Iliopsoas Tendonitis

Injury sucks. There is nothing more regrettable, restrictive and frustrating than having been injured. This time, fortunately, I don’t have these strong feelings, because the pain I have is not severe. Yet, the prospect of full recovery from this pain seems to resemble this San Francisco summer weather: Foggy and not encouraging. Yes, this is frustrating.

My self-diagnosis of this pain is I have Iliopsoas tendonitis. This past Monday, I went to Psoas to see if they can figure out what’s been bothering me. My symptoms are:

  • Groin pain when I run without sufficiently warmed up.
  • Groin pain when I do crunches with my left leg bent.
  • Groin pain when I sneeze.

LongusThe groin pain is identical in all these scenarios. Rodney checked the alignment but he had difficulties pin-pointing the cause of my pain. When he found soar spots in my lower back, he suggested the tightness in Quadratus lumborum was somehow connected to the pain in Longus. His massage gave me piercing pain as he tried to loosen the tightness in Quadratus. It was so painful that I instantly believed his diagnosis without any doubt. However, looking at the anatomy diagram now, it does not seem to coincide with the area I am feeling the pain. Longus is a muscle that goes down further deep in legs, but my pain is near the top anterior side of the Pelvis. So I searched what could be bothering me other than still potentially Quadratus and Longus.

iliopsoasFrom what I read, my symptoms are consistent with those of Iliopsoas tendonitis. It is basically inflammation of Iliacus and Psoas muscles. Psoas is the stretch of muscle that is right next to the spine. Iliacus is the muscle next to Psoas. The location of Iliacus seems consistent with the location of my pain.

Similar to other conditions that stem from muscle inflammation, there is no quick treatment for this. Suggested immediate treatment is R.I.C.E., as they say: Rest, Icing, Compression, and Elevation. Two to three weeks of rest is usually suggested but more rest may be necessary, depending on the condition. Once inflammation stops, stretching and strengthening can help prevent the same inflammation from happening. When running, it is advised not to run on the hill, up or down, as well as less speed training.This causes a problem to my training for the upcoming races. First of all, I am doing the Pride Meet less than two days from today. Then, immediately after the track meet, I am starting the Half Marathon training for the Oct 2 race. Then, I am hoping to run a Full Marathon before the end of this year. So, there is not going to be any rest between now and the Full Marathon. Three weeks or more rest is very restrictive to my training. After the Full Marathon, I will take a break for a couple of weeks before the training for Boston should start. It will be holiday season, so it is a good time to take the break. Can this condition wait until then? Would I make it worse by doing the track meet, Half Marathon, and Full Marathon? The reason injury is regrettable is because I often feel that I should have know better than getting injured. ‘I told you so’ moment is just waiting to happen, or would it go away without me knowing? It is true that I had the same pain in the right side of the groin, but it did go away after a while. I shall see. If it starts to feel worse, I will compromise.

    25 Comments
    • Lisa
      January 26, 2013

      Hi! I came across your story here by searching iliopsoas tendonitis! I too self diagnosed! lol. Anyway, I was wondering what ever came of this for you? I have this dull low right side anterior pelvic pain. Also groin issues. Which I thought initially was a groin pull! I’ve had MRIs, ultrasound and xrays of hips and I am good to go other than this strain dull pain in groin.pelvic area. So frustrating and seems hopeless even after 6 weeks off from running. :( I’m doing low, slow miles right now, but need to start training in about a week or so! So any info would be helpful! :) Thank you.

      • Koji Kawano
        January 27, 2013

        Hi, Lisa. I am afraid that my condition has not improved, either. I have not had it checked out as you have, and I am taking it easy from running these days. One new suspicion is that my hip and legs are way too tight and are causing imbalance. I have plantar fasciitis right now, and it is getting better by stretching my calf muscle. So, I’ve been doing a little more stretching, including foamrolling. Hopefully, I will get to bottom of this soon, but I think it might take a while. Sorry I don’t have anything better for you. Good luck with your situation!

    • Kaylee S
      March 5, 2013

      Hi guys. I too came across this post while Googling. Mine however was for “Running with psoas tendonitis” as I was officially diagnosed by three different doctors. Prognosis is grim. I am not sure the severity of your pain, but mine was a 12 on a scale of 0-10. I was injured in late-July and did not seek professional help until January (I missed two days of work due to pain). Like you, I continued running and working out (at least through October after the initial injury and for a couple weeks in December). I saw a physical therapist for the first time yesterday. It’s not good. The PT told me I would likely never run competitively, ever again. The psoas tendon will never fully heal. She told me the best I can do is to practice strengthening exercises to increase my tolerance level. She let me run on a treadmill for 4 minutes (I was in excruciating pain by 1:30, but kept it to myself to see how long she’d let me run – it’s been 3 months since I had any real cardio). She told me after a FEW months, I could attempt a run/walk running program (which makes me absolutely crazy… RUN WALK, you have GOT to be kidding me). But I am sanctioned to the stationary bike and target exercises for now. Long story short, this tendonitis thing is a big deal. If you can afford PT, you may want to try it out to at least learn specific target exercises. My insurance only covers a very, very small percentage, so the cost adds up. I plan on going only 2 times, once to learn (what I did yesterday) and again in a couple weeks to see if I’ve made progress and to report any changes (hoping to get cleared to use the elliptical machine… oooooo) – it’s devastating news to any runner.

