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IllioPsoas ( hip flexor muscle) syndrome

IlioPsoas Syndrome in Depth AKA: Hip Flexor Muscle Strain

Common Signs & Symptoms


IlioPsoas Syndrome Injury Explained

Pain at the front of the hip may be due to a Hip Flexor muscle strain. The IlioPsoas muscle is most commonly affected. The IlioPsoas muscle is comprised of the Iliacus and Psoas muscles.

The IlioPsoas muscle lies in front of the hip joint and sits quite deeply, below the surface of the skin. Its main job is to flex the hip (bringing the leg out in front of the body) as when kicking a ball. The IlioPsoas attaches to the thigh bone via the IlioPsoas tendon (a tendon is a structure which attaches muscle to bone).

In between the tendon and the hip joint lies the IlioPsoas bursa (a small sac of fluid). Bursae are present wherever moving parts occur, and help to reduce friction. They are normally found around joints and where tendons, muscles or ligaments pass over bony prominences.

IlioPsoas Syndrome is the name given to a condition in which a person has IlioPsoas bursitis (irritation and inflammation of the IlioPsoas bursa) and/or IlioPsoas Tendonitis (irritation and inflammation of the IlioPsoas tendon). The condition occurs primarily in gymnasts, dancers and track athletes and is caused by repetitive hip flexion.

IlioPsoas Syndrome Signs & Symptoms

A person suffering from IlioPsoas syndrome may have pain in the hip and thigh region, as well as hip stiffness and in some cases a clicking or snapping hip. The physiotherapist should be able to diagnose the condition through manual tests, but it can be confirmed by an ultrasound or MRI scan.

IlioPsoas Syndrome Treatment

What you can do

Consult a sports injury expert

Apply ice packs to relieve pain and reduce bleeding

Use resistance bands for muscle strengthening exercises

Use a Stabiliser Pressure BioFeedback device to ensure correct exercise technique

Use a Swiss Ball for Core Strengthening Exercises

The initial aim in the treatment of IlioPsoas syndrome is to allow the condition to settle down and pain to decrease through rest, electrotherapy and anti-inflammatory medications. Ice Packs can be applied for periods of twenty minutes every couple of hours (never apply ice directly to the skin as it can cause an ice burn). The Ice Packs relieve pain and reduce bleeding in the damaged tissue. This can significantly reduce the total rehab time.

Once the acute pain has settled down, a 6 week programme of flexibility and strengthening exercises for muscles around the hip can begin, followed by a gradual return to full activity. Resistance Bands are ideal for strengthening the muscles around the hip.

As with all overuse injuries, IlioPsoas syndrome can be caused by doing too much, too soon. When beginning or stepping up any exercise, gradual progress must be made. For example, it is impossible to increase from running 2 miles per day one week to running 10 miles per day the next week, without the body being put at risk of various problems.

As well as progressing gradually, your body has to be prepared for increased physical demands. Core strength exercises to help improve the stability of the trunk and pelvis are an important component of the rehab programme, as well as the prevention of overuse problems in the pelvis and groin. The Stabiliser Pressure BioFeedback device is an excellent tool to help ensure that your Core Stability exercise technique is correct. More advance mat based and Swiss Ball exercises can help to develop Core Strength for sports.

Guide to Core Strengthening Exercises

IlioPsoas Syndrome Prevention

What you can do

Wear Compression Shorts for injury prevention

Warm up before sporting activities

Cool down following sporting activities

Use a Swiss Ball for Core Strengthening Exercises

Stretch regularly to maintain muscle length

Warm up prior to sporting activity is thought to decrease muscle and tendon injuries because the tissues are more extensible when the tissue temperature has been increased by one or two degrees. Warm Pants (Compression Shorts) are extremely good at maintaining muscle temperature in the groin and pelvic region, even in cold conditions. They provide warmth and support and are very effective at preventing muscle injuries.

A good warm up should last at least 20 minutes - starting gently and finishing at full pace activity. Practicing sport specific activities helps tune coordination and prepare mentally for competition.

