Revista de Medicina Desportiva (English) January 2019 | Página 28

muscle with flexed hip as it can
occur, for example, on the sudden
blockade of the foot during kicking
or pass. For this acute injury episode,
it might contribute some overuse,
weakness or muscle shortening. By
the way, disfunctions and pain on
this muscle are quite prevalent on
sports like football. 2
On the majority of cases descri-
bing injuries to the iliopsoas muscle,
back pain is present, and it worsens
when the player sits, stands or
keeps standing. They may also have
abdominal, pelvic, inguinal and even
thigh pain 2 , like in the specific case
we present. The clinical diagnosis is
made not only with the subjective
evaluation, trying to understand
the mechanism of injury and the
local pain, but also by the objective
evaluation with muscle length tests
(Thomas e Sarhmann), often pre-
cipitating the complaint (that was
not the case) and the psoas signal
(Figure 4), that was positive. Also, the
functional and analytic muscular
tests (seated and lying on the back),
resisting hip flexion above 90° were
positive. The MRI was the image
exam chosen, because it is the exam
with better sensibility and validity to
identify acute injuries in the ingui-
nal area. 4,5,8  Before a clinical picture
like the one described (acute pain
in the inguinal area after trauma) it
was necessary to make a differential
diagnosis with other pathologies,
including injuries of the labrum,
articular infections, hernias, avas-
cular necrosis of the femoral head,
entrapment of the obturator nerve,
among others. 2
For the treatment, due to the
rarity if this injury, the literature is
scarse. 8 Consequently, the imple-
mented therapy, during all the
time of rehabilitation, was always
related to the daily athlete’s sig-
nals and symptoms, as well as for
the general principles of treatment
of muscle injuries. 6,7  For the same
reason, we had some difficulty to
establish a prognosis for this case in
point. We were convinced because
the player is left-handed and the
injury has occurred on the right side
that would have a positive impact
on the recovery, making the return
to competition faster. This convic-
tion comes from the fact that the
requests on the iliopsoas muscle are
26 january 2019 www.revdesportiva.pt
Figure 2 – Sagittal STIR MRI image: dif-
fuse para-aponeurotic edema (white
arrows) involving the intramuscular
aponeurosis of the iliopsoas muscle
Figure 3 – Axial T2-STIR MRI image:
para-aponeurotic edema involving the
intramuscular aponeurosis (red arrow)
and integrity of the femoral insertion
tendon (white arrowheads) of the iliop-
soas muscle
Table 1. Rehabilitation program for the player
Day
(after
injury)
Treatment / rehabilitation
Observations
1 – analgesic biphasic TENS 250 US/80hz/5’
– Mobilization of the soft tissue (without
stretching)
– Ice 10’ every hour during the day After training he indicates pain on the
thigh; 6/10 AVS on physical exam and
4/10 AVS when walks: Psoas injury
suspected. MRI ordered. Stops training
with the team.
2 – Keeps treatment MRI confirms structural injury of
the iliopsoas muscle.
3 – U.S. pulsatile 1w/cm 2 , 5’1:2
– analgesic biphasic TENS 250 US/80hz/5’
–  Mobilization of the soft tissue (without
stretching)
– Ice 10’ every hour during the day Still with complaints.
No complains during treatment
4 Introduction on the gym
– 10’ bike with minimum resistance
– Bridge with on extension
– Front boards
Nursery:
– We kept treatment + active assisted
mobilization of the lower limb Much better
3/10 AVS on the physical exam, 1/10 EVN
when walks.
No complaints during treatment
5 Introduction to pitch work:
– Slight run, ball driving, short and long
passes, dribbles
Gym work: we kept the structure
Nursery:
– We kept treatment Discomfort on physical exam.
No complaints when he walks.
No complaints on all work
6 Starts training with team (c conditioning:
avoids exercises with flexion of the right
hip – shot and cross and long pass)
Still in the gym and in the nursery No complaints
7-9 Training in the team but still conditioning
Still in the gym and in the nursery No complaints
Training with no limitations
Only gym work:
– 15’ bike with moderate resistance
– Leg extension
– Leg curl
– Strengthening of the adductor and
abductor muscles
– Functional and proprioceptive training No complaints
GAME No complaints and no limitations
10-12
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