      On a side note, I had similar issues with instability and imbalance in my entire leg and my back. This has to do with the whole psoas system – you are not supposed to cross your legs when sitting as this upsets the hip-flexor, which affects the psoas. No leg raises. Pilates are out – yoga is good, but overstretching that entire affected side could cause more pain. I’ve been “resting” for months now, way more than the RICE treatment. In fact, the PT said the psoas tendon is so deep, that ice may not even relieve any inflammation at all.

      No good news for me anyways. Hopefully you guys can get some relief and that I didn’t ruin anyone’s day with my poor outlook.

      Signed,
      Discouraged [I'll be canceling my gym membership this evening] Runner

      • Koji Kawano
        March 5, 2013

        Oh no! I am very sorry to hear that. And it is not very encouraging news to me and others who face the similar problems… My pain level is not as severe as yours, but if indeed I have iliopsoas tendonitis, I’d better do something about it! Thanks for your comment, and I hope at least your pain goes away soon.

    • Yana
      April 19, 2013

      Hi, I also came across your post by once again googling this injury to see if there are any new articles on it. From my experience this injury is the worst I’ve ever had, it’s extremely stubborn. I used to play competitive tennis until 2008 when I got this injury and I wasn’t able to do any lower body exercises for 2 years. In fact the pain was so bad that I couldn’t walk without pain. I was misdiagnosed by 7 or 8 different doctors until I finally saw a doctor at Duke who immediately figured out what was wrong. 5 years after I initially got injured, I am still having problems..and I’ve been taking it easy. I have been doing home work outs, so that I can control the pain level and choose the right exercises to avoid getting the groin aggravated. Yesterday I finally thought I was ready for a little run. I went for a 6 mile run and I can barely walk today. It’s a really painful sensation, mixed with pulling and it hurts to the touch. My injury started with the right hip and now I am starting to experience the same problems with my left hip. The only thing that I found helps me is stretching. Lots of groin stretches a few times a day. I am sorry that I don’t have better news, Koji, but I have to tell you that those two years of no exercise for me were very, very frustrating. :( I would recommend anyone who has this injury to take it easy when the pain starts, rest and stretch a lot before continuing with a the more vigorous runs or exercises. I really hope your injury is not as severe as mine.

      • Koji Kawano
        April 19, 2013

        Thank you, Yana. Fortunately, my symptoms are nowhere near as severe as yours but still there despite reducing mileage. I am afraid I have to live with this. =( Not happy but I agree I have to watch it closely and no make it worse.

      • Gina
        May 23, 2013

        Yana, why would you start with a little run of 6 miles? Why not do 1 mile first? I have been battling the same symptoms as all since last January. I am getting no where with dr.’s or PT. Its a vicious cycle between hip/back/shoulder and I can’t get rid of muscle spasms and tightness. Very frustrating. I hope you feel better as well as everyone else.

    • Sue
      May 9, 2013

      Sorry folks but I’ve had this for ten years. The trouble is I can’t figure out what aggravates it although I suspect a lot of bending is not good. Anyone any ideas? It only seems to hurt later not at the time I’m doing anything.
      I still do yoga .

      • Koji Kawano
        May 10, 2013

        I have not figured out what my condition actually is and it is still bothering me, although it has not gotten any worse. I am going to see a different doctor and see what she has to say.

    • Care
      May 9, 2013

      I came across this blog while researching psoas tendonitis. How frustrating for all of you who are struggling with this. Anybody have a doctor who has suggested or looked into your hip as far as impingement (FAI) or labral tears? The pain varies with patients but can be very similar to what some of you are describing. I have tears in both hips, diagnosed via MRA (mri with dye contrast) and will be having surgery for it in hopes that I can get back to an active lfestyle. Anyway, just thought I’d share for anyone who is still looking for answers and haven’t looked into the aforementioned things as a possibility. I chased my pain down for nearly 2 years and multiple doctors before I finally got an answer. Good luck!

      • Koji Kawano
        May 10, 2013

        Thank you for your comment. I have not had MRA or any images done but going to see a different doctor hopefully next week. This is going on for almost two years and time to get it over with!

