iliopsoas tendonitis

[podgornymd]

I am now about 5.5 months out from left BHR and have had this lingering pain with flexion of my hip. I initially thought it was just tightness and it would go away at least that is what i was told, but it has lingered. I have been very active with biking and swimming and PT. I finally got a hold of my doctor and he thinks it is tendonitis possibly from the head of the femur rubbing against my tendon. He is recommending an injection but i would rather not. It seems to be getting minimally better but not much. has anyone else had this problem and what did you end up doing.?

[Neild5]

This is very common, I am not a big fan of injections.  There are a couple of things to try, do a search here or on Google for IT Band exercises.  A foam roller is very helpful.

[woldaudio]

23 months post with great success. Training for a powerlifting meet and getting mild/moderate IT band pain. Rest, ice and massage therapy working the best for relief.  Can't believe your Doc would want to inject.

[John C]

If you search around the site, you will find a number of cases of this. The two treatments I have read about were the cortisone injection you mentioned, and a minor surgery to partially release the iliopsoas tendon. The theory that I have read most often did not involve the head of the femur, but involved the tendon rubbing across an exposed edge of the cup.
I understand your reluctance to go the cortisone route. If I remember right, you are a doctor yourself. I am just thinking out loud, but there has been a lot of talk recently about using PRP injections for tendon issues in general. I have not heard of it being used in this case, but maybe you could research it.

[podgornymd]

Thanks John. I meant the acetabular cup. I am not convinced that is what i have. It is possible it could be scar tissue.I guess my question is should i be pain free at 5.5 months? Should i give it more time? The pain is mostly when i try and bring my knee to my chest. In general it feels tight around my hip but i had bene doing exercises such as standing lunges which doesnt cause the pain. Did you have sharp pains at 5-6 months.? i know youwere doing squats and lunges and skiing at around 6 months.

[chuckm]

Hi Podgornymd, hip resurfacing results in Iliopsoas pain in every patient. Mine was no different. At my three week check up, I asked my surgeon why it hurt so much and he replied that when the capsule around the hip is cut, the Iliopsoas drops down to run along the bone instead of over the capsule. So there is a lot of healing needed in that area post op.

I did lots of research and concluded on my own that I would not do ANY leg lifts at all. Even getting up out of bed I would lift my leg using my arms. My PT starting at week 4 wanted me to do leg lifts and I refused. I only did light stretching to the area.

At about 3 months I got out of bed one day and didn't need to assist my leg to avoid that pain. It has never hurt since. This plan worked for me as the strength is completely normal and it never hurts.

Also, use a foam roller to relieve the tightness around the hip. It gives amazing results.

Chuckm

[Staggerwing]

Chuckm,
How soon did you start using the foam roller after surgery? 
I have not yet had my surgery (Nov. 8th) but have quite a bit of IT band pain.  So, I got a foam roller and have used it a few times but it is quite painful!  It feels a bit better afterwards but I couldn't believe how much soreness is in that area.  After a few times, I stopped using the roller for now but want to use it after surgery.  Just don't know how long I should wait. 
Thanks,

Nathan

[podgornymd]

Thanks chuckm,   I have been stressing over this for a while. i havent had a problem with it getting out of bed it is mostly flexing toward my chest or leaning forward when sitting. I can bike, lunge adn squat to 90 degrees without that sharp pain. it worries me because i am almost 6months out. i was hoping to be back to almost normal. I am going to hold off on injections for now and give it a lttle more time. i have been using the roller and it has been very helpful. Unfortunatley i did what my PT told me to do although i was their first resurfacing patient. I felt like i was doing too much early on. I hope it wont have lasting consequences. Thanks for easing my stress for the time being.

[hernanu]

Chuckm,
How soon did you start using the foam roller after surgery? 
I have not yet had my surgery (Nov. 8th) but have quite a bit of IT band pain.  So, I got a foam roller and have used it a few times but it is quite painful!  It feels a bit better afterwards but I couldn't believe how much soreness is in that area.  After a few times, I stopped using the roller for now but want to use it after surgery.  Just don't know how long I should wait. 
Thanks,

Nathan

I started using the roller at about three months. It was painful at first, but after the first week or so of religious use (yes, I wore a cassock    ), it really started to loosen up and was bearable, eventually not painful at all.

[Arrojo]

I started in with a foam roller as well as Active Release Technique at 6 weeks.  I use the foam roller pretty much every day now, and have Active Release Technique once a month.  WIll be running my first half marathon post op in a month.

Dont let that scar tissue build up!

[chuckm]

I started using the foam roller at about 4 weeks. When it is that early, you don't actually roll on the foam. You just position yourself over the roller and then lower yourself onto it but only until you feel pressure. Then you lift up again and move to another spot. So you can work from the hip and move down toward the knee. As you progress you want to wriggle around when you lower yourself on. Eventually you begin rolling and can do the whole leg in just a few minutes. But even then, when you feel a little painful spot, you stop the roller right on there and wait a few seconds until the muscle releases and the sore spot goes away. You will find it really helps build arm strength and abdominals while you do these maneuvers.

Hope that helps,
Chuckm

[Staggerwing]

Thanks, guys, that is a big help.  I need to get back to the roller now as well as after surgery. 

[Gazza2]

Regarding the foam roller how soon after surgery,  early on ~3-4 weeks it was too sore for me to use the foam roller, so I started with a rolling pin - running it up and down the IT band and hip.  This helped to ease into the foam rolling. 
For the OP at 5.5 months I would try lots of psoas stretches together with lots of rolling before going down injection route.

[John C]

Hi podgornymd,
In answer to your question, I was one of those people that never had any iliopsoas issues at all. My first day in the hospital I did a couple of hundred leg lifts before the PT came in and freaked out telling me to stop that.
I did have some trochanteric bursa issues off and on right from the first day through the first year or so, but never any iliopsoas pain at any point. I was basically pretty pain free by six months. I did have occasional twinges or aches during or after skiing, and long rides in the car were probably the worst.