Each joint in the body has at least one bursa sac, and often many more. This sac acts as a slick cushion between bones and muscle, providing lubrication to reduce friction between tissues and bones as they move across each other.

You might be suffering from Iliopsoas hip bursitis if:

• You have sharp pain on the (left or right) front of your hip that can start in the side of the groin and extend down the thigh. You may also experience pain in the (left or right) upper buttock extending into the middle of the back.
• You have pain that is worse at night when you lie down.
• You have pain with walking for long periods, climbing stairs or squatting.

If any of those statements are true for you or you're suffering from on-going pain in your hip then you might have an injury called "Iliopsoas hip bursitis".

Many people don't know that chronic hip bursitis has put many sufferers into a wheelchair (chronic = long term, ongoing). The pain of an inflamed bursa can become extreme and it is wise to deal with it quickly. Bursitis of the hip can happen to anyone who regularly stresses the area with repetitive hip and leg movements whether it was due to job-related activity, sports activities, acute trauma to the hip or tissue weakness around the hip (usually due of aging).

Hip bursitis is one of those injuries that can really bring down the quality of your life. Anyone - young or old - can suffer from this injury, and if you're active this condition will keep you from doing the things you love to do. It will interrupt many of your normal daily tasks and make living life harder than it needs to be.

The Iliopsoas Bursa is the largest bursa in the body, and exists to help reduce rubbing between the iliopsoas muscle and the thigh bone. Although an uncommon injury, iliopsoas bursitis happens when this bursa becomes inflamed. Iliopsoas Tendinitis is usually happening at the same time as Iliopsoas Bursitis, as the inflammation of one will inevitably cause inflammation of the other. If you want to reduce the pain of such an injury, it is definitely in your best interest to treat both the tendinitis and the bursitis. We have home treatment devices that treat both and are proven to be very effective.

Your hip flexors are among the most powerful muscles and tendons in your body. They are made-up of; iliopsoas are deep set muscles at the front of your hip and the outer hip muscle (tensor fasciae latae), and rectus femoris and sartorius (they lie over top of the iliopsoas muscles in your front, upper thigh area). The hip flexors help you lift your upper leg to your torso or flex your torso towards your thigh as when sitting up from a lying down position). They help to externally rotate your spine and thigh bone, and also limit your hip extension when walking or running.

Iliopsoas Bursitis affects the bursa underneath the tendon of your iliopsoas muscle, which becomes inflamed and irritated when your iliopsoas muscle is overused.

Iliopsoas bursitis is an overuse injury that results from overloading the hips with repetitive movements. This can lead to a strain of your iliopsoas muscle(s) and tendons.

People who participate in activities such as golf, hockey, cheer-leading, ballet dancing, rowing, gymnastics, and resistance training (sit-ups) are most susceptible to iliopsoas bursitis. This condition is more common in women than men, especially those who have loose ligaments.

Overuse of the Iliopsoas Muscle, changes in equipment or training terrain (mountain bike to road bike, road running to trail running) or changes in the intensity of your activity (increase running time or weight lifting poundage without proper preparation) can result in overexertion, which end in iliopsoas injuries.

Overloading your muscles, tendons and ligaments in the hip with a few specific movements such standing and twisting at the waist without moving your feet or rotating your leg outward can cause iliopsoas injuries. Hurdlers, high jumpers, baseball, soccer players, or athletes who are at risk of getting tackled are prone to this type of injury. Others who participate in activities that involve uphill running and/or jumping, lots of kicking, weight training and heavy lifting (lots of bending and squatting) are also at risk.

Iliopsoas syndrome is caused from an abrupt contraction of your iliopsoas muscle, which results in a tear or rupture of your muscle (normally a partial tear where your muscle and tendon connect).

If you experience iliopsoas bursitis, or iliopsoas syndrome you may experience similar symptoms of inflammation in the tendon or bursa. Symptoms may also include pain, tenderness, swelling, heat or redness and loss of normal mobility.

Pain and tenderness are the most common symptoms and are experienced with iliopsoas bursitis. The pain is found deep in your groin and radiates around to the front of your hip or upper thigh area, and can follow the length of the tendon down toward your knee; it will often move into your lower back and buttock area as well.

