therapy

Physiotherapy is an important part of treatment in the presence of iliopsoas syndrome. After the end of the acute pain phase, which, as already mentioned, can be treated with pain-relieving and anti-inflammatory drugs and cooling, active exercise and, above all, stretching should follow quickly. A professionally performed physiotherapy has several advantages: On the one hand, physiotherapists who know something of their craft, precisely and carefully guide all stretching and strengthening exercises that are right and important for the patient at that moment. In other words, they not only explain what the patient should do, but show him how, while he is trying out the exercises on his own and correcting any mistakes.

In addition, the physiotherapist gives clear guidelines on the number of repetitions of an exercise and the frequency of training. This is the only way to guarantee perfect execution of the exercise and an effective training course that does not result in incorrect loads and repeated overloads. Secondly, a physiotherapist, who usually works with only one patient at a time, can adjust to this patient during the entire training session and adapt the program individually. If there is severe pain on a day, he can suggest a combination of relaxing massage and light stretching exercises.

If he is dealing with a patient who is very ambitious in terms of sport, demanding strength exercises may be on the agenda sooner. Not to be forgotten is the great motivational factor that comes from a fixed appointment with a specific physiotherapist. Due to the obligation that most people feel after making appointments, training - and especially the often unpopular stretching - becomes a fixed point that is less quickly canceled or postponed than stretching at home on your own.

Duration of iliopsoas syndrome

Both the length of time that must pass before one develops iliopsoasndrome and the duration of the healing process can only be given vague information. People are different and so are their muscles. Everyone has an individual "threshold" what their body can withstand in terms of incorrect loads and overloads. Accordingly, sooner or later the iliopsoas syndrome occurs.

It is similar with the duration of healing. As a rule, it can take 6 weeks for Iliopsoas syndrome to be overcome with adequate treatment. However, these 6 weeks can also become 8 weeks. If the problem has previously been ignored and delayed over a longer period of time, or if the person affected has not consistently followed the doctor's measures and, for example, has continued training or has not performed any stretching exercises, the healing process can take significantly longer. Even if these periods of time sound very long and the therapy options sound rather uncomfortable, you should definitely give your body the time it needs to get healthy. In the worst case, an iliopsoas syndrome may never heal completely.

Iliopsoas muscle

Of the Iliopsoas muscle (Lumbar bone muscle) is part of the inner hip muscles and is made up of the large lumbar muscle (Psoas major muscle), the Iliac muscle (M. iliacus) and for some people additionally that small lumbar muscle (M. psoas minor) together.
In its entirety, it runs from the transverse processes of the Lumbar spine and the Iliac fossa (Iliac fossa) to the inside of the thigh through the fatty connective tissue of the back wall of the abdominal cavity. This is how it functions as the strongest flexor of the Hip joint. It enables us to move, such as pulling the thigh towards the body or straightening the upper body from the supine position. In this role he is an important one Antagonist gluteal muscles. He is also responsible for the external rotation of the thigh.
The iliopsoas muscle is closed due to lack of exercise and frequent sitting poorly trained, this can make it very difficult to climb stairs and walk in general, especially for older people. In this case you need two other muscles of the thigh that is straight Thigh muscle (Quadriceps femoris muscle) and the Tailor muscle (M. sartorius) take over his task.

Between the hip bone and the sight of the iliopsoas muscle is a Bursa located that Bursa iliopectinea. As with all bursa, it is their job to reduce the friction between the bone and another structure (in this case the tendon of the iliopsoas muscle). The iliopectinal bursa plays an important role in the Iliopsoas syndrome.

diagnosis

An initial diagnosis can usually be based on the characteristic symptoms be asked. For further clarification of possible other diseases (Differential diagnoses) usually becomes another roentgen the lower spine and the Basin carried out. Blood tests with focus on Inflammation parameters and a Rheumatic serology, as well as an investigation of the Urine can also be made. Further diagnostics can be carried out via neurological examination and a MRI, as well as one Colonoscopy respectively.

Possible other causes for symptoms reminiscent of the iliopsoas syndrome can, for example, be a blockage of the Sacroiliac joint, a lumbar disc prolapse or a Compartment syndrome (Entrapment of the Femoral nerve) be. However, the latter go along in most cases Sensory disturbances hand in hand.
From a simple iliopsoas tendinitis, the iliopsoas syndrome is distinguished by the nature of the pain. While it builds up slowly over a longer period of time in tendinitis, it occurs in iliopsoas syndrome sudden and stabbing on.

forecast

The prognosis for targeted therapy is quite good, depending on the extent of the disease, the muscle is after about 6-8 weeks fully resilient again. However, taking a break from your usual exercise program during this time is essential.
After completing the treatment, regular implementation of Preventive measures, how stretching and specific exercises to strengthen the M. iliopsoas, but highly recommended. In recent years it has been shown that the risk of suffering from iliopsoas syndrome again increases with each further episode of the disease.

Prevention

The occurrence of iliopsoas syndrome is common wrong movements and a overload of Muscle traced back. An intense one Warm-up program before the actual sport, as well as extensive strain before and after exercise are the best ways to avoid iliopsoas syndrome. Above all, competitive athletes should make sure they carry out intensive training sessions Rest breaks to interrupt and incorporate rest days into your training program.
Generally one is more regular moderate exercise Clearly preferable to overload from a health point of view. As a footballer, dancer or athlete there is definitely one targeted strengthening of the iliopsoas muscle to consider. Examples are the exercises "Hollow Rocks" and "L-sit'.