Groin Pain and Psoas Inflammation seem to be a post-op problem for many people with hip resurfacing. Listed below are a selection of posts by people about their groin pain and what they have done to solve the problem.
Psoas tendinitis is an important reason for groin pain in resurfacing surgery.*This is peculiar to resurfacing as the cup for resurfacing is a very large profile ie half a sphere. Nearly all THR cups are only portions ( arc) of a hemisphere. Hence if the antero-posterior orientation i.e., version of the cup is marginally off the ideal , it would not be a problem with THR. However in resurfacing, due to the very large profile , if the version is less than ideal the ant edge of the cup will protrude out of the bony front wall of the acetabulum . The psoas tendon will rub on this and patients will typically complain of pain when attempting to lift their leg in a standing position For this reason we now take extra care to get the version right and most resurfacing surgeons leave a 3mm rim of osteophytes over the ant edge as a safety precaution to avoid this problem. with best regards vijay bose chennai
*Information Obtained by Vicky Marlow Freelance Patient Advocate Volunteer 5/08
… if it’s any help, my right hip took 18 months to settle down and 2 years before it stopped giving me trouble after a prolonged and/or intense workout. The trouble was a painful groin/front thigh which my surgeon diagnosed as bursitis. The workouts which caused trouble were anything involving lifting the thigh forward such as running or walking. It’s fine now and causes me no trouble at all.
The psoas muscle set are a cranky bunch….their major objection is generally misuse/overuse for what they were intended….
I am finding that behind every cranky psoas is a lazy glute etal..i.e. the butt muscles who are supposed to be doing the job.. which is why just stretching will not help…just adds to its stress….Just why the glutes go on holidays at the slightest hint of being able too, is something I don’t know the answer too at this point…but it seems they do.
So my suggestion to you is check out the butt muscles… See if they are functioning and that they are always on before you go to lift the leg anywhere, especially in and out of cars which seems to completely upset the psoas…. The main ones are the stabilizers of the hip – the more internal glutes…. Along with some of their assistors around the inside of the groin.
One of the tests I try out on my clients is – lay on side with hips & legs straight but legs off to an angle and see if you can turn your knee to the ceiling and lift the leg keeping the knee turned all the way up and back…. A tight IT band may also come to light doing this… that will also need attention, but the major problem will be glutes asleep on the job.. From what I can see a healthy glute set not only will be able to do this easily, without a few of the thigh muscles trying to get in on the act, but be able to rotate the knee in and out at the top of the range….
If you struggle to do it then more work is needed on the glutes with much attention to making them actually do the work…. Generally meaning you need someone to hold the leg to ensure everyone else stays out of the party as you try hard to get the glutes to do the job….or tie the foot in a thero band tied to wall and try pulling against that, again making sure no one else is doing the job…or take to a pool which seems a slightly kinder way of doing it etc… Big thing is always make sure that the glutes fire first….
Hope this helps,
One thing that helps me to avoid a groin pain upon knee lifts, knee adduction & leg lifts is to first tighten my core, stretch out (lengthen the space between’ the femur and the hip joint by pulling the femur out and lifting up at the hip’ to the top of your head, thus creating plenty of room for making the movement.
I am now at the end of 8 weeks post surgery and I still have a’ significant amount of pain in’ my thigh, groin, back of thigh and knee. This is at rest as well’ as walking – even more at rest’ and during and after sitting.
Sandi, This is a topic that we revisit from time to time.’ Inflammation of the tendons, tendonitis, is one manifestation of’ faulty prostaglandin bioactivity associated with inflammatory’ precursors such as tobacco, alcohol, analgesics, and omega-6 fatty’ acids. Not to mention deficiency of omega-3 fatty acids, vitamins,’ minerals and circulation thereof. Get the circulation going with’ calf contraction, quad contraction, glut contraction, in that order’ while lying supine, 10x for about 4 seconds each, to recharge the’ blood flow from the ground up, about 6x per day. And don’t worry.’ Worry adds to inflammation by its own variety of toxic’ neurochemicals. You’ll be fine, give it time.
As of late, I’ve been having lots of ache at top of my quad muscle and inner groin pain. My PT says my glutes are very weak , but I at present can’t tolerate to do the exercises needed to strengthen.
