Overview
Iliopsoas tendinopathy is an overuse or tissue overload problem affecting the iliopsoas tendon, a key hip flexor that runs from the lower spine to the front of the hip. When the tendon becomes irritated or degenerates, it can cause pain in the groin and difficulty with movements that require bending the hip. This condition may also trigger stiffness and weakness because the tendon does not tolerate normal loading well. Symptoms can come and go, often flaring during activity or after prolonged positions.
Symptoms
You may feel pain in the front of the hip or groin, especially when you lift your knee, climb stairs, or stand up from a seated position. Pain often increases with resisted hip flexion and may be tender when pressing near the front of the hip. Some people notice a pulling or tight sensation and reduced hip flexion strength, which can limit running, kicking, or getting comfortable in bed. In some cases, movement may feel catching or "snapping," though this can overlap with other hip problems.
Causes
Iliopsoas tendinopathy most commonly develops from repetitive stress, such as frequent hip flexion during running, hurdling, soccer, or heavy lifting. It can also occur after a sudden increase in training load, prolonged sitting with the hips flexed, or changes in biomechanics that overload the tendon. Less commonly, it may follow a direct injury or persistent strain that fails to fully settle. Over time, the tendon may develop microscopic degeneration and continued sensitivity to stress.
Risk Factors
Higher risk is seen in people who rapidly increase exercise intensity or duration, especially with activities that demand repeated hip flexion. Tight hip flexors, limited hip mobility, poor core or glute strength, and technique issues can increase tendon load. Prolonged sitting, cycling without appropriate hip mechanics, and carrying loads that change posture may also contribute. Age-related tendon changes and previous hip injuries can make recovery slower.
Prevention
You can lower flare-ups by gradually building activity and avoiding sudden spikes in training volume. Improving hip flexor and core conditioning, along with gentle flexibility work, helps the tendon tolerate normal motion. Paying attention to mechanics-such as strengthening the glute muscles for hip stability and keeping pelvis control-reduces overload. During symptomatic periods, temporary activity modification and maintaining a consistent rehab routine can prevent the problem from becoming chronic.
How the Diagnosis Is Evaluated
Clinicians typically start with a focused history about groin pain, what movements trigger it, and whether symptoms relate to overuse or sitting. A physical exam often includes assessing hip range of motion, tenderness near the front of the hip, and pain with resisted hip flexion to help confirm tendon involvement. Imaging is chosen based on severity and persistence: ultrasound may show tendon thickening or irritation, while MRI can help rule out other causes of groin pain such as labral tears, stress injuries, or impingement. X-rays are sometimes used to check for bony causes, especially if symptoms are severe or not improving.
Nonsurgical Treatment Options
Treatment usually begins with activity modification to reduce provocative hip flexion while keeping you moving in pain-tolerant ranges. Physical therapy is central and typically focuses on restoring hip mobility, gradually loading the iliopsoas tendon with strengthening, and improving core and hip stability so forces are distributed better. Short-term pain control may include NSAIDs if safe for you, and heat or ice can help manage irritation depending on what feels best. A corticosteroid injection, often guided by ultrasound, may be considered for persistent pain that limits rehabilitation, though it is usually used as a targeted adjunct rather than the sole treatment. For some patients with refractory symptoms, clinicians may discuss options such as platelet rich plasma (PRP) or other biologic injection approaches, alongside continued rehab.
When to Seek Medical Attention
Seek medical evaluation if groin or front-of-hip pain persists beyond a few weeks despite activity changes, or if it repeatedly limits daily tasks. Get prompt care if you cannot bear weight, have rapidly worsening pain, or notice significant swelling, redness, or fever. Seek urgent assessment for sudden, severe weakness, progressive numbness, or any symptoms suggesting nerve involvement. Also seek care if pain follows a fall or injury with difficulty walking, because a stress injury or fracture must be ruled out.
Frequently Asked Questions
It usually causes front-of-hip or groin pain that worsens with hip flexion, such as lifting your knee, climbing stairs, or standing from a chair.
Often, prolonged sitting with the hips flexed can irritate the iliopsoas and increase stiffness or pain.
Many people improve over several weeks with consistent physical therapy and load management, but longer courses can occur if symptoms have been ongoing.
Not always; most cases improve with rehab first, and injections are considered when pain prevents progress or persists.
You may be able to continue modified activity that avoids the most painful hip flexion movements while following a structured rehab plan.
Next Steps
Start by reducing activities that sharply increase groin or front-hip pain and schedule an evaluation if symptoms persist or keep returning. A clinician or physical therapist can confirm the likely source of pain and guide a loading and strengthening plan tailored to your movements. If you have trouble walking, severe weakness, or concerning symptoms, seek prompt medical care.