Iliopsoas Bursitis

Lower Limb

Overview

Iliopsoas bursitis is inflammation of the bursa located between the iliopsoas muscle and the hip joint capsule, typically resulting from repetitive hip flexion activities or direct trauma. It presents with anterior hip and groin pain, particularly with hip flexion and internal rotation movements. This condition is common in athletes and individuals with hip pathology or muscle imbalances.

Pathophysiology

The iliopsoas bursa is a large synovial sac that reduces friction between the iliopsoas muscle tendon and the underlying hip joint capsule and femoral head. Repetitive hip flexion, prolonged sitting, muscle tightness, or direct compression irritates the bursa lining, triggering an inflammatory cascade with synovial fluid accumulation.

Patient Education

Reducing repetitive hip flexion activities and regular stretching of the hip flexors are essential to prevent recurrence; maintaining hip stability through core and glute strengthening protects the joint and reduces bursal stress.

Typical Presentation

Site

Anterior hip and groin region, may refer to medial thigh and lower abdomen

Quality

Dull ache, sharp anterior hip pain with specific movements, clicking or catching sensation

Intensity

Mild to moderate (3-7/10), often worse with activity and morning stiffness

Aggravating

Hip flexion activities (stair climbing, hill walking, sit-ups), sitting for prolonged periods, lying on affected side, internal rotation of hip, resisted hip flexion

Relieving

Rest, hip flexor stretching, ice application, anti-inflammatory medications, avoiding provocative activities, supine positioning

Associated

Hip flexor tightness, gluteal weakness, reduced hip internal rotation, antalgic gait pattern, possible hip clicking or catching, core instability

Orthopaedic Tests

Test descriptions are written with AI assistance from standard clinical texts. Where a test lists Sources, its description has been checked against them; those sources are independent and do not endorse OsteoKit. Accuracy figures and grades (A–D) appear only when checked against the published study; tests without one are marked “No accuracy study”.

Further reading: full test procedures are described in standard clinical examination texts, e.g. Magee & Manske, Orthopedic Physical Assessment (7th ed.), and Cook & Hegedus, Orthopedic Physical Examination Tests: An Evidence-Based Approach (2nd ed.).

No accuracy study

FABER Test (Flexion, Abduction, External Rotation)

Procedure

Patient supine. Place the foot of the tested leg on the opposite knee and let the knee fall outwards, adding gentle overpressure.

Positive Finding

Pain in the groin or front of the hip.

Interpretation

A general hip provocation test. It does not separate iliopsoas bursitis from hip joint problems. Iliopsoas bursitis is often linked to hip arthritis or a hip replacement; ultrasound or MRI confirms the bursa. The figure stored here belongs to intra-articular hip problems (labral tears, FAI), not to this condition, so no figure is shown.

Sources

No accuracy study

Log Roll Test

Procedure

Patient supine with the legs straight and relaxed. Roll the whole leg inwards and outwards by rolling the thigh, comparing with the other side.

Positive Finding

Groin pain, or reduced or guarded rotation.

Interpretation

Moves the femoral head in the joint without loading the surrounding muscles. Pain points to the hip joint (arthritis, synovitis, fracture) rather than the iliopsoas bursa. It is not an impingement test; the FADIR is the impingement test. The figure stored here belongs to intra-articular hip problems, not to this condition, so no figure is shown.

No accuracy study

Thomas Test

Procedure

Patient sits at the end of the plinth, then lies back hugging one knee to the chest. The other leg hangs down. Look at the hanging thigh, and repeat on the other side.

Positive Finding

The hanging thigh rises above the plinth, or passive hip extension reproduces the patient's anterior hip pain.

Interpretation

Stretches the iliopsoas over the bursa. Pain supports an iliopsoas source (bursa or tendon). Tightness alone is common and not diagnostic.

Sources

No accuracy study

Resisted Hip Flexion (Thomas Position)

Procedure

In the Thomas position with the tested leg hanging, ask the patient to lift the thigh against your resistance.

Positive Finding

Reproduction of the patient's own anterior hip pain.

Interpretation

Loads the iliopsoas in a lengthened position, compressing the bursa. Pain supports an iliopsoas source. Not a validated test.

Sources

No accuracy study

Rectus Femoris Stretch (Prone Hip Extension)

Procedure

Patient prone. Bend the knee to stretch the rectus femoris, then gently lift the thigh into hip extension.

Positive Finding

Pain in the front of the hip or upper thigh.

Interpretation

Stretches both the rectus femoris and iliopsoas. Used to help separate a muscle source from the bursa; not diagnostic on its own.

No accuracy study

Iliopsoas Palpation and Resisted Hip Flexion

Procedure

Patient supine with the hip slightly bent. Find the femoral artery pulse below the inguinal ligament, palpate just lateral to it, then ask the patient to lift the leg against light resistance.

Positive Finding

Deep tenderness or a tender fullness that reproduces the patient's pain.

Interpretation

The bursa lies deep to the iliopsoas, lateral to the femoral artery. Tenderness supports iliopsoas bursitis or tendinopathy. A large, firm swelling in the groin needs medical assessment, as a hernia, enlarged lymph node or vascular swelling can look similar.

