Iliopsoas bursitis is a common source of hip discomfort, causing pain deep within the groin or the front of the hip. This condition involves inflammation and swelling within the iliopsoas bursa, a fluid-filled sac located near the hip joint. It is common in physically active individuals, resulting from strain on the large muscles that flex the hip.
Understanding the Anatomy and Condition
A bursa is a small, flattened sac present throughout the body, typically containing a thin layer of lubricating synovial fluid. Its primary function is to act as a physical cushion, reducing friction between bones, tendons, muscles, and skin during movement. The iliopsoas bursa, specifically, is the largest bursa in the hip region and sometimes the largest in the entire body.
This bursa is strategically located deep in the anterior hip, situated between the iliopsoas muscle and the hip joint capsule. The iliopsoas muscle is the body’s strongest hip flexor, responsible for bending the hip and lifting the leg. When the bursa becomes inflamed, it swells with excess fluid, losing its ability to provide smooth gliding action. This swelling creates friction and pressure, resulting in characteristic pain deep in the hip and groin area.
Common Causes and Risk Factors
Iliopsoas bursitis is classified as a repetitive use injury, developing due to chronic stress on the hip flexor mechanism. Activities involving frequent and forceful hip flexion or extension are primary triggers, such as running, swimming, ballet, or hurdling. This continuous movement causes the iliopsoas tendon to rub excessively over the bursa, initiating the inflammatory cycle.
Risk factors also include underlying structural issues or systemic diseases that increase friction in the joint area. Conditions like rheumatoid arthritis or osteoarthritis can promote inflammation within the joint, which may then extend to the surrounding bursa. Muscle tightness or imbalance, particularly in the hip flexor muscles, causes increased pressure on the bursa, making it more susceptible to irritation and swelling. Acute trauma or a direct blow to the area is a less common trigger for the condition.
Recognizing the Symptoms
The primary symptom experienced with iliopsoas bursitis is a deep, aching pain located in the front of the hip or the groin crease. This discomfort often begins subtly and gradually worsens over weeks or months. The pain can radiate down the front of the thigh toward the knee, and some individuals may also feel it extending toward the buttocks.
Certain movements consistently aggravate the pain, particularly hip extension, such as when walking uphill or standing up from a prolonged seated position. Patients frequently report stiffness and increased pain after periods of rest or upon waking in the morning. Another symptom is a clicking, clunking, or snapping sensation deep within the hip, caused by the irritated iliopsoas tendon moving over the inflamed bursa or underlying bone.
Diagnosis and Medical Evaluation
A medical evaluation typically begins with a detailed review of the patient’s symptoms and activity history to understand the onset and nature of the pain. A physical examination involves specific movement tests designed to reproduce the pain by stressing the iliopsoas muscle and bursa. Palpation, or pressing, deep into the groin area can also elicit tenderness directly over the inflamed bursa.
Because the symptoms can mimic other conditions like hip arthritis or tendinitis, imaging is utilized to confirm the diagnosis and rule out other potential problems. X-rays check for bony abnormalities, while ultrasound or Magnetic Resonance Imaging (MRI) scans provide a clearer view of the soft tissues. A dynamic ultrasound is useful as it allows the clinician to watch the bursa and tendon during movement, confirming the presence of excess fluid or thickening. In some cases, an ultrasound-guided injection into the bursa is used both to confirm the diagnosis and to provide immediate relief.
Treatment and Recovery Options
The standard approach to managing iliopsoas bursitis is conservative, focusing on reducing inflammation and addressing biomechanical issues. Initial treatment involves relative rest, meaning the patient avoids painful activities, and the application of ice to the front of the hip several times a day. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are recommended to decrease both pain and swelling.
Physical therapy plays a significant role in long-term recovery and recurrence prevention. A therapist designs a program focusing on gentle stretching to improve flexibility of the iliopsoas and surrounding hip muscles. This is followed by strengthening exercises targeting the hip, pelvis, and core to correct muscle imbalances and improve overall joint stability. It can take an average of four to six weeks to notice significant improvement in pain and discomfort with consistent adherence to the exercise program.
For more persistent cases that do not respond to initial conservative measures, a corticosteroid injection directly into the bursa can provide substantial anti-inflammatory relief. This procedure is often performed using ultrasound guidance to ensure accurate placement of the medication. Surgical intervention, known as a bursectomy, to remove the inflamed bursa is considered only in rare situations where chronic symptoms are completely unresponsive to all other treatments. Over 95% of patients find success with a comprehensive non-operative rehabilitation program.