Iliopsoas Tendinopathy

Explanation of Diagnosis

Iliopsoas tendinopathy means irritation and overuse of the iliopsoas tendon, a strong hip flexor that helps you lift your thigh and bend at the hip. It often happens when the tendon is repeatedly loaded in a bent-hip position, such as during stairs, running, cycling with a low seat, lifting the knee high, or long periods sitting with hips flexed. Common symptoms include pain in the front of the hip or groin, tenderness when you press the area, and pain or tightness when you lift your knee, climb stairs, or stand up from a chair. Some people also notice stiffness that eases with gentle movement but can flare with activity.

Specific Work Modifications

• Adjust your chair so your hips stay near neutral (not sharply bent) and keep feet flat on the floor.
• Take brief position changes every 30 to 45 minutes, alternating between sitting and standing.
• Limit frequent stair climbing and step-ups when symptoms are flaring; use the elevator when possible.
• Avoid repetitive lifting that keeps your hips flexed; bring the load closer to your body and use a hip hinge.
• If you drive or commute, increase seat height and stop periodically to loosen the hip flexors.
• When working at a bench or desk, use a footrest or alternate-foot setup to reduce sustained hip flexion.

Specific Activity Modifications

• Temporarily reduce activities that repeatedly load the hip flexor, such as high-knee running, sprinting, and soccer-style kicking.
• Avoid deep lunges, high steps, and aggressive stretching that recreates front-of-hip or groin pain.
• If cycling bothers you, raise the seat and shorten rides while you calm symptoms; keep resistance moderate.
• Modify gym workouts by pausing or lightening movements like leg raises, hanging knee raises, deep squats, and sit-ups that increase hip flexor demand.
• Choose lower-irritation options such as walking on level ground and gentle stationary cycling only if pain stays mild and settles after.

Recommended Supplements

• Omega-3 fish oil, typically 1 to 2 grams per day of combined EPA and DHA, may help support a more balanced inflammatory response.
• Curcumin or turmeric extract, typically 500 to 1,000 mg per day with food, may help reduce inflammatory signaling in some people.
• Vitamin D3, typically 1,000 to 2,000 IU per day, can support musculoskeletal health if your levels are low.

Recommended Nutrition and Hydration

Diet Recommendations

• Aim for a protein-rich diet (for example, lean meats, fish, eggs, dairy, beans, and tofu) to support tissue repair.
• Choose an “anti-inflammatory” pattern with vegetables, fruits, whole grains, nuts, olive oil, and omega-3 rich foods.
• Limit added sugars and highly processed foods, especially during symptom flares.
• Stay consistent with meals so your activity and recovery are not followed by large swings in energy intake.

Hydration Tips

• Drink enough water to keep your urine a light yellow color.
• During longer workdays or workouts, add extra fluids and consider an electrolyte drink if you sweat heavily.

Home Exercise Prescription

Do these exercises 4 to 6 days per week, and use a pain-guided approach where discomfort stays mild and does not worsen for hours afterward.

1. Pelvic tilts (hooklying): Lie on your back with knees bent, gently flatten your low back by tightening your belly, then relax; do 2 to 3 sets of 10 to 15 reps.
2. Glute bridge: Lie on your back, tighten your glutes, and lift your hips until your body forms a straight line from shoulders to knees; keep your ribs down; do 2 to 3 sets of 8 to 12 reps.
3. Supported hip flexor isometric: Lie on your back and place your heel on the floor; lightly try to lift your thigh without actually moving much, pressing into a towel or your hand for resistance you can control; hold 10 seconds; repeat 5 times.
4. Side-lying hip abduction: Lie on your side and lift the top knee slightly while keeping your toes pointed forward, then lower slowly; do 2 to 3 sets of 10 reps each side.
5. Gentle standing hip flexor stretch (modified): Use a wall or chair for support and step one foot back, keeping the front hip from collapsing forward; stop at a mild stretch in the front of the hip; hold 20 to 30 seconds; repeat 2 to 3 times.

Stop and avoid any exercise that causes sharp pain, rapidly increasing groin pain, or significant symptoms that carry over and worsen later the same day.

Helpful Books

• "The Sports Medicine Patient Advisor" written by David R. Mattingly
• "8 Weeks to a Healthier Back" written by Robin McKenzie
• "Treat Your Own Neck" written by David Schechter
• "The Mindbody Prescription" written by John Sarno