Iliopsoas Bursitis: What Is It and Why Does Your Hip Flexor Hurt?

The iliopsoas is a strong hip flexor muscle. It runs from the lower spine, through the pelvis, and attaches to the top of the thigh bone. A bursa (a thin, slippery cushion) sits between the muscle's tendon and the bone to reduce friction. When that bursa becomes irritated and swollen, the result is iliopsoas bursitis.

This condition is sometimes called hip flexor bursitis. It can overlap with iliopsoas tendinitis, where the tendon itself is inflamed. It can also overlap with iliopsoas syndrome, a broader term for pain from the muscle, tendon or bursa. In some people, the tendon flicks over a bony prominence and makes a click you can hear. This is called snapping hip syndrome.

What does iliopsoas bursitis feel like?

Iliopsoas bursitis usually causes a deep, nagging ache in the groin or the front of the hip. The pain is often hard to point to with one finger. It can be sharp when you first stand up after sitting. It may then settle into a dull throb as you keep moving.

What causes iliopsoas bursitis?

Iliopsoas bursitis is usually caused by repeated friction between the iliopsoas tendon and the front of the hip joint. Anything that increases that friction can trigger it. This includes overuse, an alignment imbalance, or a change to the joint itself.

The iliopsoas crosses both the spine and the hip. So problems higher up or lower down the body can play a part. A difference in leg length, a stiff lower back or a rotated pelvis can all change how the muscle takes load during movement. That is why looking at one area on its own sometimes misses the bigger picture.

How does a standing scan help with pain at the front of the hip?

A standing, weight-bearing scan shows your bones and joints upright, under the load your body carries every day. When you lie down for a normal X-ray or CT scan, gravity is taken away, the muscles relax and small alignment shifts can disappear. This means the scan may look normal even when something is clearly wrong once your body is upright and under load.

EOS imaging captures a full-length view from your ankles to your skull in a single standing exposure, using about 90% less radiation than a standard X-ray, around ten times less. The image shows how your spine, pelvis, hips and legs relate to each other under real load.

For someone with iliopsoas bursitis, this whole-body view matters. A pelvic tilt may be putting extra strain on one hip flexor. A small difference in leg length may be forcing one side to overwork. These patterns show up on a standing scan. A scan of the hip alone, taken lying down, may miss them completely.

What can be done about iliopsoas bursitis?

Treatment for iliopsoas bursitis is managed by your doctor, physiotherapist or orthopaedic specialist. ScanAlign does not provide treatment. What it does provide is detailed alignment information that helps these clinicians make better decisions.

Common approaches include physiotherapy to stretch and strengthen the hip flexor, changing activities to reduce irritation, and sometimes guided injections. If the bursitis has developed because of an underlying alignment problem, dealing with that root cause is often key to lasting improvement.

For people who have iliopsoas bursitis after hip replacement, a standing alignment scan can help the surgical team check whether the position of the new joint is adding to the tendon irritation. An X-ray taken lying down may not capture this information accurately.

Knowing how your whole body lines up, from your feet through your knees, hips, pelvis and spine, gives your treatment team a clearer starting point. Pain at the front of the hip does not always start at the hip. Learn more about how hip alignment assessment works.

Before you start treatment, or change the treatment you are on, it is worth getting a detailed diagnosis. Knowing whether the cause lies in the pelvis, the legs or the spine changes what will actually help.

Frequently asked questions about iliopsoas bursitis