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What is Psoas Tendonitis?

Tendonitis refers to the inflammation of a tendon, which is a band of fibrous connective tissue that attaches a muscle to a bone. The psoas or iliopsoas is a muscle located in the front of the hip joint that provides flexion. It flexes your hips, bends your trunk towards your thigh, and rotates your femur or thigh bone. It is a deep muscle that originates from the lower back and pelvis, and extends up to the inside surface of the upper part of the femur. The psoas tendon can get inflamed from overuse, muscle tightness, and muscle weakness, resulting in a painful hip condition known as psoas tendonitis. Although, the condition can affect people of all ages, it is most often noted in athletes participating in sports such as running, cycling, baseball, swimming, tennis, and hockey. Psoas tendonitis is also known as psoas/iliopsoas syndrome or snapping hip syndrome.

Exercises for Psoas Tendonitis

Exercising may perhaps be the last thing on your mind to do when your joints are stiff and painful. Nevertheless, exercise is a significant part of the treatment for psoas tendonitis to help ease pain and keep you active. Hip strengthening exercises play a crucial role in restoring normal hip function and improving flexibility and strength by specifically targeting the iliopsoas muscles of the hip for better management of psoas tendonitis. Here are some exercises that are designed to stretch, strengthen, and stabilize your psoas muscles.

  • Prone hip extension: Lie flat on your belly with your legs extended straight behind you. Place your folded arms under your head and rest your forehead on your arms. Draw your stomach in towards your spine and stiffen your belly muscles. Now, tighten the thigh muscles and buttocks of the affected leg and lift the leg off the floor about 8 inches backward. Hold this position for 5 seconds with your leg held straight and slowly lower your leg to the floor. Do two sets of 15 repetitions.
  • Side-lying leg lift: Lie on the uninjured side of your body on the floor. Now, stiffen the front thigh muscles of your injured leg and lift the leg about 1 foot away from the uninjured leg. Maintain the leg straight as you lift up and slowly lower it to the start position. Switch sides and do 15 repetitions of 2 sets on each side.
  • Hip flexion (straight-leg raise): Lie on your back on the floor with your legs fully extended in front of you. Bend the knee on one side with your foot positioned flat on the floor. Now, tighten the thigh muscle on the other side of your leg and lift the leg about 8 inches off the floor. Keep this position for few seconds and slowly lower your leg back down to the floor. Do two sets of 15 repetitions.
  • Heel raise: Stand firmly on the floor. Hold the back of a chair or place your hands on the wall for support. Slowly lift your heels few inches off the ground and rise up on the toes of your both feet. Hold this position for couple of seconds and gently lower both the heels to the floor. Do 2 sets of 10 repetitions.
  • Lunges (iliopsoas stretch): Stand straight with your feet hip-width distance apart. Step forward and anchor on the front foot and bend the back knee towards the floor. Keep your back straight and maintain both knees around 90 degrees. Do not let the front knee move forwards past your toes. Do 2 sets of 10 repetitions with the injured leg behind and repeat the same with the injured leg in front. Lunges works on the hip flexors, psoas muscle, and rectus femoris muscle in the hip.
  • Rectus femoris/quadriceps stretch: Stand at an arm's distance away from the wall with the injured leg further away from the wall. Brace yourself by placing one of your arms firmly against the wall with head facing straight ahead. Grab the ankle of the injured leg and pull the heel towards your buttocks. Hold this position for 15 to 30 seconds. Do not twist or bend your back and keep your back straight and knees together.
  • Bridges: Lie down flat on your back on the floor. With bent knees and feet firmly on the floor, rest your palms down near your hips. Now, lift your buttocks as high as possible with a straight back and slowly lower yourself back to the floor. Do 5 sets of 20 repetitions. This exercise works on the hamstrings, quadriceps, hip flexors, gluteal muscles, and lower back.
  • Prone knee extension: Lie flat on your belly with your legs extended straight behind you. Place your folded arms under your head and rest your forehead on your arms. Now, gently bend the injured leg towards your hips until you feel a stretch in your back or leg and lower your leg back to its original position. Do 10 to 15 repetitions of 2 to 3 sets.
  • Trunk rotation: Lie on your back with your knees bent and feet firmly on the floor. Hold your knees together and turn your trunk on one side and hold for 3 to 5 seconds. Now, move your trunk to the opposite side and again holding for 3 to 5 seconds. Contract your abdominal muscles as you rotate the trunk on either side and ensure feet stays on the floor as you rotate. Do 5 to 10 repetitions on each side.
  • ¼ mini-squats: Stand with your feet shoulder-distance apart and stretch your arms out in front of you. Slowly bend your knees into a quarter-sitting posture or 45 degrees position. Keep your chest lifted and back straight without leaning forward. Hold this position for 5 seconds and slowly stand back up to your starting position.

Summary

Gentle stretches and exercises for psoas muscle strengthening can offer significant pain relief, increased mobility, and stronger hip muscles. There are several hip exercises to choose from to achieve this objective. People with psoas tendonitis can experiment with different exercises under their physician’s guidance and choose the ones that work best for them and incorporate them into their daily exercise routine for better management of psoas tendonitis.

  • American Academy of Orthopaedic Surgeons
  • New England Orthopedic Society
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