Often the reason for the pain is known such as one specific event. Sometimes there may be no major reason or injury that brings it on. If you have iliopsoas bursitis you may experience a slow onset of pain and tenderness that builds up over a long period of time. If you have iliopsoas syndrome, your pain and tenderness will be sudden and sharp.

Pain will generally be experienced for a short period of time during activities like jogging or kicking a ball. You may experience pain when getting up from a seated position, extending your leg while driving, walking up stairs, lifting something heavy or bringing your knee up to your chest (especially against resistance). You may notice that you find it difficult to lie down comfortably without support. Occasionally pain diminishes while in doing an activity, but it returns with a extreme pain when you stop your activity. Average time from initial onset of symptoms to diagnosis ranges generally between 32 and 41 months.

Weakness in your upper thigh/hip area especially when lifting up your knee which results in a limp when walking or running are common with hip bursitis.

Hip stiffness and tightness in groin as well as the knee, can result from a tight iliopsoas muscle. Swelling and increasing amounts of fluid in the bursa can cause added pressure and increased pain and may be accompanied by redness and warmth in the groin.

You may experience clicking, snapping and/or popping hip sounds (crepitus) in your hip. Along with an inflamed iliopsoas bursa or snapping hip syndrome caused by your iliopsoas tendon catching on your pelvis when your hip is flexed. This will also occur with a severe or complete iliopsoas tear. If you have a complete tear it will generally prevent you from walking upstairs.

Should I seek medical attention?

This is up to your discretion; however any continued discomfort in your groin or pelvis area should be investigated. If you continue to experience the iliopsoas tendinitis or bursitis symptoms and have tried the suggested conservative treatments (see conservative treatments for iliopsoas tendinitis or bursitis), it is recommended that you seek professional medical attention. If you experience any of the symptoms noted below it is recommended that you seek immediate attention:

• Severe pain and tenderness.
• Problems or swelling in or around the genitalia (penis, scrotum, testicles).
• A cut, lump or bulge or bleeding in your groin area.
• Major hip/thigh movement problems causing a severe limp.
• Urinary problem.
• A groin rash.
• Postoperative problem after groin operation.
• Exposure to an STD.
• Groin pain has not improved after 1 week, where symptoms are more severe or frequent.
• Signs of shock (light headedness, restlessness, shallow breathing, sweating, weakness and/or nausea.)

Diagnosing iliopsoas bursitis can be difficult as many conditions (iliopsoas tendinitis, hip flexor muscle strain, iliofemoral ligament sprain, etc.) have bursitis-like symptoms. Your doctor will need to narrow down the possibility by run tests to determine if your pain is caused by bursitis or by muscle or joint injury, local bleeding, synovitis, arthritis, tendonitis, cellulitis or a number of other conditions.

You will generally be asked to complete a series of movements to measure your active (performed by you) and passive (performed by your examiner) range of motion. These movements will test any possible, as well as your leg/hip strength, joint stability, and location of tenderness. If you feel sharp pain with both of these motions you may have hip bursitis and/or other related conditions.

In order to rule out other conditions your doctor may recommend blood tests, an x-ray or MRI to investigate your bone structure and/or to examine the soft tissues and fluid in your hip.

Fluid Removal - Your doctor may aspirate (use a needle) to remove fluid from the bursa to check for possible staphylococcus epidermis (or staphylococcus aureus) bacterial infection. The knee and elbow tend to be the joints most prone to septic (infectious) bursitis. If infection is detected you will be prescribed an antibiotic to treat it.

X-rays - X-rays will provide a two-dimensional image of the overall structure of your pelvis. Although bursitis cannot be diagnosed from an X-ray, they are helpful in identifying other possible causes of pain and/or ruling out other conditions.

Some other possible causes of pain that an x-ray can identify include instability, abnormal bone shapes (bone spurs or bone cysts), wear and tear on the joints, avulsion fractures (when a fragment of bone tears away from the main bone along with the muscle, tendon, or ligament as a result of trauma), dislocations, arthritis, calcium deposits in the bursa or joint, and/or other problems.