Sources

⚠ Red Flags

  • •Severe trauma with inability to bear weight or hip dislocation
  • •Acute onset with systemic fever suggesting septic bursitis
  • •Signs of infection including erythema, warmth, and lymphadenopathy
  • •Progressive neurological deficit suggesting nerve compression
  • •Hip pain with constitutional symptoms suggesting malignancy or systemic disease
  • •Inability to passively abduct the hip suggesting severe capsular involvement

⚡ Yellow Flags

  • •High fear-avoidance beliefs regarding hip movement
  • •Persistent pain disproportionate to clinical findings
  • •Multiple joint involvement suggesting polyarticular disease
  • •Poor exercise tolerance and deconditioning
  • •Prolonged work absence or vocational uncertainty
  • •Passive coping strategies and low self-efficacy for recovery

Osteopathic Techniques

No trials of osteopathic or manual techniques for iliopsoas bursitis were found. For iliopsoas problems, a reference chapter puts stretching, strengthening and changes to training first.

Region

Hip flexors (iliopsoas and rectus femoris)

Technique

Soft tissue, hip and thighNo trials found

Rationale

Eases tension in the hip and thigh muscles. Not tested in trials for this condition.

How it's done & evidence

How it's done

Hands-on kneading, stretching and sustained pressure to the muscles around the hip and thigh: the hip flexors, adductors and hamstrings, and tensor fasciae latae with the iliotibial band.

Evidence in Iliopsoas Bursitis

Searched 24 Oct 2026: no trials of iliopsoas soft tissue technique in iliopsoas bursitis.

Sources

Region

Psoas and iliacus

Technique

Muscle energy, psoas
Grade D
Low evidence: expert consensus or could not be verified against literature
No trials in iliopsoas bursitis. A reference chapter describes MET and counterstrain procedures for the psoas.

Rationale

Low-force MET or counterstrain to ease a tight, tender psoas. Described in a reference chapter; not tested in trials for this condition.

How it's done, cautions & evidence

How it's done

The hip is taken into extension to the barrier (prone, or supine with the leg off the table). The patient pulls the hip toward flexion for 3–5 seconds against equal resistance, relaxes, and the hip is taken further into extension. Repeat 3–5 times, then re-check.

Cautions

Do not use with a fracture in the area, an unstable pelvis or hip, recent surgery, or a patient who cannot contract on request or follow directions.

Evidence in Iliopsoas Bursitis

Searched 24 Oct 2026: no trials of psoas MET or counterstrain in iliopsoas bursitis. Indirect: a StatPearls chapter describes MET and counterstrain procedures for the psoas.

Region

Hip joint

Technique

Articulation, hipNo trials found

Rationale

Gentle, rhythmic movement of the hip joint within its range to ease stiffness. Not tested in trials for this condition.

How it's done, cautions & evidence

How it's done

Rhythmic, low-velocity passive movement of the hip joint within its range, with no thrust, usually with the patient supine. In hip osteoarthritis trials it was given as a course of about 9–10 sessions over 5–12 weeks.

Cautions

Side effects are usually mild and short-lived. In one hip osteoarthritis trial, 41% of the active group (manual therapy plus exercise) reported mild side effects, against 14% with sham.

Evidence in Iliopsoas Bursitis

Searched 24 Oct 2026: no trials of hip mobilisation in iliopsoas bursitis.

Region

Gluteal and deep hip muscles

Technique

Soft tissue, lumbar and glutealNo trials found

Rationale

Eases tension in the gluteal and deep hip muscles. Not tested in trials for this condition.

How it's done, cautions & evidence

How it's done

Hands-on soft-tissue work (kneading, stretching and sustained pressure) to the lumbar paraspinals, quadratus lumborum and gluteal muscles, usually prone or side-lying.

Cautions

Only minor side effects have been reported in trials.

Evidence in Iliopsoas Bursitis

Searched 24 Oct 2026: no trials of gluteal soft tissue technique in iliopsoas bursitis.

Sources

Rehabilitation Exercises

Supine Hip Flexor Stretch (Modified Thomas Test Position)

StretchingBeginner

Couch Stretch / Deep Hip Flexor Lunge Stretch

StretchingIntermediate

Supine Gluteal Bridge with Hold

StrengtheningBeginner

Side-Lying Hip Abduction (Clamshell) with External Rotation

StrengtheningBeginner

Single-Leg Glute Bridge Hold

StrengtheningIntermediate

Side-Lying Hip Abduction Lift Series

StrengtheningBeginner

Core Engagement and Dead Bug Progression

PosturalBeginner

Quadruped Hip Extension with Glute Activation

PosturalIntermediate

Supine Hip Internal and External Rotation Mobility

Range of MotionBeginner

Standing Hip Abduction with Resistance Band

StrengtheningIntermediate

Single-Leg Stance with Hip Stability

BalanceIntermediate

Supine Hip Flexor Isometric Resistance Exercise

StrengtheningBeginner

Referral Criteria

  • •Persistent symptoms beyond 6-8 weeks despite conservative treatment
  • •Suspicion of septic bursitis indicated by fever, severe pain, and local erythema
  • •Signs of hip joint pathology such as femoroacetabular impingement or labral tear
  • •Progressive neurological deficit suggesting nerve compression
  • •Significant functional limitation affecting activities of daily living or work capacity
  • •Failure to improve with appropriate physiotherapy and conservative management
  • •Need for imaging confirmation (ultrasound or MRI) when diagnosis is unclear
  • •Consideration of corticosteroid bursal injection by orthopedic specialist if conservative measures fail