Iliopsoas bursitis is a condition affecting the hip, characterized by inflammation of a small, fluid-filled sac located deep within the hip joint. This inflammation can cause discomfort and limit hip movement.
Understanding Iliopsoas Bursitis
A bursa is a thin, fluid-filled sac that acts as a cushion between bones, muscles, and tendons, reducing friction during movement. The body contains over 150 bursae, strategically placed in areas of high friction. The iliopsoas bursa is the largest bursa in the body, typically measuring about 5 to 6 cm in length and 3 cm in width. It is situated deep in the front of the hip, beneath the iliopsoas muscle and its tendon, and lies anterior to the hip joint capsule.
The iliopsoas muscle, composed of the psoas major and iliacus muscles, is a primary hip flexor, playing a significant role in movements such as lifting the leg, walking, and maintaining posture. The iliopsoas bursa facilitates the smooth gliding of this muscle and its tendon over the hip joint during flexion and extension. When inflamed, the bursa can distend with excess fluid.
Common Causes and Risk Factors
Iliopsoas bursitis frequently arises from repetitive motions that stress the hip joint. Activities involving repeated hip flexion, such as running, cycling, dancing, or performing sit-ups, can lead to irritation and inflammation of the bursa. This condition is sometimes called “dancer’s hip” or “jumper’s hip” due to its prevalence in athletes who engage in such movements. Overuse injuries, where the hip is subjected to prolonged or intense activity without adequate recovery, are a common contributing factor.
Acute injury or direct trauma to the hip area can also trigger iliopsoas bursitis, such as a fall onto the hip or sudden, forceful movements. Certain underlying medical conditions, like inflammatory arthropathies such as rheumatoid arthritis and osteoarthritis, can increase the likelihood of inflammation. Anatomical factors, including tight hip flexor muscles or a prominent lesser trochanter, can also predispose individuals by increasing pressure and friction on the bursa.
Recognizing Symptoms and Diagnosis
The primary symptom of iliopsoas bursitis is pain, typically located deep in the groin or at the front of the hip. This pain can sometimes radiate downwards along the front of the thigh towards the knee, or occasionally towards the buttocks. The discomfort often intensifies with movements that involve hip flexion, such as walking, climbing stairs, getting up from a seated position, or extending the leg. Some individuals might also experience stiffness in the hip, particularly in the mornings, and a sensation of weakness in the hip or thigh. A clicking or snapping sound or sensation deep within the hip, especially during hip flexion or extension, can also be present.
Diagnosing iliopsoas bursitis typically begins with a thorough physical examination. This involves assessing symptoms, medical history, and performing specific movements to identify pain or tenderness in the hip. The inguinal area might be painful upon palpation. Imaging studies, such as X-rays, ultrasound, or MRI, are often used to confirm the diagnosis and rule out other conditions. Ultrasound and MRI can visualize an inflamed bursa and differentiate it from other soft tissue problems, with musculoskeletal ultrasound being a cost-effective option.
Treatment Approaches
Treatment for iliopsoas bursitis generally begins with conservative measures aimed at reducing inflammation and pain. Rest from aggravating activities is often recommended to allow the bursa to heal. Applying ice to the affected area for 20 minutes every few hours can help alleviate swelling and discomfort. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) may be used to manage pain and reduce inflammation.
Physical therapy plays an important role in rehabilitation, focusing on gentle stretching exercises for the hip flexor muscles and strengthening exercises for the surrounding hip musculature. This helps improve flexibility, address muscle imbalances, and prevent recurrence. Activity modification, which involves adjusting daily routines or exercise habits to avoid movements that provoke symptoms, is also an important part of recovery.
If conservative treatments do not provide sufficient relief, corticosteroid injections may be considered. These injections deliver anti-inflammatory medication directly into the iliopsoas bursa, often under ultrasound guidance for precise placement. Corticosteroid injections can provide significant pain reduction and improve function, with effects potentially lasting for several weeks to months. Surgical intervention is a rare option, typically reserved for severe, persistent cases where conservative measures have failed. Surgical procedures might involve bursectomy, the removal of the inflamed bursa, or addressing underlying anatomical issues contributing to impingement.