MRI and CT Scans - You doctor may also order an MRI (magnetic resonance imaging) or a CT (computed tomography) scan for more detailed information to help evaluate the soft tissues (bursa, muscles, tendons, ligaments, fascia, and other connective tissues) in and around your hip joint. They will show fluid next to the muscle, and may identify bursitis, tendinitis, inflammation, tears and other associated conditions.

Diagnostic Ultrasound - Ultrasonography can confirm diagnosis and show tissue tears or thickened tendons. It is good for identifying bursitis and excessive fluid in bursa, and/or ruling out other causes of pain.

Are You Sure It's Iliopsoas Bursitis?

It is possible for you to suffer anyone of the below secondary condition and bursitis at the same time. This occurs when the bursa's outer lining, called a synovial membrane, becomes inflamed and irritated.

Pain, swelling and inflammation in your hip could mean that you have hip bursitis. It's also important to consider that there are other conditions that might cause pain in your hip as well. You hip is a complicated joint with 5 bones, 17 muscles, numerous tendons, ligaments and bursae connecting your leg bone (femur), pelvis and spine all together. With so many connections of tissue to the bone it's easy to see why any pain in the hip can be bursitis or some other injury in the same area. It is common to have bursitis AND another hip condition at the same time.

The only way you can know for sure whether you have hip bursitis is if you get a proper diagnosis for the condition by your doctor. Some other related hip injuries include:

• Iliopsoas Tendonitis involves inflammation and irritation of your iliopsoas tendon and the area surrounding your tendon. Overuse and repetitive activities cause small micro-tears to the iliopsoas tendon tissue.

  Iliopsoas bursitis and iliopsoas tendinitis are similar and often occur at the same time as inflammation of the tendon often causes inflammation of the bursa and vice versa. Both of these conditions have similar symptoms but are less common than other groin strains.

• Iliopsoas Syndrome refers to a stretch, tear or complete rupture of your iliopsoas muscle and tendon where the tendon attaches to your thigh bone. This condition is frequently experienced along with iliopsoas bursitis. Although ruptures do happen, it is rare for your iliopsoas muscle-tendon to rupture completely. A damaged or swollen iliopsoas tendon will typically cause added friction on on the iliopsoas bursa sac, inciting inflammation and pain on the bursa.
• Crystal Deposits in the Joint - Rheumatoid arthritis or gout can cause iliopsoas bursitis. Some people with diseases such as rheumatoid arthritis, gout or scleroderma may contract bursitis from crystalline deposits in the joints. Although not much is known about how this process happens, it is common knowledge that uric acid is a normal byproduct of daily metabolism. If you have gout, you are unable to break down this uric acid properly, leading to crystallisation of this excess acid which gets deposited in joints. These crystals will cause joint pain that can often lead to bursitis.

• Excessive Friction - Iliopsoas bursitis and iliopsoas tendonitis are often caused by excessive rubbing against a broad, shallow groove over which your iliacus and psoas major (muscles) pass (the pubic iliopectineal eminence). The tendon may first become irritated and inflamed, leading to swelling; this swelling will increase friction on the iliopsoas bursa underneath.
• Leg Length Discrepancy may result in a skewed gait (abnormalities in the way you walk) which can cause more pressure on the iliopsoas bursa than usual. In addition, age and degeneration of soft tissue often causes a decrease in your tendon flexibility which can change and/or alter movement in your hip joint, leading to excess friction on the tendon and bursa.

Iliopsoas tendinitis and/or bursitis are common during growth spurts when you are younger because your biomechanics are altered around the hip area. As tendons and muscles in the area get tight, the pelvis begins to tilt, and the rest of the lower body goes out of alignment. This can affect the lower back, hip joints, knees and your gait which can result in lower body joint issues.

