Introduction
The word "tendinopathy" refers to a clinical state of pain, edema, and decreased tendon function and performance that is not caused by tendon disease but that has arisen from either acute or chronic overload. Despite being a prevalent illness among athletes, the pathogenesis of tendinopathy is still unclear.
It is commonly accepted that tendinopathy includes both degenerative and inflammatory processes. Even though inflammatory markers are often seen, tendinopathy lacks the usual inflammatory response, and the production of these markers is triggered by cyclic load. Furthermore, the link between tendon disease, pain, and function is poorly understood. These contradictory tendinopathy characteristics challenge physicians because the right treatment must be determined by clearly understanding the pathology's chronology and sequence.
What Is Iliopsoas Muscle?
The iliopsoas muscle, which is the strongest hip flexor, is essential for preserving the strength and stability of the hip joint because it helps in femur external rotation. It also serves as a pelvic and lumbar spine stabilizer. It has been demonstrated that pathologic diseases of the iliopsoas, such as asymptomatic snapping hip syndrome, tendinitis, bursitis, and impingement, are major causes of hip discomfort and dysfunction. In addition, iliopsoas muscle issues have been linked to lumbopelvic illnesses, including low back and gluteal discomfort, severe groin pain, especially in athletes, and even anterior thigh and knee pain.
Iliopsoas tendinopathy can be brought on by repeated hip flexion and other biomechanical system deficiencies that cause the tendon to deteriorate over time. Since the Iliopsoas tendon and its associated bursa are so close together, inflammation in one will always result in inflammation in the other. Due to the identical clinical appearance, assessment, and treatment, iliopsoas tendonitis and iliopsoas bursitis are frequently referred to as synonymous conditions.
What Are the Causes?
Tendinopathy is defined as a structural alteration of the normal architecture of the fibrillar tendon. It is thought to be caused by microtrauma resulting from long-term use of the tendon. The two most often reported causes of irritation to the iliopsoas tendon are acute injury or injury due to overuse from repeated microtrauma, while the precise etiology is still unclear.
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Acute trauma is less frequent but can cause a lesser trochanter avulsion fracture or damage to the musculotendinous unit. This is usually caused by eccentric muscle contraction or rapid flexion over an extension force that exceeds the tendon's ability.
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Overuse injuries to the iliopsoas can occur due to any action that requires repeated hip flexion, external rotation, or flexion of both the hip and trunk.
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Exercises like cycling, ballet, rowing, inclined jogging, soccer, and gymnastics can put someone at risk for an iliopsoas injury. The biomechanics of these movements involve repetitive hip flexion in an externally rotated position, which may predispose an individual to injury, which is why this injury is also known as "dancer's hip" or "jumper's hip." According to one research, over 90% of ballet dancers have heard a pop, click, or snap in their hips.
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Teenagers undergoing development spurts may be more vulnerable because of their reduced hip flexor flexibility.
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Iliopsoas bursitis has been linked to rheumatoid arthritis as one of its primary causes.
What Are the Signs and Symptoms?
Depending on several variables, the clinical appearance of iliopsoas tendinopathy varies. Hip flexion and extension can produce a palpable and audible snap sound, a common characteristic of an asymptomatic iliopsoas tendinopathy. The tendon, underlying bursa, or both may become inflamed due to consistent irritation of the tendon. Prolonged irritation is more likely to be characterized by painful tendon degeneration and fibrosis rather than inflammation.
What Are the Tests Used to Diagnose Iliopsoas Tendinopathy?
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Thomas Test or Modified Thomas Test: Extreme hypertonicity can be detected in the hip flexors.
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Iliopsoas Test: The patient is supine and asked to resist hip flexion while the hip is in external rotation. Any signs of weakness or pain indicate a positive test result.
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Ludloff's Sign Test: Isolated strength muscle examination of the iliopsoas involves asking the patient to lift the heel of the affected side while seated with their knees extended. Any signs of weakness or pain are regarded as positive test results.
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Stinchfield Test: Patients undergo the Stinchfield test, which involves actively raising their legs to a 45-degree angle. Next, a downward force is given to the anterior thigh, and the patient resists. Weakness or pain indicates intraarticular disease or engagement of the psoas muscle.
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Snapping Hip Technique: The afflicted hip is flexed, abducted, and externally rotated during this technique. Internal rotation and hip extension are accomplished passively. A palpable or audible snapping in the inguinal area indicates a positive test. This movement may cause pain that suggests bursitis or tendinitis in the iliopsoas muscles.
How Is Iliopsoas Tendinopathy Treated?
Iliopsoas tendinopathy is treated by following methods,
Conservative Management:
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Conservative treatment of iliopsoas tendinopathy includes rest, activity moderation, and exercise.
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The suggested neuromodulatory effect of soft tissue methods like myofascial release may be helpful in reducing muscle tension.
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Manual therapy for joint mobility impairments, including the pelvis, lumbar spine, hip capsule, and other areas.
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Exercises for strengthening, extending range of motion, and targeting antagonistic muscle groups should focus on the hip flexors.
Surgical Intervention:
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Surgery is only considered after a protracted trial of nonoperative therapy yields only limited improvement. This includes at least three months of specialized conservative treatment, which may involve corticosteroid injections, non-steroidal anti-inflammatory medicines (NSAIDs), physical therapy, activity modification, and rest.
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Two surgical methods that involve either a full or partial release of the iliopsoas tendon have been documented in the literature. Both treatments have generally reported satisfactory results, with reduced pain and no substantial residual weakness.
Conclusion
There were no empirical investigations on people with iliopsoas tendinopathy found. It is possible. Therefore, iliopsoas tendinopathy reacts equivalent to other lower limb tendinopathies based on the patient's response to the treatment. However, during athletic performance, consideration should be made to the unique loading condition of the tendon.
