What Is Iliopsoas Bursitis?
Sometimes a Post-Op Side Effect
Medically reviewed by Oluseun Olufade, MDMedically reviewed by Oluseun Olufade, MD
Iliopsoas bursitis, also called hip bursitis, is inflammation of the iliopsoas bursa. This bursa is a large fluid-filled sac found under the iliopsoas muscle, which supports hip movement. The iliopsoas bursa provides cushion for tendons, ligaments, and muscles to prevent friction during movement.
Inflammation of this bursa can occur from factors such as overuse, hip injury, or hip surgery. Spinal disease or other issues that prevent a normal gait (manner of walking) can also cause this problem. An inflamed bursa can cause pain and prevent normal leg movement.
Since hip pain is a common problem caused by many factors, getting the right diagnosis can be challenging. Other issues, such as arthritis or pain in the psoas muscle (which helps flex the hip joint), can cause similar symptoms. Imaging tests can often help define the cause. Most cases respond to treatment that includes rest and exercise.
This article explains iliopsoas bursitis symptoms, causes, and diagnosis. It also describes treatment and ways to prevent the problem from coming back.
Photo composite by Julie Bang for Verywell Health; Getty Images
How Iliopsoas Bursitis Symptoms Feel
Iliopsoas bursitis and other problems with your hip usually cause groin pain. Most people with iliopsoas bursitis feel pain in the front of their hip and the groin, like a pulled groin muscle. This pain may radiate down the inside of your groin through your thigh to your knee.
Main iliopsoas bursitis symptoms usually involve:
Hip and groin pain that starts sharp and pronounced, then changes into a more persistent and widespread achiness
Stiffness or reduced range of motion in activities that involve bending your hip, such as rising from a seated position, jogging, or walking up stairs
A tendency to avoid lifting the painful leg by leading with the unaffected leg when ascending stairs
Limping while walking to avoid putting pressure on the affected leg
Snapping or clicking within the front of your hip
Tenderness at the affected area when touched
Learn More: Common Cause of Pain With Hip Bursitis
Do I Need an Ultrasound or MRI?
The first step in diagnosing iliopsoas bursitis involves a complete physical examination and discussing how and when your pain began. Your healthcare provider may ask you to perform simple movements, such as standing on the affected leg, to determine the impact of pain on your function.
An imaging test—such as an X-ray, ultrasound, or magnetic resonance imaging (MRI)—can aid in diagnosis if the bursa is too deep for physical examination. These tests can also confirm that the problem is bursitis and is unrelated to a broken bone or other condition.
Your healthcare provider determines the specific imaging technique necessary to diagnose the source of your hip pain. Considerations involve the following:
X-ray: An X-ray provides images of bony structures to identify bone fractures and the characteristics of those fractures. It can also show whether an injury to surrounding soft tissue is contributing to your pain.
Magnetic resonance imaging (MRI): An MRI uses a high-strength magnet and radio waves to produce cross-sectional, multiplanar images (images along the same plane) of structures such as cartilage, tendons, ligaments, and bones. If a subtle fracture or injury exists, an MRI can reveal swelling within the bone.
MRI may be best suited to evaluate damage to cartilage, bone, or other structures inside and around a joint. An MRI may be better if your provider wants a detailed image of an entire joint.
Ultrasound: Ultrasound images are obtained using high-frequency sound waves sent and received through a transducer (a small handheld device). Ultrasound images show details of soft tissues around joints, tendons, and muscles. The technology can provide a higher level of detail in a structure than MRI, especially those that are not very deep.
Ultrasound can effectively diagnose abnormalities near the surface, on the outside of a joint. These abnormalities are readily visible to an ultrasound probe on the skin overlying the structure, making ultrasound ideal for diagnosing hip bursitis.
Ultrasound can also be used in iliopsoas bursitis treatment procedures, such as corticosteroid injections or aspiratio,n so the provider can guide the needle to an exact location.
In many cases, ultrasound is advantageous over MRI in orthopedics because it costs less, is more widely available, and allows for dynamic examination of the musculoskeletal system. Since ultrasound is readily available, it can save time and prevent the need to schedule an MRI in a separate location at a later date.
The Anatomy of the Iliopsoas Muscle
The iliopsoas muscle runs from your lower back through your pelvis, where it attaches to the lesser trochanter (a small bump on the top of your thigh bone near your groin.) This muscle helps you bend your hip.
A fluid-filled sac called a bursa protects and allows the tendon to glide when you make these movements. When this bursa becomes inflamed or overworked, it is iliopsoas bursitis.
Cause of Iliopsoas Bursitis Pain
Inflammation of the iliopsoas bursa can occur when the area becomes overworked or irritated. While the condition can affect anyone, it happens more often in people who are middle-aged or older. Women are more likely to develop it than men.
