What is Iliopsoas Tendinopathy/Bursitis?

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How does the iliopsoas major tendon and bursa become injured?

Iliopsoas tendinopathy/bursitis is predominantly an overuse injury. As the iliopsoas tendon passes the front of the hip joint it can come impinged (pinched). Repetitive compression or pinching of the tendon causes an inflammatory reaction to occur. Inflammation of the tendon is called tendinitis. Tendinitis is often short lived and self-limiting, usually resolving within a few weeks of rest. When the iliopsoas tendon is subjected to multiple bouts of tendinitis with insufficient recovery, the tendon structure becomes weaker. Driven by a maladapted healing process the tendon also becomes thickened and compromised. This process is commonly called tendinopathy. It is not uncommon in this condition to experience associated ‘snapping’ or clicking at the front of the hip. Sometimes the ‘clicking’ causes pain but it can often be asymptomatic (painfree).

Surrounding the iliopsoas tendon at the level of hip joint is a small sac or cushion called a bursa. Bursa contain a naturally occurring lubricant known as synovial fluid. There are over 150 bursae located throughout the body, found in ‘anatomical friction hotspots’. These protective structures are perfectly designed to allow frictionless gliding between structures during movement. However, if they are exposed to repetitive movements (as in running) or trauma (in this case total hip surgery) the bursa can become inflamed. Bursal inflammation is known as bursitis. Iliopsoas bursitis is relatively rare and can be associated with an underlying problem with the hip joint such as such as osteoarthritis. It is therefore critical that a full and accurate assessment of the hip be completed when diagnosing iliopsoas tendinopathy/bursitis.