        Good luck with your surgery and recovery! I would love to hear how your recovery goes.

        • Care
          August 3, 2013

          Hi Koji, havent had my surgery *yet* but saw your post about needing to find a good doc in San Fran. Dr Thomas Sampson is in San Fran and very well respected, and there is also Dr. Mark Safran who isnt far outside of the city. He is well thought of too but sometimes moody lol! Anyway, just thought I’d share in case it helps at all.

    • nick
      July 31, 2013

      Hi Koji, that is a great picture looks like the stadium in Stockholm. Thanks for the post. Muscle instability is very uncomfortable. The science of alignment and myofacial injury has many grey areas and often these acute injuries develop chronic problems. By the time we become aware of the pain the problem is well ingrained. I live in S.F. Bay area and cycle a lot. My pelvis lopsided, this is where problems arose. Retraining the body and learning how to release these pelvic strains ie psoas or groin injury, is deeply healing. Iyengar yoga and its emphasis on vigour, rigour and rest to affect the body systemicaly and improve alignment is a worthwhile method. The Iyengar institute of Marin has a very experience 35year teacher . Evlaleah Howard. In my humble opinion and personal experience, if there is psoas injury there is also a problem with the groin as the there functions in stabilizing the pelvis is sometimes overlapping. Try sitting on a firm surface eventually on the floor, and look up the yoga pose upavista konasana. Practice release and activation of the inner legs with the feet at a wall. This is a variation. There are many variations and the adjustment of a skilled teacher can effect the affects of a persons injury thru intelligent alignment principles. There is an art to this and it has many of the same principles of good photography and composition. Take care.

      • Koji Kawano
        August 3, 2013

        Thank you for the comment, Nick. Since this post, I’ve now strained lower back and not able to run much these days… I am looking for a good specialist for my conditions and at least have MRI or some sort of imaging done so I know what might be going on. I live in San Francisco and think there must be a good specialist. I will try the yoga pose you suggested, too. Yes, the photo is Stockholm, my favorite city!

    • Taren
      August 14, 2013

      Last fall my right psoas hurt a lot so I stopped running for a week or two but that was definately NOT enough time. I ended up “resting” for 4 months. I eventually started running again in the spring…it was slow going especially since I was used to 6 mile runs. Everything was great and suddenly the left psoas decided to get pissed off 6 months later! I hate resting! Ive been trying to do yoga and circuit training to get some core strength and to not loose all my cardio. Ive got a mud run in a month and a 10 k in October… (Obviously I signed up for them before I got hurt) My pain is not terribly bad… only when I get done running. I just don’t want to jack it up so bad that I cant run any more. I feel everyone’s frustration! Chiropractic helps!!

    • Tim
      September 11, 2013

      Hi Everyone. Thanks for all your posts I have enjoyed reading them and see myself (my injury and struggle with it) in a lot of them. I injured my hip flexor in 2005 (heard a pop and excruciating pain in the groin that made me take very short strides and lot of pain and difficulty walking. I rested it for several weeks then thought I was better and picked up and set down a very heavy lawnmower. Ever since then my psoas tendon has never been the same. What I have found over the years is that “less is more”. What I mean is this: if you think you’re feeling better and can run 6 miles don’t do it. Try walking 1 mile and retire, evaluate it the next day and see where you’re at. The problem with the hip flexor is that the very powerful iliopsoas muscles heal easily and give us the sense that we can resume our activities but the iliopsoas tendon is not ready for the strain. As a consequence the muscles fatigue and tear will remind us the next day — and will keep reminding us for several weeks, months or years afterward. Trust me. This is year 8 for me. My damaged hip flexor has produced a labrectomy and a spinal fusion of L5-S1. Otherwise I am as healty as can be. You would never guess that I have this injury until you see me try to walk, i.e., limp. My advice to you is to trust your instincts as the doctors never figured my injury out until year 8. Although I had my suspicions, doctors don’t like you playing the doctor role in front of them. Amazing how many doctors do not understand what a hip flexor injury looks like, its symptoms, why it is so hard to heal and remedies for it. If you’re still reading this I recommend lots of rest, rest and more rest. Remember, you’re not so much healing the iliopsoas muscles as the tendon that connects to your lesser trochanter. And trust me it takes a long time to heal. Gently, stretch it daily — stand on the unaffected leg and with your hand pull your foot up (of injured leg) behind you to touch your butt — like performing a gentle quad stretch — and no more. Do not do a hurdler stretch even though you can because the tendon is far from ready. For the runners out there please here me. I used to love to run long distances, now I am doing good to walk. I have searched and searched for a doctor to repair my iliopsoas tendon just like they fix and abductor tendon or a ACL. There is no such procedure. In fact, you can read several medical journal acticles IMJ , AMJ where elderly folk have had a spontaneous rupture of the tendon and they do not repair it for them. I am telling you this so you know that pushing your injured tendon could result in very unfortunate consequences for the long term. I really hope all of you can get relief and heal. I have had to give up baseball, basketball, and many other activities to ensure I can support my family and be a parent for my son. God Bless and prayers for everyone’s healing.

