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Iliopsoas Bursitis

Understand the cause of your hip pain to get the right treatment.

What is iliopsoas bursitis?

Dr. Rx

Hip joint problems usually cause groin pain. People often think of their hip as the area on the outside of the upper thigh or even the area at the back of the hip and buttock. But in fact, when there are problems with the actual joint, the pain is usually in the groin area at the inner part of the upper thigh. —Dr. Benjamin Schwartz

Iliopsoas bursitis is an inflammation of the iliopsoas bursa, a large thin sac containing fluid that is located in the groin area (where the upper thighs meet the abdomen).

Bursa sacs are found near your joints. They provide cushioning to reduce friction between bones, muscles, and tendons. When it is inflamed, it fills with fluid, becoming enlarged and painful.

Symptoms include pain and stiffness in the front of the hip and groin area (where your abdomen meets your thigh). It can also limit the range of motion in your hip and cause limping.

Iliopsoas bursitis can be treated with physical therapy, pain medications, and reducing activities that make it worse.

Most common symptoms

Most people with iliopsoas bursitis feel pain in the front of the hip and the groin. Sometimes it radiates down the inside of the thigh to the knee. The area can also be tender when touched.

Bending (flexing) your hip—like when jogging, walking up stairs, and standing up from a seated position—makes the pain worse. It may also hurt when bringing your knee to your chest or when lifting your leg, like when getting into bed or in and out of a car.

You may start to limp as a way of avoiding the pain. Sudden inflammation of the bursa can cause more intense pain.

Main symptoms

Iliopsoas bursitis causes

  • The bursa can be injured or traumatized by repetitive flexing of the hip. The body responds to the injury by increasing the fluid in the bursa. The swelling and inflammation of the bursa cause pain or discomfort.
  • Inflammation can also occur when a flexed hip is rapidly extended (for example, during a quick rise from a squat).
  • Iliopsoas bursitis can be triggered by tendonitis, an inflammation of the tendons.
  • Having arthritis can lead to iliopsoas bursitis because it causes stiffness and tightness of the muscles around the joint.

Pro Tip

The most common cause of bursitis is repetitive motion that causes a tendon to rub or slide over bone.  When this happens, the bursa gets pinched between the tendon and bone and, over time, becomes inflamed. Two of the most common activities that irritate an inflamed iliopsoas bursa include lifting the leg to get in and out of bed or in and out of a car. —Dr. Schwartz

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How is iliopsoas bursitis treated?

Once a doctor confirms the diagnosis, they will recommend you decrease the activity that is causing the pain and inflammation. If the activity can’t be avoided, like walking, try a cane (or walker) to temporarily relieve pressure while you’re healing.

If you can’t stop an activity, your doctor may suggest physical therapy. A physical therapist (or sports coach) may be able to suggest ways to change movements to put less strain on the hip joint.

It’s also helpful to ice the area to reduce inflammation.

Medications

  • Your doctor will likely recommend non-steroidal anti-inflammatory drugs (NSAIDs) to reduce the inflammation and relieve pain. You can take over-the-counter NSAIDs (like ibuprofen or naproxen) or your doctor may prescribe a stronger version (like celecoxib). NSAIDs may increase certain risks if taken continuously, so discuss with your doctor first.
  • If you have an infection, you’ll need to take antibiotics.
  • If inflammation is severe, your doctor may give you a corticosteroid injection. The shot relieves the inflammation immediately. For some, the pain doesn’t come back, but for others, it may return after a period of time.

Risk factors

People who participate in sports with repetitive bending at the hip are more likely to develop iliopsoas bursitis. These include running, skiing, strength training, and swimming.

Having tight hip flexor muscles makes you more prone because it increases friction and rubbing. So does rheumatoid arthritis and osteoarthritis since they both cause pain and swelling of the joints.

Pro Tip

Although it can be slow to get better, the good news is that this is a curable condition. Start by avoiding anything that puts stress on the hip flexor such as bending, squatting, and lifting the leg repetitively. Regular use of anti-inflammatories, ice or heat (whichever feels better), and stretching exercises can help relieve discomfort. —Dr. Schwartz

Prevention

  • Avoid repetitive activities
  • Stretching can help prevent iliopsoas bursitis. Focus stretches on the groin and hip area.
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