Does iliolumbar syndrome cause difficulty walking and sitting

If you experience pain in the lower back or pelvic area that sometimes radiates to the upper thigh, and you notice that walking has become more difficult or that the pain worsens after sitting for long periods, you may be dealing with what is known as iliopsoas muscle syndrome. This condition is considered one of the common muscular disorders that affect hip movement, due to the key role this muscle plays in flexing the thigh and supporting normal walking.If the symptoms are ignored, what starts as mild pain may gradually develop into a problem that interferes with daily activities such as standing or climbing stairs. In this article from Dalili Medical, we explore how this syndrome affects walking, the relationship between prolonged sitting and increased pain, as well as the most effective treatment methods to relieve symptoms and restore normal mobility.

What Is Iliopsoas Syndrome?

Iliopsoas syndrome is a painful condition caused by spasm, inflammation, strain, or tearing of the iliopsoas muscle (sometimes referred to as the “soul muscle”). This condition can lead to pain in the lower back, hip area, and upper thigh, and its symptoms may sometimes resemble those of a herniated disc. It commonly develops due to prolonged sitting, repetitive mechanical stress, or weakness in the muscles surrounding the pelvis.

Is Iliopsoas Syndrome Serious?

In most cases, this syndrome is not considered dangerous. However, it can be very uncomfortable and may become a chronic condition if it is not managed properly with appropriate treatment and rehabilitation exercises.

Where Is the Pain Usually Located?

The pain commonly appears in the following areas:

Lower abdomen
Groin area (upper inner thigh)
Lower back
Sometimes the front of the hip joint

Does It Cause Difficulty Walking?

Yes, this condition may cause difficulty walking. Some people experience a slight limp or stiffness during movement because the iliopsoas muscle plays a major role in hip motion and normal walking.

Can Iliopsoas Syndrome Improve on Its Own?

Mild cases may improve on their own. However, most cases require therapeutic exercises, lifestyle modifications, and physical therapy to prevent recurring symptoms or progression into a chronic condition.

Does Sitting Make the Pain Worse?

Yes, prolonged sitting is one of the most common factors that increase muscle tightness and pain because it keeps the hip in a constantly flexed position, which increases pressure on the iliopsoas muscle.

Can Exercise Make the Pain Worse?

Yes, exercises may increase the pain if they are performed incorrectly or too aggressively. However, proper and gradual exercises are considered one of the most important treatment methods, as they help relieve muscle tightness and improve movement significantly.

How Can Iliopsoas Syndrome Be Distinguished from a Herniated Disc?

In Iliopsoas Syndrome:

Pain usually increases with hip movement or hip flexion.
The pain is commonly located in the groin, pelvis, or lower back.

In a Herniated Disc:

Pain may radiate down the leg.
It is often associated with numbness, tingling, or an “electric shock” sensation.

Is Exercise Helpful or Harmful?

Light exercises such as walking and stretching are very beneficial because they improve muscle flexibility and reduce tightness. However, intense workouts or heavy physical effort should be avoided during the early stages of treatment.

Types of Iliopsoas Syndrome

1. Muscle Tightness Syndrome

This is one of the most common types.

It involves chronic tightness of the iliopsoas muscle.
It is often caused by prolonged sitting or lack of stretching.
It causes pain in the pelvis and lower back.
Movement may become somewhat limited without a clear muscle injury.

This condition usually improves with stretching exercises and regular physical therapy.

2. Iliopsoas Tendinitis

In this type, the problem affects the tendon itself.

Sharp pain in the front of the pelvis or groin area.
Pain increases with movement or lifting the thigh.
It may be associated with a snapping or clicking sensation.
It is more common in athletes or after excessive physical activity.

3. Snapping Hip Syndrome (Internal Type)

This condition involves friction during movement.

The tendon rubs against the pelvic bones.
A noticeable snapping sensation occurs when moving the hip.
It may initially be painless but can become painful over time.

4. Iliopsoas Bursitis

In this case, the problem affects the bursa, which is a small fluid-filled sac.

Pain in the front of the hip joint.
Pain worsens with walking or climbing stairs.
A feeling of pressure or fullness in the pelvic area.

5. Iliopsoas Syndrome Caused by Injury or Trauma

This type occurs after a direct injury or sudden movement.

Sudden and severe pain.
Clear difficulty moving the thigh.
It may affect the ability to walk normally.

Causes of Iliopsoas Syndrome

1. Overuse or Excessive Strain

This is one of the most common causes and may result from:

Sudden long-distance running or walking.
Exercises involving repetitive knee lifting.
Sports such as football or dancing.

2. Prolonged Sitting

Long periods of sitting keep the muscle in a contracted position, leading to:

Muscle stiffness.
Reduced flexibility.
Pain when standing up or moving suddenly.

3. Weak Surrounding Muscles

Weak abdominal or lower back muscles place extra stress on the iliopsoas muscle, causing:

Repeated muscle strain.
Increased risk of inflammation or muscle tightness.

