Iliopsoas Bursa

• A direct blow to the iliopsoas bursa from falling on the outside of the hip or on the buttocks can produce inflammation and irritation. .
• A fall onto the hip or iliopsoas bursa.
• Constant pressure on the iliopsoas bursa from lying on that side.
• Repeated stress or friction injury as the tendon rubs over the iliopsoas bursa during activity.
• Weakness of the muscles over the iliopsoas bursa.
• Complications from rheumatoid arthritis, osteoarthritis or gout.
• Infection of the iliopsoas bursa.
• Tightness of the structures of the hip like the psoas hip flexor, iliotibial band and hamstrings.
• Iliopsoas bursa can become swollen as a response to other hip conditions.

• Pain and tenderness over the location of the iliopsoas bursa especially on the outside of the greater trochanter bursa that may radiate down the outside of the thigh. The iliopsoas bursa will produce groin pain while the ischial bursa may produce pain in the buttock area because this is where the body bares weight while in a sitting position.
•  Swelling
• Loss of motion of the hip
• Pain with activities that stress the iliopsoas bursa like kneeling, jumping, running or activities that cause stress on the tendons that are lubricated by the iliopsoas bursa.

• Initial treatment of bursitis includes avoiding activities that produce pain or stress of the iliopsoas bursa and associated tendons (jumping, running, kneeling, etc.)
• The use of ice to reduce inflammation and pain.
• NSAIDS (non-steroidal anti-inflammatory drugs)
• Physical Therapy to reduce pain and inflammation, improve flexibility and strengthen the surrounding muscles of the hip.
• In severe cases the fluid in the iliopsoas bursa may need to be drained. Fluid can be checked for possible infection.
• Antibiotics if there is an infection of the iliopsoas bursa.
• Surgery may be indicated in extreme cases if the problem becomes chronic.

Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals. Physical therapy for hip bursitis must remain conservative at the onset in order to not aggravate the condition. Emphasis will be on rest, reducing the inflammation and increasing the blood circulation for healing. Once the initial inflammation has been reduced a program of stretching and functional strengthening will be initiated to restore full motion, and improve strength to reduce imbalances and stress on the tendons and iliopsoas bursa of the hip joint.

Common Physical Therapy interventions in the treatment of Hip Bursitis (iliopsoas bursa) include:

• Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to regain mobility and range of motion of the knee. Use of mobilization techniques also helps to modulate pain.
• Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen muscles of the knee to support, stabilize, and decrease the stresses placed on the iliopsoas bursa and tendons of the hip joint.
• Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity and improve movement techniques and mechanics (for example, running, kneeling, squatting and jumping) of the involved lower extremity to reduce stress on iliopsoas bursa and tendons in daily activities.
• Modalities including the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation of the iliopsoas bursa.
• A home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.

• Avoiding the activities that produce the pain or stress the iliopsoas bursa is the first line of treatment.
• RICE: (Rest, Ice, Compression, Elevation) should be used to reduce the stress on the iliopsoas bursa.
• NSAIDS (non-steroidal anti-inflammatory drugs) to reduce pain and inflammation.
• Needle drainage to remove excessive fluid from the iliopsoas bursa.
• Injection of steroids to reduce inflammation in iliopsoas bursa.
• In the case of infection, antibiotics may be prescribed,
• In severe recurrent conditions surgery to remove the iliopsoas bursa may be indicated.