The head of the femur (thigh bone) into the socket of the acetabulum (pelvis) forms the ball-and-socket configuration of the hip joint. Occasionally, the femoral head can rub against the acetabular socket incorrectly causing a painful hip condition known as femoroacetabular impingement (FAI). The abnormal articulation of these bones can also cause a tightening of the psoas muscle and iliopsoas tendon or create a pinching sensation of the psoas muscle and the surrounding soft tissues. This hip joint condition, known as psoas impingement, may develop spontaneously or can occur from underlying FAI. Psoas impingement is also known as Internal Snapping Hip Syndrome because the inflammation of the iliopsoas tendon can cause the iliotibial (IT) band to snap across the acetabulum. Dr. Frank McCormick, orthopedic hip specialist serving Orlando, Palm Beach County, and surrounding Florida communities, has the knowledge and understanding, as well as substantial experience, in treating patients who have experienced psoas impingement.
Yes. Athletes are the most susceptible to developing psoas impingement, particularly those involved in sports with repetitive use of the hip flexor muscles such as dancing, gymnastics, and track-and-field. Although a tailored stretching program may help prevent psoas impingement, certain individuals may still be at risk due to underlying hip abnormalities. Psoas impingement can also occur if sitting for prolonged periods of time.
Pain and tenderness deep in the groin area are commonly reported among individuals with psoas impingement. Some other common symptoms of psoas impingement include:
A medical history is obtained by Dr. McCormick with a focus on any previous hip injuries, underlying health conditions, and current symptoms. This is followed by a thorough physical examination to assess the flexibility and strength of the psoas muscle and iliopsoas tendon. Diagnostic imaging studies are also useful tools for confirming a psoas impingement diagnosis. X-rays and magnetic resonance imaging (MRI) can identify any bone-related injuries or damage to other soft-tissue structures.
The majority of patients with psoas impingement find their symptoms are easily managed with conservative therapies alone. Modified physical activity and hip movement combined with non-steroidal anti-inflammatory medications (NSAIDs) can minimize any pain and inflammation. A corticosteroid or local anesthetic can be administered directly into the affected hip joint if symptoms still persist with oral medications. A physical rehabilitation program is also strongly encouraged when appropriate. This physical therapy program should focus on gradual muscle strengthening with tailored stretching exercises to prevent re-injury.
More invasive treatment measures may be required if conservative therapies are unsuccessful at managing symptoms of psoas impingement. A minimally invasive surgical procedure is performed with a small camera (arthroscope) and specialized surgical instruments. Dr. McCormick examines the psoas muscle and iliopsoas tendon and addresses any areas of damage. Fractional lengthening of the iliopsoas tendon can alleviate the muscle and tendon tightness while protecting muscle power and hip flexion strength. Other hip joint irregularities, such as FAI or loose bodies, can also be corrected at the same time.
There can be consequences of a tightened psoas muscle if not addressed in a timely manner. Lordosis, a condition characterized by overarching of the lumbar spine, is often the result of an impinged psoas muscle. Arthritis damage of the lumbar joints can also be accelerated by psoas impingement. When the psoas muscle becomes overstretched, the pelvis can be pushed forward beyond the knees and chest. This postural misalignment can lead to hamstring tightening and a flattened lumbar spine which increases the risk of an intervertebral disc injury.
For more information on psoas impingement, or the excellent treatment options available, please contact the office of Frank McCormick, MD, orthopedic hip specialist serving Orlando, Palm Beach County, and surrounding Florida communities.
