The Rehabilitation of a Runner With Iliopsoas Tendinopathy Using an Eccentric-Biased Exercise-a Case Report

Abstract

Background and Purpose: While there is much discussion about tendinopathy in the literature, there is little reference to the less common condition of iliopsoas tendinopathy, and no documentation of the condition in runners. The iliopsoas is a major decelerator of the hip and eccentric loading of the iliopsoas is an important component of energy transfer during running. Eccentric training is a thoroughly researched method of treating tendinopathy but has shown mixed results. The purpose of this case report is to describe the rehabilitation of a runner with iliopsoas tendinopathy, and demonstrate in a creative eccentric-biased technique to assist with treatment. A secondary objective is to illustrate how evidence on intervention for other tendinopathies was used to guide rehabilitation of this seldom described condition.Case Description: The subject was a 39-year-old female middle distance runner diagnosed with iliopsoas tendinopathy via ultrasound, after sudden onset of left anterior groin pain. Symptoms began after a significant increase in running load, and persisted, despite rest, for three months. The intervention consisted of an eccentric-biased hip flexor exercise, with supportive kinetic chain exercises and progressive loading in a return to running program. Outcomes:The Copenhagen Hip and Groin Outcome Score, the Visual Analogue Scale, the Global Rating of Change Scale and manual muscle testing scores all improved after 12 weeks of intervention with further improvement at the five-year follow up. After 12 weeks of intervention, the subject was running without restriction and had returned to her pre-injury running mileage at the five-year follow up. Discussion:The eccentric-biased exercise in conjunction with exercises addressing the kinetic chain and a progressive tendon loading program, were successful in the rehabilitation of this subject with iliopsoas tendinopathy. This case report is the first to provide a description on the rehabilitation of iliopsoas tendinopathy, and offers clinicians suggestions and guidance for treatment and exercise choice in the clinical environment. Level of Evidence: 5

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

“…Iliopsoas tendinopathy presents more as anterior hip pain in younger athletes, especially after a rapid growth spurt (Rauseo, 2017). Examination usually reveals painful hip flexors.…”

“…As for other tendinopathies, most patients benefit from conservative treatment (Johnston et al, 1998). Eccentric exercise is an appropriate method to use in the rehabilitation of iliopsoas tendinopathy, as seen in runners (Rauseo, 2017). Rehabilitation treatment is divided into five steps, according to Nanni et al (Nanni, 2017): pain, swelling, and inflammation reduction; range of motion and extensibility recovery; strength and resistance recovery; coordination and proprioception recovery; specific technical movements and athletic sport-specific parameters recovery.…”

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