Iliopsoas bursa pinching during straddle

Hi All,

I have recently had an MRI done on my left hip and have discovered I have a mild form of Iliopsoas bursitis. This pain is focued in the front of the hip but also stingingly radiates down the ITB. Unfortunately this is having a major effect improving on my range of motion particular during frog stretch, frog rocks and wall middle split pulls.

I just wondering if anybody had a similar problem and if there was any added mobility exercises to help reduce the weakness in my hip.

thanks guys.

What treatment are you having? What has caused the bursitis?

Hi Mark,

In regards to treatment I have been advised to rest from exercises that aggravate the area, and to also have a cortisone injection to reduce inflammation. I have also been given a list of exercises from the physio to help strengthen deeper muscles within the hip for better stabilisation. So far treatment is going well.

In terms of the cause of bursitis I’m guessing overuse training in the area from tumbling.

What is your hip extension mobility like? How many hours of sitting do you do? Are you also performing Foundation?

Hip extension I would say is better than it was a year ago. Can do the front splits on the left leg and almost can on the right leg (its slightly behind). I have been performing all the stretch series once a week consistently for almost a year now and have missed 4 sessions in total in that time. Front split series I have no problem with pain its only straddle series where I feel the sharp pain in certain movements and it’s more down the itb area and in the centre of the groin on the left leg. I will also get a lot of pain when performing a round off or in particular any rotation type tumbling routines.

At work I used to be sitting down all day (8 hours) but within the last 3 months have acquired a standing desk.

Yes I have been performing foundation for about 2 years in-between gymnastic skill training, however since I went to the Adelaide GB seminar last november I feel I have been “cheating” on a few mobility movements and have gone back to the start to properly master them, in particular swivel hips as my internal rotation is terrible.

thanks for your help by the way :-)

Can you post a picture of your swivel hips, bent hurdler stretch and modified Thomas test(do an image search on google). Post a picture of side on and front on for the Thomas test. 

I suspect your lack of internal rotation is the problem. It sounds like you are doing exercises with the tumbling that are exposing your lack of connective tissue preparation. Should you be doing round offs if you have terrible hip internal rotation?

Attached are pics. Thanks Mark for taking the time to have a look. I appreciate it. Its good to know you are thinking along the same lines as myself. 

Josh, 

For the modified Thomas, you need to start the test by placing your Ischial tuberosity (sitz bone) at the edge of a table (or box) hugging one knee close to your chest, while your other leg hangs without touching the floor like picture. Don't forget to take front view (looking directly into your groin) as Mark requested.

http://www.exrx.net/Testing/FlexFunction/ThomasTest.html

Thanks Eva, you saved me from writing those instructions.

 You're welcome! You've saved me from believing my APT won't budge. Even if slightly, the rocks are helping.

No worries thanks for the link Eva, there are so many versions of the Modified Thomas Test on the net :-)

Can you also post a picture of this test.

Hi Mark. Im hoping these are sufficient. Also only just noticed this other test you posted just now I will give this one a go also. Thanks again. 

Also I tried to make sure when i pulled my leg up my lower back was touching the block, is that correct?

Ah, so close! We're starting to see things. Maybe Mark has enough with this. Ideally, you should set up with your butt (sitz bone) by placing it right at the front edge of the mat, so only your glutes end up on the surface of the mat/table (now part of your hamstrings is on the mat). It's the correct entry to this exercise that reveals what's what. I think that if you only use the red mat, it's high enough that your other foot is not touching the floor and it will be easier to place your sitz bone at the edge of the mat. Then gently roll down to horizontal. With elderly, we usually assist them with one arm around their back as they're rolling back to feel safe. Sorry it's an awkward position to begin with!

Nearly the right image.

already can see a tight rectus femorus.

Take 3

Again please correct me if I'm in the incorrect position. 

Nothing obvious with these. What did the physio say is the cause of the bursitis? 

How much walking do you do in a day? And what type of shoes? What other activities do you do in the week that would compromise hip function?

Hi Mark,

Again thanks for taking the time to have a look.

Physio suggested cause - most likely overuse of explosive movements and lack of deep muscle hip strength.

Physio advice – avoid overactivity of the more superficial muscles in low load activities, focus on strengthening the deeper smaller muscles within the hip.

Other Activities:

-          Very limited walking during the day.

-          I have custom orthotics which slip into neutral shoes

-          Standing up for about 3-4 hours a day.

-          Sitting for about 3 hours a day (If sitting I have noticed I will tend to favour/ have more pressure on the left side of the hip.)

-          6 hours a week of gymnastic skill training.

-          3-4 hours a week on foundation, HS, mobility and stretch training.

Just to give you an update:

-          Any training involving explosive internal rotation which highlights the pain has been stopped for the past 5 weeks.

-          Focusing on swivel hips and physio related exercises (hip flexion, hip abduction, hip squeeze and deep abdominal exercises.)

-          I feel like working on my internal rotation mobility has helped.

-          Pain is slowly subsiding but is still noticed in certain stretch movements.

Cheers

It sounds like you are doing everything right. I would increase the walking as this is an easy way to open the hips up and wake up the glutes. You need to wean off the orthotics and get some barefoot time. As we get out of winter this should be easier.

Can you also list the gymnastic skills you are doing and approximate repetitions. 

Thanks for the advice Mark I appreciate it.

In terms of gymnastics skills I am performing basic level 7 Open MAG skills on all apparatus. Im not sure how much detail you are after but below is an example.

A typical week for me:

I will perform skill training from 8am-12pm on Saturdays on all apparatus and on Tuesday night 6-8pm on 3 apparatus. Foundation and stretch series sessions are performed on Tues, Wed and Thurs nights.

Below are my basic routines and we train 30minutes on each apparatus starting with warming up on the individual skills then combining them all in the routine from the 15-20 min mark. However this type of training will vary depending on at what stage of the season we are training in. (this stage described above would be during competition season)

Floor (30 mins)

Front handspring to front tuck sault, scale, round off Arabian, jump to front support, splits, handstand, round off backflip back tuck.

Rings (30 mins)

Muscle up, L-sit, back lever, dorsal hang, dislocate, lay dismount

Vault (30 min)

Handspring

Parallel Bars (30 min)

Kip to L support, basket to upper arm support, back uprise, handstand, lay dismount

High Bar (30 min)

Back uprise, kip, 2x giants, lay dismount

Pommel (30 min)

False scissor, scissor, scissor hop, 2x loops, wendy