Iliopsoas Release - Groin - Pain

[karlos.bell]

  Hi all. I am on the hunt for some information and or experiences – knowledge of Iliopsoas release.
I had bilateral surgery April 2015 which has been great but still got this groin burning when I use my legs. The Hip replacement has been very helpful but not completely solved the chronic pain groin.

I had FAI Femoral ace tabular impingement (congenital Issue ) and injury.
Very deep hip sockets the range of movement was very poor.
Example I had locking at 65 degree Flexion so really could not walk up a stair.
There has been changes in the hip to accommodate the FAI and injury.
My resurfacing surgeon is aware of Iliopsoas and has advised me to wait post op 1 year to see if it comes right.

I believe I have had this accumulative with worn hips as well and this has complicated my issues. However seeing another specialist yesterday he informs me I am over the hurdle and on a downward trend.
It seems to be you can fix the root cause but still the muscles - tendons have changed to accommodate whatever has happened. One that looks like it is an issue is iliopsoas.

I have had the injection Ilioposas bursa worked I treat as this is about the only diagnostic tool. As it is not injured, does not show up many issues just is a swollen bursa.

The bursa is a tube in which the Iliopsoas moves in.
The iliopoas sits on front across the hip joint as well so it can also be very confusing to limit this out at the same time as a hip thing.I can strap the groins the issue goes away strapping relaxes the muscles.
There is no studies on strapping but that is what my physio has said.
I also cannot stretch these things this seems to default back to what they were or conditioned themselves to.
They seem to be that tight like guitar strings and they make your hips flinch around and seem like they are clunking but due to tight muscles. Relax iliopsoas (strap) this stops.

So I am wanting to see if anyone here or anyone else has had the experience to release iliopsoas. I have seen some bad press about releases but also read about some very, very  good outcomes.
It may be what  I need to get these groins out of chronic pain.
Obviously I do not want any more surgery just cannot fix it myself that is all.

Look forward to your reply if there are any on this.
Cheers K

[Tim Bratten]

Hi Karlos
I don't know anything about  this procedure but it does sound rather violent. All I can offer is that it doesn't seem like it's been very long since your surgery and maybe you just need more time to fully recover. In my case, I walked  (hiked) a lot with trekking poles, but the first time I tried a brisk hike (maybe 10k) without the sticks at around four months I got some groin pain and had to cut back my activity for a few days before it went away. At around 6 months I tried another 10k without the poles and my hip was sore after but was all better by the next day. Shortly after I was able to put away the poles for my hikes although I still use them when I shoulder up a backpack. The point is it took me six or seven months before I could go on 10k hike without sticks and not feel pain afterwords. Maybe you just need more time (I see De Smet says wait until a year is up before you try the propcedure). Good luck!

[karlos.bell]

Thanks Tim.
Yes that is correct about 1 year. About 8 months now. The procedure is probably worse than we think. Seems to get worse with exercise. I forgot to put in the post of the back issues I did have for a long time. I got those fixed with Disc replacement. But accumulative short iliopsaos muscles will cause iliopsoas tendinitis. I may have had this as well as hip stuff. I will have to keep working through it. Cheers K

[chuckm]

Hi Karlos, changes from arthritis of the hip can really affect the iliopsoas. It can be come degraded with scar tissue.
Then to compound that, hip resurfacing surgery really messes up the iliopsoas bursa. The tendon drops down and rubs across the hip implant instead of gliding through bursa. That is why it is so painful to lift the leg right after surgery.
The body has to heal in that area and create a new way to deal with the friction.
That was the last item from my surgery to come back to normal.
But even then it never was as flexible as the non operated hip. Two years after my surgery I sought out a physical therapy firm that specialized in active release therapy (ART) after hearing others on this site talk about the benefits.
Be patient, it does take time for the bursa area to remodel itself, especially since you have written how bad your situation was before surgery.
But I do recommend the ART. It can be a bit painful how they manipulate the tissue but the results have been good for me.

Chuckm

[karlos.bell]

  Hey Chuck . I am grateful to have respondents like you to help out. Your awesome. Yes I understand exactly what you are talking about and yes I will have to wait more time. My healing seems to be pretty good and yes I am aware of the protrusion. However I did have some of this issue prior to the resurfacing and is so hard to work out which one is causing so much grief.

The resurfacing in my eyes has just made my hips better causing the iliopsoas to swell more and needing to be longer. If I draw my knees up to my chin when sleeping the pain goes away as the same as sitting down so when standing or walking it gets worked up. I believe it is nothing to do with the resurfacing only the resurfacing has highlighted the issue.

I found this article.