• Hip Tendonitis - is a condition where you experience pain, swelling and inflammation from damage or micro-tearing of one or more of the tendons in your hip. The tendons in your hip connect muscle to bone and when these tendons are injured they usually cause pain and tenderness at the front, side and back of your hip, and even into your buttocks as well. If you have hip tendonitis, you could be suffering from different kinds of tendonitis including iliotibial band (IT band) tendonitis, gluteus medius tendonitis, or hip flexor tendonitis (iliacus tendonitis or iliopsoas tendonitis).

• Snapping Hip Syndrome - Snapping hip syndrome is when you feel a snapping sensation or hear a popping sound in your hip when you walk, get up from a chair or swing you leg around. This feeling and/or sound is made by a tendon in your hip as it moves over a bony bump. Most of the time this is more annoying than painful - however, long-term snapping/popping can lead to hip bursitis, a condition that is very painful.
• Greater Trochanteric Pain Syndrome - (GTPS) causes chronic pain on the side of the hip. Symptoms of GTPS include constant pain in the side hip that travels along the whole side of the thigh to the knee and occasionally below the knee and/or buttock. If you have this condition you will probably feel very specific point tenderness on the side of the hip.
• Hip Arthritis - hip joint pain and can be described as a dull aching pain in the groin, outer thigh, or buttocks. You may feel more pain in the morning that could worsen as the day continues but generally lessens as you get more active. Doing anything vigorous can result in pain, stiffness and may limit your movements or make walking difficult. Arthritis means inflammation of a joint and there are a number of types of arthritis of the hip - including:
• Osteoarthritis - the inflammation happens as the smooth covering (articular cartilage) on the ends of bones wears away.
• Rheumatoid Arthritis - an immune system disease that usually affects multiple joints on both sides of the body at the same time.
• Ankylosing Spondylitis - a chronic inflammation of the spine and the point where the spine meets the pelvic bone (sacroiliac joint) that can also cause inflammation in other joints
• Systemic Lupus Erythematosus - an autoimmune disease in which the body harms its own healthy tissues
• Labral Tear - The labrum is the cartilage that surrounds the hip joint. If you have a tear in your labrum you may feel a catching sensation and pain in the hip joint and/or groin as well as stiffness and limited range of motion of the hip. Any changes or abnormalities in the physical structure of the hip can lead to a tear in the labrum cartilage.

• Osteonecrosis - A disease that affects blood flow to an area of bone. This lack of blood flow to the bone in the hip joint causes tissue to die inside the bone and the bone may eventually collapse. Osteonecrosis is a condition that develops in stages, general hip pain is usually felt first that may progress to a dull ache or throbbing pain in the groin or buttock area. If you have this condition you may also have more pain and find it difficult to stand and put weight on you hip. Moving your hip joint will also be painful. These stages can last anywhere from several months to over a year. Early diagnosis of this disease provides a much better outcome with consistent, proper treatment.
• Fractured Hip - Degenerative hip fractures are most common in elderly patients with osteoporosis. Treatment of broken hips requires surgery to either replace the broken portion or repair it with a metal plate and screws. Stress fractures of the hip are most common in athletes who participate in high-impact sports, such as long distance runners. Treatment of stress fractures is usually successful as long as the patient discontinues their high impact activities.

Of all sports injuries that occur, hip and pelvic injuries account for 2-5% of the total. The most common hip & pelvic injuries that happen are muscle and tendon related (musculotendinous injuries), with most of the injuries occurring at the top of the femur (around the lesser trochanter and tendon of the iliopsoas). Iliopsoas tendinitis and iliopsoas bursitis are in the top 5 most common hip injures, yet iliopsoas injuries are poorly recognized/diagnosed as a cause of hip and groin pain.

Conditions and symptoms related to iliopsoas bursitis are snapping hip syndrome, trochanteric bursitis, torn hip labrum, neuromyofascial tightness, iliopsoas tendinopathy, lumbar spine abnormalities, iliopsoas syndrome, iliopsoas tendinitis, inflammation of the tendon, anterior hip pain, groin pain, rheumatoid arthritis, hip fractures, hip overuse syndrome, lumbosacral injuries, osteitis pubis or a groin injury.

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During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort at the location of your soft tissue injury until the pain and inflammation settle. The more diligent you are with your treatment and rehabilitation, the faster you will see successful results!