A Note on Gender and Sex Terminology
Verywell Health acknowledges that sex and gender are related concepts, but they are not the same. To accurately reflect our sources, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
Having any of the following risk factors can increase your chances of developing iliopsoas bursitis pain:
Overuse (repetitive stress) injury: This type of injury can occur from participating in activities such as running, bicycling, or stair-climbing for long periods, especially without proper stretching beforehand. Lifting your leg to get in and out of bed and in and out of a car can also cause this condition.
Hip injury: A hip injury can arise from falling onto your hip, bumping your hip on a hard surface, or lying on your side and exerting pressure on your hip for a long period.
Conditions that affect your spine, hips, knees, and legs: Spine diseases such as arthritis of the lumbar (lower) spine and scoliosis, knee osteoarthritis, pinched nerves, or having one leg shorter than the other (leg-length inequality) can affect the way you walk and contribute to irregular pressure on your hip.
Rheumatoid arthritis: This degenerative condition can make the bursa more susceptible to inflammation because of the stiffness and tightness of the muscles around the joint.
Previous surgery: Surgery on your hip or prosthetic implants, including hip replacement, can irritate the hip bursa and lead to bursitis.
Calcium deposits or bone spurs: These small, hard deposits can develop within the tendons that attach muscles to your trochanter, irritating the bursa and causing inflammation.
What Is Trochanteric Bursitis?
Trochanteric bursitis is another type of hip bursitis. It occurs in the bursa that covers the greater trochanter, the bony part of the hip bone where it meets your femur (thigh bone). This type of hip bursitis usually causes pain in the outer edge of your upper thigh.
Iliopsoas Bursitis Treatment Options
Iliopsoas bursitis treatment options vary based on the severity of your condition and other factors concerning your overall health. Treatment for most cases of iliopsoas bursitis often begins with conservative treatment that addresses the cause of the inflammation.
Pain Relief
The first steps in pain relief of iliopsoas bursitis symptoms involve:
Avoid repetitive hip motions and other activities that aggravate your condition.
Try using a walking cane or crutches to remain mobile without exerting unnecessary pressure on the affected areas.
Apply ice compresses every four to six hours for about 20 minutes at a time to reduce pain and swelling.
Consult your healthcare provider about the use of over-the-counter pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used for limited periods but should not be considered a long-term solution. NSAIDs that may help symptoms of iliopsoas bursitis include:
Nonprescription NSAIDs include:
Prescription NSAIDs include:
Home Exercises and Stretches
Home exercises and stretches can help increase hip strength and flexibility. While these exercises are performed at home without supervision, you should consult a healthcare provider or a physical therapist before starting any exercise while you have pain and/or swelling.
Build in time for warm-up and cooldown in any home exercise routine. Some home exercises and stretches commonly used to relieve Iliopsoas bursitis include:
Press-Ups: This simple exercise stretches the iliopsoas tendon. It is performed as follows:
Lie face down on a mat for a few minutes before starting.
Begin by resting on your forearms with your hands in front of your shoulders.
Push up and support your upper body with your hands.
Keep your pelvis and legs relaxed while you extend your back. This should trigger a stretch within the front of your groin.
Try to hold the stretch for 30 seconds.
Repeat this exercise for three sets, with five to 10 repetitions per set.
Hip adductor stretch: This exercise stretches the hip adductors, a group of muscles on the inner aspect of your thigh that promote balance. It is done as follows:
Lie on your back.
Keep your knee straight and your leg in a straight line with your body, with your toes pointed toward the ceiling.
Slowly move your leg out to the side until you feel a comfortable stretch in your groin.
Try to hold the stretch for up to 30 seconds.
Aim for three sets, with five to 10 reps per set.
Hip bridges: This exercise works all your hip muscles at the same time and is performed in the following way. It is done in the following way:
Lie on your back with both knees bent and your feet flat on the floor.
With your hands at your side, lift your buttocks off the floor by tightening your leg and abdominal muscles, pulling your belly button toward your spine.
Lift your buttocks about 15 inches off the floor, making a bridge with your body and holding the stretch for three to five seconds.
Slowly release and bring yourself back down to the starting position.
Repeat three times, with 10 reps per set.
With a Physical Therapist
Working with a physical therapist can often help speed up recovery. Physical therapy involves a personalized treatment plan that uses hands-on care, patient education, and prescribed movement. If you work with a physical therapist, your program will likely involve the following:
Education on how to avoid or modify certain activities to reduce pain and swelling
"Passive" motion that is performed on your hip and leg to improve your range of motion
Active stretches that you perform with your physical therapist and eventually on your own
Working with weights and cardio exercise equipment to improve strength and agility
Regaining balance through specific exercises
Retraining activities and sport-specific drills to help you return to your normal activities
Following a home exercise program prescribed by your physical therapist
Steroid Injections
A steroid injection involves a single injection of a corticosteroid drug with a local anesthetic into the inflamed bursa. This in-office procedure may provide temporary or permanent relief of pain and swelling.
If symptoms do not improve after a few months, you may qualify for another injection. However, steroid injections can't be used as a long-term solution if the problem persists.
