pelvis up and down
The hip, which links the trunk and lower extremities together, the iliopsoas is the main flexor between the trunk and lower extremities. The “iliopsoas” is composed of two muscles, the psoas major (psoas major m.) and the iliacus (iliacus m.) (a small number of people have psoas minor muscles, so some people have three), and the psoas major is one muscle. Originates from the transverse process of the twelfth thoracic vertebra to the fifth transverse process of the lumbar vertebra, passes down through the pelvis, and descends with the iliacus muscle originating from the medial iliac fossa, through the pelvis rim and the anterior border of the hip joint capsule, through the iliac The anterior inferior ridge and the iliopectineal eminence are connected to the lesser trochanter of the femur. There is a bursa between the pelvic rim and the iliopsoas tendon, called the iliopsoas bursa, that provides cushioning between the iliopsoas and the pelvic rim.
The main function of the iliopsoas muscle is to flex the hip (hip flexion) and rotate the thigh slightly (femur external rotation) when the muscle contracts, so The iliopsoas is used in movements such as running and jumping, squatting and sitting, and forward kicking. In addition, the lower limbs do not move, and when the iliopsoas muscle contracts, the pelvis can be tilted forward and the lumbar lordosis can be maintained to maintain the body’s upright and lumbar-straight posture.
Anatomy and function diagram of the iliopsoas muscle
iliopsoas syndrome
iliopsoas syndrome, in short, is a general term for the inflammation and pain of the iliopsoas tendon itself or the soft tissue around the tendon, which may include a diagnosis of iliopsoas muscle Myokeyitis, iliopsoas fasciitis, iliopsoas bursitis, snapping hip…etc. The most common causes are (1) acute injury and (2) overuse due to repeated hip flexion. It can happen at any age, a little more in young people and a little more in women.
Athletes who require more repeated hip flexion or prolonged hip flexion (iliopsoas shortening) are prone to this, such as cyclists (below), rowers , football players, ballet dancers, taekwondo players, judo players, runners (especially those who often run uphill sections)…etc.
When a cyclist rides, the distance between the iliopsoas and the pedal is often shortened, especially when the distance between the seat cushion and the pedal is shortened. It is more obvious when it is too close.
Also sit in a curled baby position (such as a fishing rod position) for long periods of time, lean forward too much when sitting at a desk, or put the soles of the feet on the legs of the chair When you go up or sit on the sofa, lift your feet and put your feet on the bench, which will make the knee joint higher than the hip joint, so that the iliopsoas muscle is in a state of contraction for a long time, which is also prone to symptoms. In addition, hospitalized patients are also prone to symptoms if they sit on the bed for too long, or sit on the bed and play with their mobile phones (as shown on the left in the picture below).
The flexion of the trunk-lower extremity, the knee joint is higher than the hip joint, will make the iliopsoas muscle in a long-term contraction Received status
Symptoms of iliopsoas syndrome
Patients usually There will be pain in the front of the hip joint or in the groin, from dull pain at the beginning to obvious pain later, pain at the beginning of activity but no pain at rest, and pain after movement or rest. Pain usually occurs between sports or after certain sports, such as running, hiking, kicking a ball, sit-ups, or climbing stairs.
Some pains can be induced when standing up after sitting for a short period of hip flexion. Some people experience pain when going up and down stairs. When the pain is severe or the inflammation is severe, you may need crutches to complete the movement of walking.
Groin pain can sometimes radiate to the inside of the knee, especially when standing up; some people feel tightness in the groin or front of the hip combined with pain on the inside of the knee. To be more serious, when standing upright, in addition to the groin and the inside of the knee, the waist on the same side will also feel sore and soft, and a few people will also have a feeling of dull pain in the abdomen.
iliopsoas fasciitis pain range and pain pattern, referred pain trigger points)
Some patients may hear an internal snapping hip on the front of the hip joint when they change from sitting to standing. Because the iliopsoas muscle is tight, during the flexion and extension of the hip joint, it will rub against the pelvic edge to produce sound and pain, which is often associated with iliopsoas bursitis. This situation is more common in young adolescent patients who are in the rapid growth period. In addition to the above pain, some patients also experience pain at the patellar ligament and the front of the knee, because running with tight iliopsoas increases quadriceps tension and patella-femoral pressure.
medial snapping hip
figure
Clinical examination and differential diagnosis
Not all groin pain is iliopsoas syndrome, so clinicians need to do detailed examination and differential diagnosis. The appearance of the hip joint should look for a bulge (hernia) or localized rednessheatheat. Whether there is any abnormality in the range of motion of the hip joint, usually patients with tight iliopsoas should perform external rotation of the hip joint under the bending of the knee joint ( < /span>Fabere-Patrick test ) will feel tight and painful. In addition, a cord can be felt on the lateral border of the inguinal triangle, and there will be tenderness.
X-rays are usually necessary
Adolescents and children must be excludedPediatric avascular necrosis of the femoral head (Legg-Calve-Perthes Disease), Slipped Capital Femoral EpiphysisandApophysitis;pubic Osteitis Pubis
Exclusion of femoral head ischemia in patients with alcoholism or prolonged steroid use Femoral Head Avascular Necrosis
Middle-aged or older, degenerative arthritis of the hip joint and degeneration of the lumbar spine should be excluded Or intervertebral disc disease combined with nerve compression symptoms
There is a history of trauma or an accidental fall of the elderly, and the possibility of hip fracture should be excluded. In addition, dialysis patients or patients with hyperparathyroidism must exclude the possibility of femoral neck stress fracture orbrown tumor. In patients with a history of malignant tumors, the possibility of tumor bone metastasis or pathological fractures must also be excluded.
normal pelvic necrosis of the left hip and pelvis. The symptoms of femoral head necrosis are also very similar to iliopsoas syndrome.
