A 28-year-old male recreational football player presented with an acute onset of significant left hip pain. He described experiencing an acute onset of hip and groin pain while striking a ball during a football match. He was unable to continue and had to be helped from the field. On examination he was unable to walk without assistance. He had pain with deep palpation over the anterior aspect of the left hip. His symptoms were also reproduced with resisted hip flexion – this provoked pain and weakness.
An MRI scan was then ordered to help clarify the diagnosis. This exam shows a partial tear of iliopsoas muscle fibres involving approximately 30% of the muscle thickness. There is a disorganised haematoma surrounding the muscular fascia.
This player had a partial tear involving less than 50% of muscle fibre width (often described as a ‘grade 2’ muscle strain). The player was successfully treated with a period of rehabilitation. The player was able to walk without pain after seven days. At this stage a graded rehabilitation programme was then progressed. This involved a range of soft tissues therapies, with a progressive strengthening and a cross training programme. After two months the patient had made a full clinical recovery. He was pain-free, had completed a running progression and returned to football training without restriction.
The iliopsoas muscle is the strongest flexor of the hip, assists with external rotation and acts as a stabiliser of the lumbar spine and pelvis. The iliopsoas can be injured as a result of acute trauma, as illustrated in this case, or can sustain an overuse injury from repetitive microtrauma. Psoas-related groin pain has been defined as a discrete cause of pain during the Doha agreement meeting on terminology and definitions in groin pain in athletes. This group defined several key clinical findings that might suggest an injury to the iliopsoas muscle group. These are tenderness to palpation over the anterior hip and pain on resisted hip flexion and/or pain on stretching the hip flexors. While these signs were described in reference to more longstanding pain, this case illustrates that these can be important findings following acute injuries as well.
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