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Iliopsoas Tenotomy An iliopsoas tenotomy is a procedure where the surgeon will nick the iliopsoas (psoas) tendon to in effect lengthen a chronically contracted muscle.  This procedure is usually performed during surgery for an underlying hip issue.  Quite often the affected muscle has been so contracted for so long, it would be nearly impossible to resolve the issue through conventional stretching exercises.  Compound that with a irritated joint right under the psoas and the fact that the psoas is difficult to stretch out using conventional methods.  A surgical tenotomy is usually the most efficient recourse for a successful recovery. 
The reason that a psoas is chronically contracted in people with hip issues is because the body is attempting to protect the affected hip from further injury by keeping the femur tight in the pelvis.   The tightening of my psoas was so gradual over a period of at least a year that I never even noticed until it began ‘snapping’.
I was very concerned about tendinitis as a result of this procedure post surgery.  I went very easy on my psoas post op and was very careful with my excercises.  This continued until well into my recovery.  Even after the first few months when the discomfort of the tenotomy resolved, I found I my poas was still weaker than the rest of my surrounding muscles and it was very easy to push that too hard and wind up sore for several days. 
I did experience a level of discomfort post surgery where the tenotomy was performed whenever I contracted or stretched my psoas muscle.  It felt a bit like the sting from a battery on your tongue, or the sting of a needle when giving blood.  Fortunately, that resolved within eleven weeks.
One thing I noticed during recovery was that there would be periods where my psoas would feel completely stretched out without any discomfort.  After activity though, I would have to work very actively to keep it stretched out.  I had to carefully balance stretching with exercise during the course of my rehab.  This lessened significantly after around twelve weeks.  But I still had to work on stretching and strengthening my psoas and surrounding muscles during the entire rehab process.   I have a desk job at work and I was able to get a standing type desk setup.  I would stand nearly all day just stretching my psoas trying to keep it from tightening up.  I was told pre-surgery that I would need this type of work environment modification.  They weren’t kidding.  If I did sit for any longer than an hour I’d have to walk for several minutes just to get all my muscles loosened up again.
I’m told that there are no issues to be aware of regarding the tenotomy once the recovery phase has passed.  I asked about the most psoas loading exercise I could think of (snowshoeing) and I was told, sure thing – six months after surgery.
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It explains yes if you have hips issues basically the iliopsaos compensates or contracts due to the joint. That seems very logical. talking to my old FAI surgeon they do not know why this happens only that it can happen and this can be their fix.
I would assume other muscles can do this as well around the hip joint but these 2 are the only ones that venture mostly through the internal to external of the hip. There is lots of plumbing in this area I have been told by surgeons.
I hope this helps and if others have this issue groin and still hip region it is an area to be on the look out for. The injection completely numbed the situation meaning that this was the issue.

I must learn how to add in a text box etc. Cheers K

[chuckm]

Sounds like you are really on top of this issue.
My experience is that I had a badly contracted iliopsoas before surgery.
Post surgery it was much improved within six months and so my back pain was gone because of that. But it never balanced with iliopsoas on the non-op side. It didn't really hurt but I could feel it restricting a full stride when walking - although I had no observable limp at all.
It did not seem to interfere with returning to playing soccer.
But to improve the length of my stride I would try to stretch the iliopsoas regularly and it would help for that day. But then it returned to the way it was by the next day. If I tried to stretch even more it just became sore so finally I just accepted that it was going to be the way.
Then I tried ART (Active Release Therapy) because of posts on this site. This is done by a trained ART person. The sessions can be painful at times but even a single session would provide huge gains in range of motion. But, just like stretching on my own you would lose those gains - but not as much.
I went two times a week for about two months and then stopped.
It has been six months since and there is no question that it has helped lengthen my iliopsoas. It has also helped loosen my entire lower body including the low back. 
I am definitely going back soon for more sessions.

Chuckm

[karlos.bell]

  Awesome Chuck.
Wish I could play soccer miss kicking that ball. Mine gets that bad I limp then the pain is horrific across the groins (below hip region  area) that bad you almost want to throw up the only way to alleviate it is heavy drugs, or lie down legs drawn up.
However I just have to keep on trucking along. Thanks for your experiences and wisdom I looked up the ART yes it has some advantages. I will probably try it.
Like every thing try it before surgery. Problem is I am running out of years waiting.... its ok better to make the right decision than a wrong one you cannot turn back on.
Sounds like your on to it as well and if it was real real bad you would do something about it.
Mine just does nothing if I try and stretch it. Zilch.
Cheers K

[chuckm]

That is your most vivid description of the pain. I would consider surgery if I were in your shoes.
I think ART might help but it could take years to get to a satisfactory condition because the improvements are slight compared to the drastic results you would need.
Good luck Karlos. Let us know if you find answers.

Chuckm

[karlos.bell]

  Thanks Chuck again for your help on the iliopsoas. The last surgeon I spoke to recently about the lengthening iliopoas has done a few. He does not do resurfacing or Femoral Ace tabular Impingement but does know all about this stuff. At the end of the day there is so much stuff in the hip region it is impossible to go to 1 specialist and get it all sorted one for all!!!!

The most positive thing he said was I am on the the down hill slope whether I have to take this next step or not but also he said "it is what it is" unfortunately. We all seem to have different issues when it comes to muscular skeletal and from my experience some of it is not nice. It is not degenerate so it never gets worse just stays the same until you can really find 100% all of the issues which is causing the pain. So yep those resurfaced hips they are really good now I am most impressed but they are no good to me if I cannot get motivators (ilipsoas) sorted.

I let you know how I get on some time. Cheers K