Further imaging studies such as MRI can rule out rupture of the hip labrum, initial avascular necrosis of the femoral head, bursitis, and intramuscular pus Ulcers, lumbar discs and nerve compression.
If the patient has a fever and chills, or the groin is redred and hot, laboratory tests are necessary to rule out unexplained causes. Iliopsoas abscess (iliopsoas abscess). In addition, when iliopsoas tendinitis occurs in the psoas minor, the clinical symptoms will be similar to those of appendicitis, so be careful to identify it!
Clinical treatment
In acute inflammatory pain, the main goal of treatment is to relieve pain and relieve the tightness of the iliopsoas muscle, and restore the ability to walk without crutches. state. Oral anti-inflammatory pain relievers (NSAIDs) and muscle relaxants will be prescribed by general physicians. If necessary, local injection of low-dose steroids and local anesthetics will provide the fastest pain relief. I am worried about the side effects of steroids. The effect of local acupuncture (acupuncture) is also good.
In the acute phase, patients must suspend sports or activities that may increase iliopsoas tone and improve poor sitting posture. Local ice compresses can help relieve pain. Generally, ice compresses are recommended for 15 to 20 minutes every 1 to 2 hours. Gentle iliopsoas stretches can be started during this period, but should not be done right after the ice application, as ice will reduce pain and lead to possible overstretching of the muscle that can cause injury.
After the pain is relieved, the stretching of the iliopsoas can be strengthened, and theRestore full range of motion (ROM) of the hip joint. Restoring the original exercise intensity needs to be gradual and do not be impatient. It is necessary to strengthen the stretching of the iliopsoas before and after exercise. After the pain is completely relieved, the muscle strength training of the iliopsoas should be strengthened and the wrong sitting posture should be avoided.
Self-training at home
stretching
< span>Rehabilitation in the acute pain stage is mainly based on gentle movements. Use a firmer pillow to cushion the junction of the waist and pelvis, bend the painless foot to the chest, and then extend the affected limb. You can lie on the edge of the bed and let the affected limb hang down to stretch the iliopsoas. Each stretch for 20 seconds, then rest for 30 seconds, and repeat 5 times. Remember not to do it after icing to avoid overstretching and further injury. Keep your breath smooth and don’t hold your breath while doing thestretchstretch. This set of movements is also suitable for stretching the iliopsoas when there is no pain.
Iliopsoas stretching method suitable for acute use.
After the pain is relieved, you can start to do advanced stretching exercises. Remember to keep straight and do not lean forward. Picture (A) stretch the affected limb as far back as possible, and picture (B) bend the calf to stretch the iliopsoas and quadriceps at the same time. Hold the stretch for 20 seconds, then rest for 30 seconds and repeat 5 times. This set of movements is suitable for stretching the iliopsoas before and after exercise.
Advanced iliopsoas stretch
figure>
Strengthening exercise
Strengthening exercise, please do it after it is completely pain-free. It is divided into standing and lying positions. The standing posture can be integrated into the warm-up before exercise and the slow-down after exercise.
(A) Standing high stride, slowly raise one foot to knee The joint is slightly higher than the hip, hold for 20 seconds, then slowly lower and switch feet. Loop 20 times on each foot.
(B) Lie down, knees slightly bent about 15 degrees, feet 15 cm off the table or the ground, and then slowly raise your legs Stay for 5 seconds until the knee joint slightly exceeds the hip joint. At this time, the buttocks should be as flat as possible against the bed surface and do not lift. Then slowly lower it back to 15 cm above the ground, and go back and forth for about 30 seconds each time. Cycle 20 times.
Iliopsoas muscle strength training
Summary and Postscript
The iliopsoas originates from the lumbar spine, crosses the pelvis, and joins at the lesser trochanter of the femur. Symptoms of iliopsoas syndrome range from low back pain, low abdominal pain to groin pain and even pain on the inside of the knee. (1) Acute injury and (2) repeated hip flexion are the main causes of iliopsoas syndrome. The treatment method is local low-dose steroid injection for the fastest pain relief (within 15 minutes). Combined with improved sitting posture, cessation of movement, and gentle stretching, you can quickly return to normal life.
The usual improper sitting posture (hip flexion) will cause the iliopsoas muscle to be in a state of shortening and tightness for a long time, plus the lack of stretching and warm-up of the iliopsoas muscle before exercise , it will affect sports performance or be prone to injury. Therefore, athletes who are interested in good sports performance should always be careful not to put themselves in bad postures. In addition, stretching before and after exercise and maintaining the elasticity of the iliopsoas muscle are necessary.
The general public, especially those who lack full-body exercise, the most important way to avoid iliopsoas syndrome is to avoid wrong sitting posture; office workers who need to sit for a long time should pay attention In addition, do not sit on the bed (or the floor) to play with mobile phones or tablets. If you have time, you can do the iliopsoas extension action to maintain the good elasticity of the iliopsoas muscle, and you can avoid iliopsoas syndrome from finding you!
Reference source: Bone Strength Clinic, Rehabilitation Xiao Nanning