Professional Warm Up Guide

Maintaining good muscle strength and flexibility may help prevent overuse injuries. Core strength exercises using a Swiss Ball are ideal. Tight muscles are associated with injury and stretching on a Gym Mat should also be practiced to maintain muscle length and prevent injury.

What is the Core Strengthening Programme?

The Core Strengthening Programme is an exercise programme that aims to improve stabilisation and support to the spine. This is achieved by re-training specific trunk muscles, which may be under used.

Once these stabilising muscles have been re-trained the muscles of the arms and legs will have a more stable base to work from. This allows you to carry out arm and leg movements with more control and is thought to improve the quality of your movement.

How will it help during sport?

  • It will provide more support for your back and may reduce the risk of back injuries.

  • It will provide a more stable base for arm and leg movements, improving the control and quality of your movements.

  • It will improve your muscular co-ordination during movement.

  • As the stabilising muscles gain more endurance you will be able to perform movements without your technique deteriorating excessively, due to fatigue.

  • Your ability to hold off opponents in contact sports should improve.

Programme Overview

The programme is broken down into stages and must be completed step by step. You should not progress to the next stage until you have mastered the exercises of the previous stage.

The stages are:

  • Stage 1 Learn to contract the deep muscles which stabilise the spine. At first this takes quite a bit of concentration. Each individual will master this at their own pace. There is no set time, but perseverance is the key.

  • Stage 2 Increase the endurance capacity of the deep stabilising muscles of the spine, by practicing to contract them in different situations for as long as you can. This will become easier with practice.

  • Stage 3 Begin arm and leg movements whilst contracting the deep stabilising muscles of the spine.

  • Stage 4 Progress to the core strengthening exercises, while contracting the deep stabilising muscles.

  • Core Strengthening Programme Introduction

  • Stage 1: Contracting Deep Muscles

  • Stage 2: Increasing Deep Muscle Endurance

  • Stage 3: Arm & Leg Movements

  • Stage 4: Core Strengthening Exercises

  • Trunk Circuit Exercises

  • Arm Circuit Exercises

  • Leg Circuit Exercises

  • Back Circuit Exercises

  • Gluteal Circuit Exercises

There are two main deep stabilising muscles that support your lower back: the Multifidus muscle and the Transversus abdominis muscle.

In order to practice getting Transversus and Multifidus muscles to contract, it is easiest to get on all fours. Without moving your back, or pelvis, draw your stomach up gently - try to bring your belly button up towards your back. This is a very subtle movement so it is best to get your technique checked by a physiotherapist .

Important notes:

  • This movement should not be confused with breathing in - it is important to breathe normally while activating the stabilising muscles.

  • Do not use the muscles at the front of the stomach - using your 'six pack' is not the correct technique.

Using the same techniques described in Stage 1, you should eventually aim to hold the contraction for as long as is possible. You will find that once you have activated the muscles to this level it will become second nature to you.

To progress from Stage 1, simply increase the duration of the contraction to ten seconds, then twenty, while continuing to practice in sets of ten. Then progress the contraction to as long as possible, aiming for five minutes, then longer.

At this point, progress to contracting the deep stabilisers in different positions such as sitting and standing. Practice while you are doing everyday activities, such as sitting at the computer, watching TV or on an exercise bike.

Once you have mastered this you will be ready to progress to stage 3.

The whole point of the Core Strenthening Programme is to increase the support for your back and trunk in order to provide a more stable base for arm and leg movement. The best position to start these exercises is on all fours.

Commence by contracting the deep stabilisers (as described in Stage 1) and hold this contraction. Then raise your right arm straight out to the horizontal. Perform the movement slowly and in a controlled fashion - there should be no wobbling or unwanted movement of the trunk. Hold the arm up for four seconds and then slowly lower.

Repeat for the left arm.

Next, whilst maintaining the same position, contract the deep stabilisers and then slowly lift your right leg up straight to the horizontal. Hold it there for four seconds and then slowly lower. The movement should be controlled and there should not be unwanted movement of the trunk or pelvis.

Repeat for the left leg.

Once you have mastered these exercises, whilst maintaining a contraction of the deep stabiliser muscles, you can start doing the core strengthening gym exercises.

Go to below link for full program

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