Iliopsoas Pain: How to Find the Cause & Relieve Pain?

Is the iliopsoas muscle really the source of the problem?

Pain felt in the area where the iliopsoas muscle passes through the groin does not automatically mean that this muscle is the main problem. There are several other structures and mechanisms that can contribute to the pain felt in this region.

💪🏻 Other muscles and surrounding tissues: There are many different structures located in this area! The mere location of the pain is not sufficient to indicate that your iliopsoas muscle is the problem.

🎯 Referred pain: Sometimes, the pain felt in a certain area can be referred from a different source. For example, issues with the back or abdominal organs can cause pain that seems to originate from the region where the iliopsoas muscle passes.

What are the most common causes of pain in this area?

If you have pain in the groin, it is important to distinguish between pain related to the iliopsoas muscle and other possible causes.

Causes related to the iliopsoas muscle

🤦‍♂️ Simple muscle contracture

This occurs when your muscle fibers contract in a prolonged and involuntary manner, which can cause a feeling of stiffness and tension in the affected muscle. The pain usually resolves on its own within a few days.

💪🏃‍♀️ Tendinitis/tendinopathy of the iliopsoas muscle

Often observed in people who engage in sports that heavily involve the hips: dance, running, athletics, etc.

⚡ Psoas muscle tear or strain (muscle pull)

If you experience sudden pain following a sudden movement, such as sprinting.

🦴 Psoas syndrome

Sometimes occurs following hip replacement surgery or hip arthroscopy, when groin pain lasts for several months. See our article on pain after hip replacement.

Or a name given to persistent pain in the psoas area without other explanatory factors.

Source: Dydyk 2023; Zhu 2019

🩸 Psoas hematoma

Following trauma or an overdose of anticoagulants (AVK).

🚨 Most of the time, it’s not the exact cause of your pain that determines the most appropriate treatment, but a combination of factors: your personal preferences, the practices of the professionals you consult, the precise nature of your symptoms and their triggers, etc.

Other causes

🕳️ Inguinal or femoral hernia.

🦴 Hip osteoarthritis or chondropathy.

🤕 Hip injury.

Bursitis, hip dysplasia, fracture, injury, or tendinopathies of other muscles or tendons, pubalgia.

🚽 Urinary infections or kidney stones.

🧠 Vascular or neurological conditions.

Such as compression of the nerve roots in the back, radiating pain to the groin area (radiculopathy).

How to know what’s causing your pain and when to see a doctor?

As you may have noticed, there are more than thirty possible causes for pain in the iliopsoas area.

Three things can help you make an initial assessment:

1️⃣ Did the pain suddenly start after a movement or trauma?

This could suggest a simple muscle contracture or a more serious injury to the psoas… or another tissue in the area, including the thigh bone, the femur!

🔴 An appointment with your doctor seems appropriate to clarify the diagnosis and rule out a fracture or another injury that would require specific treatment.

2️⃣ Is the pain unbearable or very bothersome?

If the pain almost prevents you from putting your foot on the ground and is very intense after a blow or sudden movement, it suggests a fracture or muscle tear.

🔴 An appointment with your doctor seems appropriate to clarify the diagnosis and rule out a fracture or another injury that would require specific treatment.

If the pain is less severe, less constant, and still allows you to walk, then a simple contracture or tendinopathy seems more likely.

🟢 In this case, it does not seem necessary to see a doctor or other health professional for at least a few days, to see if it resolves on its own!

3️⃣ Do you have any other symptoms?

These other symptoms can include, for example, urinary issues, sensory disturbances, difficulty moving the leg, and pain in other areas of the leg.

🔴 In this case, seeing a doctor seems appropriate to help you determine the cause.

What can you do to relieve this pain?

You have nothing more than a contracture, tendinopathy, or unexplained pain in the psoas area: what should you do then?

Here are several possible approaches, depending on what you feel most comfortable with.

1️⃣ Let nature take its course.

Simply go about your usual activities. If the pain increases too much while doing certain things (walking, exercising, sports), reduce the frequency, intensity, or duration of that activity.

Find the right balance between doing too much (which may increase the pain or make it last longer) and doing nothing (which could lead to deconditioning or dissatisfaction).

2️⃣ Implement short-term pain relief measures: conservative treatment.

You can do certain things on your own, such as trying to find more comfortable positions at times. Often, keeping the hip more flexed helps. For example, placing a cushion under your knees if you are lying on your back.

Applying heat to the painful area can also provide relief, while others may prefer cold: there is no contraindication for either as long as you do not have sensory disturbances in this area.

Some people will find relief from self-massage, while for others it will increase the pain. The same goes for stretching. My approach is usually to leave the area alone.

You will, of course, find numerous suggestions on the internet or in magazines for “natural remedies” or “home remedies” to relieve iliopsoas pain: poultices, application of tiger balm or essential oils, homeopathy, etc. Personally, I am less inclined to recommend these types of solutions, as they often rest on less solid theoretical foundations than the other options already mentioned.

3️⃣ Consult a trusted healthcare professional.

Physical therapists, general practitioners, and sports medicine doctors are accustomed to supervising the recovery of people bothered by this type of pain.

If the natural course and the simple measures described earlier have not been enough to improve your situation, other therapeutic modalities may be proposed. Although their effectiveness for this indication is not well established.

For example: TENS machine, therapeutic ultrasound, shock waves therapy, anti-inflammatory drugs (NSAIDs), manual therapy, corticosteroid injections, progressive muscle strengthening and stretching programs, etc.

Osteopaths are also often consulted for this type of pain. However, osteopathy also receives less of my endorsement, because what it does not share with physical therapy and medicine is based on less solid foundations.