Iliopsoas Tendinitis Treatment & Management

Iliopsoas Tendinitis Treatment & Management
Acute Phase Rehabilitation Program Physical Therapy The primary objective of the acute rehabilitation phase is to alleviate pain, spasm, and swelling. A secondary issue, if necessary, is to return the patient to activities of daily living (eg, walking unassisted). A combination of medication, ice, rest, and gentle stretching assists these goals in coming to fruition. A pack of crushed ice in a damp cloth-covered ice bag applied for 20 minutes every 1-2 hours also can provide the patient with relief of pain, spasm, and inflammation. In addition to relative rest (avoidance of activities that stress the iliopsoas muscle), a gentle stretching regimen can assist in reduction of spasm in the iliopsoas complex. Note that stretching must not immediately follow icing, when the sensitivity to pain is lessened, because a potential to overstretch exists. A gentle stretch for the iliopsoas muscle is demonstrated in the image below. Hold the stretch for a count of 20 seconds, relax for 30 seconds, and repeat the stretch 5 times. Caution patients to not hold their breath while maintaining a pain-free stretch. If a normal gait is not present at the time of diagnosis, the patient needs to begin ambulation exercises with the assistance of crutches, gradually moving to partial weight bearing, progressing to full weight bearing, and, finally, walking without an antalgic gait and without assistance. The patient can practice walking in front of a full-length mirror to ensure that ambulatory rhythm and techniques are correct. The average time from onset of symptoms to diagnosis typically ranges from months to years; therefore, most patients may present in the subacute or chronic phases of the condition. Despite this, medical treatment during the acute phase consists of relative rest and avoidance of activities that cause pain. Rarely, crutches may be necessary if sufficient pain is associated with ambulation or activities of daily living. The application of ice for 20 minutes every 1-2 hours for the first 1-3 days is recommended in addition to a short course (eg, 5-14 d) of nonsteroidal anti-inflammatory drugs (NSAIDs) in order to potentially limit inflammation and assist with analgesia. Original article and pictures take http://emedicine.medscape.com/article/90993-treatment site