For Infection
Rarely, the iliopsoas bursa can become infected with bacteria, resulting in septic bursa. This can occur when bacteria living on your skin gain entry into the bursa through a cut, scrape, puncture, bug bite, or other trauma to your skin. It can also occur from a previous surgery or corticosteroid injection or as a result of an infection in another part of your body that has spread.
Septic bursa is a serious condition that requires prompt medical treatment to prevent the infection from spreading to other areas of your body. The most serious complication is sepsis or septic shock, a life-threatening infection.
Get immediate medical attention if you develop any of the following symptoms of a bursa infection:
Joint pain and stiffness
Extreme tenderness
Redness and warmth at the skin overlying the affected bursa
Chills
General feeling of illness
Treatment for septic bursitis includes antibiotics. In more severe cases, aspiration of the affected fluid or surgical drainage and removal of the infected bursa sac may be required to eradicate the infection.
Surgical Treatment
Surgery is rarely needed to treat iliopsoas bursitis. If pain persists, fluid may be removed from the affected bursa with a needle.
Surgery is reserved as a last resort for cases in which the bursa remains inflamed and painful despite conservative treatment. Surgical removal of the inflamed bursa (bursectomy) does not interfere with normal hip function.
In some cases, the bursa is removed using minimally invasive arthroscopic surgery rather than open surgery. This procedure is typically faster and less painful than open surgery.
It involves removing the bursa through a one-fourth-inch incision over the hip. An arthroscope, a small camera, is placed into a second incision to guide the instruments during the procedure.
Daily Activities and Movement
A physical therapy program can help you return to your normal lifestyle by helping you to modify daily activities and movement. This program typically involves the following strategies:
Follow a consistent flexibility and strengthening exercise program. This helps to maintain good physical condition of your hip muscles, especially if you are an athlete in a sport's off-season.
Always warm up before starting a sport or heavy physical activity. Pay special attention to stretching your quadriceps (muscles in the front of the thigh) and hamstrings (muscles in the back of the thigh).
Increase activity gradually. Increasing activity or intensity is a common cause of injury.
Get and wear properly fitted shoes, including footwear specific for activities. Use a shoe insert to address any difference in leg length.
Learn and maintain correct posture.
Work to avoid repetitive motion activities you know are harmful to your bursitis.
Rest your hip after activities and if you are having a flare-up. This will help your body to heal.
Establish and maintain a healthy weight if you are overweight to reduce the strain on your hips.
Many people who have pain from iliopsoas bursitis benefit from working with a physical therapist two to three times weekly for a few weeks. The number of weekly visits can be reduced as your symptoms improve.
Warm-up exercises prepare your body for more intense activity. Cool-down exercises are done at the end of your exercise session as you gradually decrease your intensity level. Sample stretching exercises advised by the American Academy of Orthopaedic Surgery (AAOS) include:
Quadricep (front of thigh) stretch is done as follows:
Hold the top of your right foot with your left hand and gently pull your heel toward your buttocks.
Repeat with the other leg.
Calf stretch is done as follows:
Stand close to a solid support and lean on it with your forearms as you rest your head on your hands.
Bend one leg and place your foot on the ground in front of you, with the other leg straight behind.
Slowly move your hips forward to keep your lower back flat without bouncing.
Inner-thigh, hip, and groin stretch is done as follows:
In a seated position, slowly press your elbows into your inner thighs.
Hinge forward at your hip.
Iliopsoas Bursitis Healing Time
Iliopsoas bursitis healing time varies by individual. Factors such as your age, the underlying cause of your iliopsoas bursitis, and the type of treatment you receive can affect your recovery.
Other personal characteristics, such as your medical history and conditions, may impact which treatments are available and relevant. Depending on your situation, iliopsoas bursitis can improve in periods ranging from a few days to a few weeks.
The American Association of Hip and Knee Surgeons (AAHKS) advises that it can take four to six weeks to improve the pain and discomfort typically associated with iliopsoas bursitis. Having surgery can involve longer recoveries. A good stretching program performed two to three times daily is key to managing iliopsoas problems.
Some cases develop into chronic iliopsoas bursitis. This is more likely if you continue putting pressure or stress on an injured bursa before it heals or if you injure your hip after the original episode. Chronic iliopsoas bursitis involves repeated attacks of pain, swelling, and tenderness that go away and return.
Recurring episodes of inflammation can thicken the bursa, which can worsen swelling. This can deteriorate muscles and cause a limited range of motion in the affected joint.
Summary
Iliopsoas bursitis can occur as a result of overuse or repetitive injuries. Having certain health problems that hinder the way you walk can also increase your risk.
While iliopsoas bursitis can cause severe hip pain, the problem often resolves with proper treatment. Getting the right diagnosis ensures that you get appropriate treatment to promote healing. A physical therapist can provide education and movements needed to stretch and strengthen muscles and prevent a chronic problem.
When pain or swelling persists despite conservative treatment, contact your healthcare provider for further treatment. A corticosteroid shot or draining fluid from the affected bursa may be needed. In rare cases, removing out the affected bursa is the only way to achieve relief.
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