Iliopsoas Syndrome in Dancers

Abstract

Background:Coxa saltans refers to a constellation of diagnoses that cause snapping of the hip and is a major cause of anterior hip pain in dancers. When the internal type is accompanied by weakness or pain, it is referred to as iliopsoas syndrome. Iliopsoas syndrome is the result of repetitive active hip flexion in abduction and can be confused with other hip pathology, most commonly of labral etiology.Purpose:To report the incidence, clinical findings, treatment protocol, and results of treatment for iliopsoas syndrome in a population of dancers.Study Design:Retrospective case series; Level of evidence, 4.Methods:A retrospective database review of 653 consecutive patients evaluated for musculoskeletal complaints over a 3-year period was completed. The diagnosis of iliopsoas syndrome was made based on anterior hip or groin pain, weakness with resisted hip flexion in abduction, or symptomatic clicking or snapping with a positive iliopsoas test. Patients identified with iliopsoas syndrome were further stratified according to age at time of onset, insidious versus acute onset, duration of symptoms, side of injury, presence of rest pain, pain with activities of daily living, and associated lower back pain. All patients diagnosed with iliopsoas syndrome underwent physical therapy, including hip flexor stretching and strengthening, pelvic mobilization, and modification of dance technique or exposure as required.Results:A total of 49 dancers were diagnosed and treated for iliopsoas syndrome. Within this injured population of 653 patients, the incidence in female dancers was 9.2%, significantly higher than that in male dancers (3.2%). The mean age at the time of injury was 24.6 years. The incidence of iliopsoas syndrome in dancers younger than 18 years was 12.8%, compared with 7% in dancers older than 18 years. Student dancers had the highest incidence (14%), followed by amateur dancers (7.5%), while professional dancers had the lowest incidence (4.6%). All patients responded to conservative treatment, and no patients required corticosteroid injections or surgical intervention.Conclusion:This is the largest series reported to date of iliopsoas syndrome in the dance population, treated noninvasively. This study supports that conservative treatment with nonsteroidal anti-inflammatory medication, activity modification, and a physical therapy regimen specific to the iliopsoas should be the primary treatment for patients with iliopsoas syndrome.Clinical Relevance:This study supports current literature and conservative treatment of iliopsoas syndrome diagnosis. Furthermore, this study gives specific information regarding incidence of iliopsoas syndrome in dance populations and provides a test for diagnosis and an algorithm for treatment.

Immediate effect of application of the pressure technique to the psoas major on lumbar lordosis

“…This study is the first paper to describe changes of the lumbar lordosis by the PM pressure technique. Laible et al 20 ) reported that repetitive flexion in an externally rotated hip during a dancer’s passé developpé, often resulted in painless internal coxa saltans. When these patients accompanied by weakness or pain with this area caused by tendonitis or bursitis, it is usually referred as iliopsoas syndrome.…”

Tendinopathies of the hip and pelvis in athletes: A narrative review

“…It is more commonly found in young people with prevalence in females (Dydyk & Sapra, 2020). Iliopsoas tendinopathy occurs most frequently as a result of overuse in sports requiring repetitive hip flexion and external rotation movements (Tyler et al, 2014), such as football, artistic gymnastics, canoeing, uphill walking (Milic et al, 2020) and dancing (Tyler et al, 2014) (Laible et al, 2013) (Brunot et al, 2013). This condition in sedentary subjects could be secondary to hip arthroplasty and arthritis (Tyler et al, 2014).…”

non-arthroplasty iliopsoas impingement in athletes: a narrative literature review

“…38 Also, intraarticular pathology may coexist, 39,40 making them less reliable. Laible et al 41 describe in a retrospective study the "iliopsoas test", which revealed a 94% sensitivity rate in their patient pool. This test consisted of assessing the pain or weakness of the iliopsoas on flexion and external rotation of the hip against resistance, but its accuracy was only measured on professional dancers.…”

“…This test consisted of assessing the pain or weakness of the iliopsoas on flexion and external rotation of the hip against resistance, but its accuracy was only measured on professional dancers. 41 Overall however, there is no pathognomonic sign for iliopsoas impingement on clinical examination and clinical examination in isolation is not sufficient to confirm underlying iliopsoas impingement and further investigations are always necessary.…”