      Tim

    • Tim
      September 11, 2013

      Sorry, I read my post and it is very saddening and discouraging, but I did want to tell you what treatment has worked through the years for me: Three things. PRP injections at the lesser trochanter…very safe and effective. Prolotherapy injections at the lesser trochanter. And lots of collagen and protein supplements. Yes, the injections don’t feel good. But these treatments are effective since there is so little blood flow to ligaments and tendons, which is why they heal so slowly, by providing the healing materials directly to the tendon (PRP) or forcing the body to send healing materials to the area (Prolotherapy). Hope these help you too.

      Tim

      • Koji Kawano
        September 11, 2013

        Thank you for taking time to comment here and share your experience, Tim. My conditions are better, and it appears that time has healed much of it. I am having other issues, but with the help of physical therapy, the other issues are going away. I am sorry you had to go through the hardship. I hope you are able to spend quality time with your family.

    • Mako
      January 3, 2014

      How did you manage to fix your pesky psoas? I have had problems with mine for years.

      • Koji Kawano
        January 15, 2014

        Thanks for the comment. I cannot say it is fixed, but with lots of rest it has been manageable and has not been bothering as much. Hopefully, it will not come back as I increase mileage and intensity…

    • Lisa
      February 6, 2014

      Hey! I wrote to you here back in January 2013. Sorry I have not updated, but I’m here now! :) I think I have my issue resolved! Yay! Soooo, just a quick background…I’ve had this groin pain on right side and lower right pelvic pain since April 2012. You can go back and read my initial comment to this post. Anyway, I ran, I took breaks, then ran, took breaks. This injury has been so frustrating. Pain subsides with rest and comes back if I push too hard or run too fast. My longest break was 7 weeks and then I started at 1 mile and trained quite successfully for a half marathon until the half marathon itself and then the groin and pelvic pain flared again. During my 7 week break, I foam rolled twice a day and that helped significantly. Anyway, fast forward and I started going to see docs. They thought it was psoas tendonitis at first, possibly hip impingement (FAI), labral tears, or sports hernia. I finally went to a hip specialist as I ended up having right hip flare ups. Had an mri which did in fact show a partial thickness tear on right labrum and linear tear in left labrum. I also have a partial insertion tear of hamstring. I know this all sounds terrible, but hip doctor said it wasn’t so bad that he needed to operate. Also, clinically I was showing all the signs for a sports hernia. I had pain with sit ups and with coughing and pain with lunges. My initial pain started with groin pain andlower right pelvic/abdomen pain. That pain has been consistent over the last two years. I was then sent to a hernia specialist who agreed completely that I had a sports hernia. He was the one that sent me for the new mri that showed the tears. The hernia doc and hip doc spoke to each other on the phone and agreed that although the mri did NOT show a sports hernia, it did not mean I didn’t have one. It is possible to have a sports hernia and it not show on mri. so after two years of dealing with this issue and clinically showing signs of sports hernia and based on my history, the hernia doc and I agree to surgery for a sports hernia/exploratory. I just had surgery monday feb. 3. Sure enough I did have a tear in my abdomen right where I’ve had pain for the last 2 years. Crazy, huh? He applied the mesh that they put for sports hernia. Anyway, I’m recovering well and just resting. I can resume running until about 4-6 weeks give or take. Everyone is different. I personally dont want to rush it. It doesn’t mean that I won’t be active, just not going to rush into running. Hope this helps some of you…The true test for me will definitely be when I get back to running and truly see if its gone and the surgery truly helped! good luck!

      • Koji Kawano
        September 4, 2014

        Thank you, Lisa, for the information. After I wrote this, I got burnout from running and got other problems, all of which allowed me to take a long break. Fortunately, after the break, the pain has gone away. I am definitely paying more attention to my body parts, so that I won’t experience the same. I am not at the level I once was but expect to get there after a while. I never knew what caused the pain I experienced, but hip mobilization exercises seem helpful.

    • Lisa
      February 6, 2014

      I also want to add that it’s quite possible that a sports hernia can lead to labral tears and/or hip impingement and vice versa. I think having the sports hernia is what eventually caused me to start having hip pain.

    • Joe
      August 24, 2014

      Go and try working with a good deep tissue/sports massage therapist or a rolfer!!

      • Koji Kawano
        September 4, 2014

        Yes! I have been doing both, and hopefully I won’t get the same pain back any time soon.

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