Runner’s back / double-sided iliopsoas syndrome / tendinopathy
Rehab for the injury
Rehab mobility and stability – Rehab strength training
Focus on training the rest of the body, so you do not lose your current mobility, stability, and strength. Find out what you can do from workout programs and exercise according to the level you have. Training the rest of the body accelerates healing of your injury for several reasons, two of which are increased nerve activity and circulation.
Description
Iliopsoas syndrome can be divided into two types; the double-sided syndrome also called a “runner’s back”, and one-sided, which is often confused with groin injury, i.e. injury of the adductor muscles.
The muscle originates from the front of the vertebrae as well as the inside of the hip, and attaches to the inner side of the upper thigh. Its main function is to bend (flex) in the hip, which can cause overload from most types of sports, races/running included.
Runner’s back / 2-sided syndrome:
If you have a double-sided iliopsoas syndrome, which usually affects runners, you typically have pain across your lower back when your muscles are cold. That means that the first kilometer on a run hurts the back. When the muscle is warmed up, it becomes longer and more flexible and the pain disappears. But when you finish running and have been in the shower etc. the pain begins again. The paradox is while running exacerbates the problem, it is also during running that the pain decreases. You will often see an excessive curvature of the lumbar spine as the muscle pulls the back forwards (anteriorly). The treatment is mainly exercise therapy that aims to reduce the “resting-pull” of the muscle.
One-sided iliopsoas syndrome:
A unilateral iliopsoas syndrome may result from any type sports, with an increased tendency in football. The pain is located in the lumbar area, but is not provoked by bringing the leg inwards towards the midline (adduction), as a groin injury typically would. The injury can however be provoked when you bend your hip. The muscle must be relaxed so that the hyper-tension is released. If not, the bursae between the pubic bone and the muscle may become irritated, and with a continually tense muscle it is possible to develop an internal snapping hip (coxa saltans) over time. The treatment is mainly exercise therapy that aims to reduce the “restingpull” of the muscle.
Symptoms
- Runner’s back: Basically, you can divide the injury into two types:
- If the injury is double-sided, the injury will most often be located in the back, where excessive curvature of the spine will usually be visible and / or back pain initiates when training begins or after training. The pain will most likely be related to strong hip stretches; e.g. in running, hence the name “Runner’s Back”.
- If the injury is unilateral, the injury will be felt in the attachment area of the groin and possibly in the bursae. It’s not strong enough to pull the back into a sway. The pain is most often provoked by heavy hip stretching and use; e.g. running, soccer and the like.
Examination
- Thomas test. Lie on your back and hold one knee with both hands and then pull it far up to the chest as possible. The other leg should relax without bending the knee.
- Examination of the lumbar curvature.
- The 4 muscle tests – Use, force, stretch of the muscle and applying pressure on the muscle (3 should be positive)
- Conversation about the symptoms.
Treatment
- Use the Rehab programs with mobility, stability and strength of the pelvis to counteract the lumbar curvature and pelvic rotation.
- Thermal treatment.
- Muscle energy technique and others with Manuel Therapist, Sports Injury Therapist or Physiotherapist.
- Spascupreel (2 tabl 3 g. daily for 9 days) as a muscle relaxant.
- Kinesiology tape
The muscles lies too deep to be massaged, although some therapists treat m. Iliacus (part of iliopsoas) along the hip. This has little or no effect as the muscle covers the entire inner hip and can’t be considered treated by grabbing the outermost centimeters.
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