Iliopsoas tendonitis is inflammation or irritation of the tendon connecting your primary hip flexor muscle to your thighbone. It causes pain in the front of the hip or groin that worsens with activities like walking, running, or standing up from a seated position. The condition is especially common among dancers, runners, and athletes who repeatedly flex their hips, though it can affect anyone.
The Muscle Behind the Problem
The iliopsoas is actually three muscles bundled together: the psoas major, psoas minor, and iliacus. They run from your lower spine and the inside of your pelvis, merge into a single tendon, and attach to a bony bump near the top of your thighbone. This muscle group is the strongest hip flexor in your body, responsible for lifting your thigh toward your torso every time you take a step, climb stairs, or sit down.
Beyond movement, the iliopsoas plays a stabilizing role you probably never notice. The psoas major holds your lumbar spine steady when you’re sitting, and the iliacus keeps your pelvis aligned during running. The psoas major also helps seat the ball of your femur snugly into the hip socket during the first 15 degrees of movement. When the tendon connecting this complex to your thighbone becomes inflamed, all of these functions can become painful.
Who Gets It Most Often
Dancers are one of the best-studied populations. In a review of 653 dancers evaluated for musculoskeletal complaints over three years, 7.5% were diagnosed with iliopsoas syndrome. Female dancers were nearly three times more likely to develop it than males (9.2% versus 3.2%). Younger dancers were hit hardest: those under 18 had a 12.8% incidence compared to 7% in adults. Interestingly, amateur dancers had the highest rate at 14%, while professionals had the lowest at 4.6%, likely because professionals have better conditioning and biomechanics from years of training.
Runners, soccer players, gymnasts, and anyone whose sport demands repeated hip flexion face elevated risk. But you don’t have to be an athlete. Prolonged sitting with tight hip flexors, sudden increases in activity, or muscle imbalances in the core and hips can all contribute.
What It Feels Like
The hallmark symptom is a deep ache or sharp pain in the front of your hip, often radiating into the groin. Some people also feel it in the lower back, particularly where the base of the spine meets the buttocks. The pain tends to worsen when you try to stand up straight after sitting, walk uphill, or lift your knee toward your chest. Stiffness and tightness in the lower back or hip are common, especially first thing in the morning or after sitting for a long time.
In some cases, you may also feel or hear a snapping sensation in the front of your hip when you walk or swing your leg. This happens when the irritated iliopsoas tendon catches on bony structures underneath it, such as the front of the femoral head or a ridge on the pelvis. This is called internal snapping hip syndrome, and it frequently overlaps with iliopsoas tendonitis. The snapping itself isn’t always painful at first, but over time it can worsen the tendon irritation.
How It’s Diagnosed
Doctors typically start with physical exam maneuvers that stress the iliopsoas in specific ways. One common test involves lying on your back and pulling one knee toward your chest while the doctor watches whether your opposite leg lifts off the table involuntarily, a sign of iliopsoas tightness called a positive Thomas test. Another approach is the FABER test, where your hip is placed in a figure-four position (flexed, rotated outward, with your ankle resting on the opposite knee). Pain in the front of the hip or groin during this maneuver points toward the iliopsoas tendon as a source.
If snapping hip is suspected, you may be asked to actively flex your hip to 90 degrees and then sweep it in a circular motion back down to an extended position. A palpable clunk during this movement confirms iliopsoas snapping. Imaging adds another layer. On ultrasound, a thickened tendon with increased blood flow signals active tendonitis, while fluid collecting between the tendon and the hip joint capsule suggests bursitis (the bursa and tendon sit right next to each other, so both can be involved). MRI can show similar findings and help rule out labral tears or other hip joint problems that mimic iliopsoas pain.
Conservative Treatment and Rehab
Most people recover without surgery. The first step is relative rest: reducing or temporarily stopping the activities that provoke pain. This doesn’t mean total immobility, but rather a shift away from aggravating movements for the first four to six weeks while rehabilitation gets underway.
A structured physical therapy program typically runs about 12 weeks and follows a progressive pattern. In the first month, the focus is on gentle hip stretches targeting the iliopsoas, hamstrings, glutes, and piriformis, alongside eccentric hip flexion exercises. Eccentric exercises involve slowly lowering a load rather than lifting it, which helps remodel the irritated tendon. These are usually done for three sets of 15 repetitions, twice a day, at a pace that produces moderate discomfort but not severe pain. Core stability work, single-leg bridges, forward lunges, squats, and resisted lateral walks fill out the early program.
During weeks five through eight, exercises progress to unstable surfaces like a balance trainer, single-leg deadlifts, and weighted core work. The final month introduces multi-directional lunges with added weight, more advanced bridging progressions, and sport-specific loading. A gradual return to running or other high-demand activity begins during this phase. Load is increased whenever pain becomes minor or absent during the exercises.
Injections
When physical therapy alone doesn’t provide enough relief, an ultrasound-guided corticosteroid injection into the iliopsoas bursa is a common next step. The injection delivers anti-inflammatory medication directly to the irritated area. Research shows about 75% of patients experience meaningful improvement, with significant gains in pain, physical function, and activity levels measured at both three and six months after the procedure. Studies using this technique have reported no adverse events, making it a relatively low-risk option when conservative care stalls.
Injections work best as a bridge: they reduce pain enough for you to engage more effectively in physical therapy, not as a standalone fix. Without addressing the underlying tightness, weakness, or movement patterns that caused the tendonitis, symptoms often return.
When Surgery Is Considered
Surgery is reserved for cases that don’t respond to months of conservative treatment and injections. The most common procedure is an arthroscopic iliopsoas tendon release, where the tendon is partially cut or lengthened through small incisions using a camera-guided instrument. In the largest review of outcomes, over 90% of releases were performed at the level of the hip labrum, with the remainder done lower on the thighbone. Results across studies showed satisfactory return to sports and daily activities.
One trade-off to be aware of: releasing the tendon can cause some degree of hip flexion weakness, at least temporarily. Post-surgical rehab focuses on gradually rebuilding that strength. For most people, the weakness is mild and improves over several months.
What Recovery Looks Like
With consistent physical therapy, many people notice meaningful improvement within the first four to six weeks, though full recovery from a structured 12-week program means three months before you’re back to unrestricted activity. More stubborn cases that require injections or surgery add time. The key variable is compliance with the eccentric loading program and patience with the early activity restrictions. Returning to aggravating activities too quickly is the most common reason for setbacks, particularly in runners and dancers who are eager to get back to training.