I started with a new pain two days ago that is in my groin but towards the back of my leg. It is worse when I have to extend that leg or stretch that leg. Feels sort of like a tingle but worse, stops me in my tracks. Sometimes I think it feels muscular but other times I feel like it is in the bone. I’ve been great up to this point so I’m concerned. Anyone else know what I’m describing? Any advice?
I’m six months post-op and still occasionally experience what I call “growing pains.” Not only are your muscles recovering from the surgery, but also from years of not working fully (atrophy due to loss of mobility), regrowing those muscles (hypertrophy), and unlearning those bad habits we developed to compensate for our hips (e.g. one-legged squats to pick stuff up, limping, etc.). There’s a lot of growing and retraining going on. So, it’s like when we were kids – we have growing pains again! 🙂
I have recently visited my surgeon (5th October) who has stated that “it is not right” and believes the problem is the psoas tendon and has recommended I have an injection into the groin/tendon to see if this relieves the pain.
Hello, Stephan. You have had a lot of problems! This thing with the psoas tendon is a common feature of back pain. I have this picture here to show how it is a massive structure and emanates from as high up as the thoracic vertebrae in the chest and ends in the upper end of the femur, just below the hip joint.So this could be contracted for some reason since the surgery. I have heard of it before. But I would try the injections first – probably some depomedrone* and local anesthetic. It’s worth a try. You might also try a good chiropractor as well. Sometimes they can get the muscles to lengthen with manipulation and acu-pressure. However, it is very common for the psoas to get into spasm in the course of back pain in the normal course of events so do not rule out that it just ‘might’ be coincidental to the hip surgery.
Only your doctor can recommend exercises and stretches just for you after hip resurfacing surgery. We recommend you contact your doctor for the proper stretches if you are having problems.
About a month after the resurfacing of my left hip, I would experience an excruciating pain on that side whenever I would attempt to get up and walk after being in a deeply seated position (as in a car seat or a low upholstered chair). It would be very painful to take the first step. But after taking 3 or 4 steps, the pain would disappear entirely. This would happen each time. If I took the time to stretch my left leg a bit after first getting up, it would not be a problem. This went on for several weeks, and did not seem to be improving. When I emailed Ms. Webb about it, she said this was a fairly common observation and suggested I look into a stretching exercise for the iliopsoas muscle (which I had never heard of!). I found this exercise online and started doing that stretch daily. I don’t know whether it was a coincidence or not, but within a few days that pain started subsiding, and within a week or two it was completely gone. I continue to do that stretch as part of my daily exercise routine, and the pain never did return.
90-90 Quad-Psoas Stretch
Here’s a favorite stretch, dubbed the 90-90 Quad-Psoas stretch. It resembles the 90-90 stretch with a twist to more strongly target the quadriceps and hip flexor muscles. Sit on the floor on your left hip with your left leg bent at a right angle in front of you and right leg back behind you somewhat. Gently pull the right foot back behind you as close to your right butt cheek as is comfortable. Rotate your torso to the left until you can rest on your left elbow, and press the right hip forward to enable you to feel a good stretch through the front of the right thigh (quadriceps) and right hip flexor (psoas). As you get comfortable with this position, walk your left elbow even farther left and then rotate your right shoulder toward the floor, maintaining that squeezed hip position. Slowly release the stretch and repeat on the other side. You may find that one hip or quad is tighter than the other; if so, start with the tight side first during future stretching sessions.
Hi ! Psoas inflammation and/or tendonitis seems to be a common issue on this board. I am a sufferer, being about 10 months post-op. My condition is improving at a glacial pace. What I try to do daily is careful psoas stretching, glute strengthening and two kinds of pool-walking:
You will also read of people who get steroid shots in that tendon/muscle with good results, although I am holding that one out as a very last resort. (You will also find that people will think you’re nuts for even considering that.)
I have not found that my surgeon or PT’s have much insight on this, so the board has been SO USEFUL!
Good luck. M
The Psoas Muscles and Abdominal Exercises for Back Pain by Lawrence Gold certified practitioner The Dr. Ida P. Rolf method of Structural Integration, Hanna Somatic Education®