File
Rauseo C.1
1Total Rehabilitation Centre, San Juan, Trinidad and Tobago
Background: While there is much discussion about tendinopathy in the literature, there is little reference to the less common condition of iliopsoas tendinopathy. In particular, there is no literature in relation to runners, despite the importance of this tendon in energy transfer in runners during the gait cycle. As a result, there are no guidelines on appropriate methods and exercises to rehabilitate such a condition.
Purpose: The purpose of this case report was to describe the rehabilitation of a runner with iliopsoas tendinopathy, and demonstrate a modified eccentric-concentric technique to assist with treatment. A secondary objective was to highlight the use of current research on other tendinopathies to guide rehabilitation of this rare condition.
Methods: The patient was a 39 year old female middle distance runner with sudden onset of left anterior groin pain after increasing her running load, which persisted despite rest for 3 months. A physician confirmed the diagnosis using ultrasound. Pain and disability were assessed with the Visual Analogue Scale (VAS) and Copenhagen Hip and Groin Outcome Score (HAGOS) respectively. Manual Muscle Testing assessed hip strength. These were measured at baseline, after 12 weeks of therapy and eccentric exercise, and at a five year follow-up. The patients perception of overall improvement post intervention was assessed using the Global Rating of Change Scale (GROC) at the 12 week and five year marks. Based on the continuum of tendon pathology, the tendinopathy was staged to help guide intervention. The intervention consisted of a modified eccentric hip flexor exercise, with supportive kinetic chain exercises and progressive loading in a return to running program. The Pain Monitoring Scale was used to guide progression.
Results: The patient noted a decrease in pain within 2 weeks of initiating the eccentric exercise. At the 12 week follow up, she reported being "a great deal better" on GROC. HAGOS scores improved in all subsets and the patient perceived a 4 point improvement in pain on VAS. Manual muscle test scores had also improved and the patient had returned to running unrestricted. At the five year follow up she reported further improvement in pain, although the change was not significant. However, disability and perceived improvement were significantly improved, and she was running at the level she was at prior to her injury.
Conclusion(s): The eccentric exercise used, in conjunction with kinetic chain training and a progressive tendon loading program were successful in the rehabilitation of this patient with iliopsoas tendinopathy. Staging of the tendinopathy, proper monitoring of pain through the loading progression, and patient education were important to the success of this runner. Further research is needed to be able to generalise this study to others with iliopsoas tendinopathy.
Implications: This case report is the first to provide a guideline on the rehabilitation of iliopsoas tendinopathy, and offer clinicians suggestions and guidance for treatment and exercise choice in the clinical environment.
Funding acknowledgements: No funding was used in this study
Topic: Musculoskeletal: lower limb
Ethics approval: Ethics approval was not required
All authors, affiliations and abstracts have been published as submitted.
