Revista de Medicina Desportiva (English) January 2019 | Page 27

Rev. Medicina Desportiva informa, 2019; 10(1):25-27.
Partial Myotendinous Injury
of the Iliopsoas Muscle on a
Professional Football Player
Dr. Nuno Anjinho 1,4 , Dr. José Pedro Marques 2,4 , Dr. Sérgio Rodrigues Gomes 3,4
1
Physiotherapist; 2 Sports Mediicne Specialist 3 Musculoskeletal radiologist; 4 Health and Performance Unit
of the Portuguese Federation of Footbal. Lisbon, Portugal.
RESUMO / ABSTRACT
Acute injuries of the Iliopsoas are uncommon. The authors present a rare case of a professional
soccer player, left footer, who sustained a partial myotendinous tear of the right iliopsoas during a
training session. We implemented a rehab protocol encompassing P.R.I.C.E, physical agents and soft
tissues techniques followed by progressive loading, allowing a successful return-to-play on the 13 th
day post-injury. Since this day he referred no complaints or functional limitations and no recurrences
or relapses were reported in the next three months.
PALAVRAS-CHAVE / KEYWORDS
Iliopsoas, lesser trochanter, magnetic resonance imaging, injury, rehabilitation program.
Introduction
The iliopsoas muscle acts as a hip
flexor and lateral flexor of the trunk,
with contribution to the to the lat-
eral rotation of the hip as well. It is a
pair muscle, symmetric and polyar-
ticular. 1 It originates at the anterior
and lateral aspect of the 12 th dorsal
vertebra and at the transverse apo-
physis of the five low back verte-
bras 1,2 , and then it goes inferior and
laterally, going deeply into the iliac
cavity under the inguinal ligament,
where it fuses with the iliac muscle.
The common tendon travels over
the pectineus eminence, then going
anteriorly to the femoral arcade to
reach its insertion at the small tro-
chanter of the femur Figure 1). 1-4
The overuse injuries are the majo-
rity of the injuries in this myotendi-
nous unit and they are associated to
the excessive and repetitive overload
of the muscle flexors of the hip.
Football is a paradigmatic exam-
ple, in that the iliopsoas muscle is
continuously solicitated to perform
several technical moments (exam-
ple: running, kicking, shots, passes,
and so on). 1  The dominant limb is
the most affected.
We present a clinical case of a
partial myotendinous injury of the
iliopsoas muscle on a professional
football player. Because it is a very
uncommon injury, it is pretended to
discuss the etiology, the diagnosis
and treatment, in order to contribute
to the increase on the knowledge
about this clinical entity.
Presentation the case
Figure 1 – The iliopsoas muscle
(https://foodgreenmood.com/2016/06/10/bellydance-y-
mi-utero/psoas-iliaco/)
It was 19 years old male, profes-
sional football player, left handed,
that on the beginning of the warm-
up for a training session felt an
acute pain in the groin. The player
hid this fact to the medical team
and decide to proceed with the
training because the discomfort was
minimum. On the following day the
pain was worse, and it was referred
to the groin area. On physical exam,
on palpation there was pain over the
anterior aspect of the proximal third
of the thigh, immediately distal to
the inguinal ligament. He also had
pain with resisted hip flexion but
didn’t have pain on the passive
stretching. He didn’t know the
mechanism of injury and he didn’t
have any complains around that
area. The clinical observation was
compatible with pathology on the
iliopsoas muscle and a magnetic
resonance (MRI) was prescribed. It
revealed “para – aponeurotic edema
of the iliopsoas muscle on the
myotendinous transition, with
integrity of the intramuscular
aponeurosis and inserting tendon on
the small trochanter, indicating a
process of partial rupture with slight
disorganization of the fibrillar
structure” (Figures 2 and 3). It was
decided the conservative treatment
and the player underwent the
protocol PRICE and then a program
with increasing loads, assisted with
myofascial techniques and physical
agents (see Table 1). When he was
pain free and after accomplishment
of all the criteria, he went back to
trainings without any limitations. He
returned to play on an official game
13 days after the onset of the injury.
Since that time, he never felt pain or
functional limitations. Until now,
and three months are gone, there
was no reported relapse.
Discussion
It is difficult to find in the literature
review articles or clinical cases
about acute myotendinous injuries
of the iliopsoas muscle, contrary to
what happens with quite often
overuse injuries of this myotendi-
nous structure.
Although we didn’t realize during
training the mechanism of injury
and also the player has had diffi-
culty to explain how the injury
arouse, we can hypothesize that
might occurred in the moment when
the player suddenly stiped the run-
ning. We advocate this hypothesis
because it was on the non-dominant
limb and, as such, we fell that was
less likely the injury occurred during
the more prevalent mechanism:
sudden contraction of the iliopsoas
Revista de Medicina Desportiva informa january 2019 · 25