Ileopsoas contracture or lesion
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Ileopsoas
The ileopsoas is a muscle composed by:
– Psoas major: originates from the transverse processes of the lumbar vertebrae, the corpses of the last thoracic vertebra and of all the lumbar vertebrae, intervertebal discs included, and inserts on the lesser trochanter of the femur.
- – Ilium: originating from the concavity of the iliac fossa of the pelvis, from the inner part of the iliac crest, the sacroiliac ligament and the lateral portion of the sacrum. The majority of its fibres converge on the lateral edge of the psoas major and only in a minor part inserts 2,5 cm underneath the lesser trochanter of the femur.
- – Psoas minor: that is the less important from a functional point of view, is placed in the abdomen, in front of the psoas major and it originates from the lateral facet of the body of the twelfth thoracic vertebra and first lumbar and from the interposed disc. It is a weak thoracic flexor.
The main action of the ileopsoas is that of flexing the thigh on the pelvis; the psoas major intervenes in the lateral rotation and at a minor extent, in the medial rotation of the hip.
Injury is a very rare occurrence and it can be a first symptom in haemophiliac patients. More common are bruises, hypo-tonicity and hypo-extensibility of this muscle. The contracture of ileopsoas is very common.
There is no correspondence between anatomic-pathologic condition and functional manifestations.
Before arriving in Isokinetc, you must have probably called on many internist specialists. A subtle starting of pain in the iliac fossa is typical, arising when performing particular movements. It does not provoke prolonged functional impotence, but visibly reduces the sports performance. You can sometimes hear a “click” coming from the articulation, due to hypo-sensibility of the psoas and, so, to the excessive traction on the corresponding tendon, acting as a guitar cord.
The rehabilitative treatment is based on the myofascial massage of ileopsoas, recovery of extensibility and muscular strength, together with an evaluation of the piriform muscle and a reflexology massage of the piriform. Previously, it is necessary to remove a possible joint block and a wrong positioning of the sacrum.
You will be able to return to sports in a short time after a specific and personalised treatment. The ileopsoas injury is a huge functional limitation, determining a condition of worry and caution especially because it is often a muscular injury that is not diagnosed when calling on the first aid.
La lesione dell’ileopsoas è una grande limitazione funzionale, che determina uno stato di frustrazione e preoccupazione, anche perché spesso è una lesione muscolare che, nel pronto soccorso, non viene diagnosticata.
The conservative treatment is the only type of treatment suggested when dealing with this pathology. The therapeutic process is based on: interruption of sports activity for a variable period of time according to the entity of the injury (usually no less than three months); analgesic and antiphlogistic physical therapy for the distal injuries, laser therapy, myophascial massage, specific stretching, subsequent tone of the same muscle, gradual recovery of the specific technical gesture, followed by a relaxing massage or chiropractical kneading in all those cases in which a wrong positioning of the sacrum or sacroiliac and vertebral blocks are diagnosed. To decide when to let the patient get back to sports, it is necessary to keep in mind variables such as the sports activity and the entity of the lesion.
Iliopsoas contracture rehabilitation
It is a very common disease among sportsmen and amateurs, and there is a match between pathological picture and functional manifestations.
The patient complains of a pain in the iliac region, which exacerbates in some movements and does not produce prolonged functional impairment, but greatly reduces the sport. Sometimes the patient reports one joint pop in the groin (SNAP) due to ipoextension of the psoas and then excessive traction on the tendon and a reduction of hip mobility.
The first phase of the treatment protocol is focused on solving the muscular contraction through the massage therapy: iliopsoas myofascial massage, relaxing massage of the lumbar paraspinal loins square, the small and medium gluteal and piriformis reflexology massage that often occurs contract (muscle who works in contrast to the psoas in the movements of the pelvis). At this stage it is important the global postural and pelvis correction through exercises of rebalancing (postures retroversion) and cancellation of the antiverso attitude due to the retraction of the psoas and stretching exercises of the psoas itself, quadriceps, hip flexors of the knee and piriformis to retrieve extensibility.
Solved muscle contracture you can start the next step of the protocol with the aim of rebalancing the muscles: you should perform exercises for reinforcement, especially eccentric, iliopsoas (manual and ballast), quadriceps, buttocks and muscles of cores with free-body exercises, and with the use of destabilizing tools and at the same time will begin the aerobic activity for the metabolic recovery.
Achieved a good compliance between strength and extensibility the rehabilitation protocol ends with the last stage of recovery of the athletic gesture on the sports field, with exercises that involve the hip both from the joint point of view as well as a muscle tendon (hyperextensions of the hip, stage of preparation for kicking the ball). Gradually will then be performed proprioceptive exercises for global development and specific exercises for the core of the sport gesture.