4. Injuries or Incorrect Movements

Examples include:

Sudden twisting of the pelvic area.
Lifting heavy objects incorrectly.
Falls or direct trauma to the pelvis.

5. Hip Joint Problems

The condition may be associated with hip joint disorders such as:

Hip osteoarthritis.
Joint inflammation.

These problems can increase abnormal tension on the muscle.

6. Lack of Warm-Up Before Exercise

Starting exercise without proper warm-up increases the risk of:

Muscle strain.
Recurrent inflammation and muscle stress.

Symptoms of Iliopsoas Syndrome

This syndrome can cause several uncomfortable symptoms that affect daily movement, including:

1. Pain in the Lower Abdomen or Groin Area

Pain appears in the front part of the pelvis and may feel like deep pain or internal tightness.

2. Lower Back Pain

Especially in the lumbar region, and it often worsens with movement or bending.

3. Difficulty Fully Extending the Leg

The patient may feel pain or restriction when trying to extend the thigh backward.

4. Increased Pain While Walking or Climbing Stairs

Because the muscle plays a major role in lifting the thigh during movement.

5. Snapping or Clicking Sensation in the Hip Joint

This symptom may appear during hip or thigh movement.

6. Weakness in the Front Thigh Muscles

The patient may feel heaviness or weakness in the affected leg.

7. Pain That Worsens with Prolonged Sitting

Especially when sitting in a position where the hip remains continuously flexed.

Diagnosis of Iliopsoas Syndrome

1. Medical History and Symptoms

The doctor usually asks about several important points, including:

The location of the pain (lower abdomen, groin, or lower back).
Whether the pain increases with walking or climbing stairs.
Difficulty lifting the thigh or extending the leg.
History of prolonged sitting or repetitive sports activity before the pain started.
Presence of snapping or friction sensations in the hip joint.

Pain that increases during hip flexion (lifting the thigh) is considered an important clue suggesting this condition.

2. Physical Examination (The Most Important Step)

The doctor performs several tests to evaluate the muscle condition, including:

Hip Flexion Test

The patient is asked to lift the thigh against resistance.
Increased pain during the test strongly suggests the condition.

Passive Stretch Test

The doctor moves the leg backward to extend the hip joint.
Pain or tightness indicates muscle stiffness or inflammation.

Thomas Test

The patient lies on their back.
One knee is pulled toward the chest.
If the other leg rises or does not remain flat on the table, it indicates tightness of the iliopsoas muscle.

3. Ruling Out Similar Conditions

Because the symptoms may resemble other medical conditions, the following disorders should be excluded:

Herniated disc
Hip joint inflammation
Inguinal hernia
Thigh muscle strain

4. Imaging Tests (Only When Necessary)

Imaging studies are not always required, but they may be used in chronic or unclear cases, including:

X-rays

Used to rule out bone-related problems.

MRI (Magnetic Resonance Imaging)

Helps evaluate the muscle, tendon, and inflammation in detail.

Ultrasound

May detect bursitis or tendon inflammation.

5. Final Diagnosis

In most cases, the diagnosis is mainly clinical and depends on:

Symptoms
Physical examination
Excluding other similar conditions

Complications of Iliopsoas Syndrome

1. Chronic Pelvic and Lower Back Pain

The pain may progress from simple muscle tightness to persistent daily pain, affecting:

Sleep quality
Ability to move
Daily activities and work performance

2. Stiffness and Difficulty Moving the Hip Joint

Long-term muscle tightness may lead to:

Difficulty fully extending the leg
Reduced hip flexibility
Increased stiffness during movement

3. Altered Gait

The patient may notice changes in walking style, such as:

Leaning forward while walking
Mild limping

This occurs because the body tries to reduce pain, but over time it may place additional stress on other joints.

4. Strain on Other Muscles

When the iliopsoas muscle function becomes weak, other muscles begin compensating, such as:

Lower back muscles
Front thigh muscles

This may lead to additional pain in different parts of the body.

5. Secondary Lower Back Pain

Persistent muscle tightness may increase pressure on the lumbar vertebrae, causing:

Increased lower back pain
Symptoms similar to chronic back pain

6. Hip Joint Irritation or Inflammation

Abnormal movement over a long period may result in:

Hip joint irritation
Inflammation of tendons or surrounding tissues

7. Reduced Physical and Athletic Performance

The condition may affect the ability to:

Run
Jump
Climb stairs

This can significantly impact daily or sports activities.

Medications for Treating Iliopsoas Syndrome

1. Pain Relievers and Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

These are considered the first line of treatment in most cases.

Examples:

Ibuprofen
Diclofenac
Naproxen
Etoricoxib

How They Work:

Reduce pain
Decrease inflammation in the muscle or tendons
Improve mobility

Important Notes:

They should be taken after meals to reduce stomach irritation.
They should not be used by patients with stomach ulcers or kidney problems except under medical supervision.
They are usually prescribed for 5 to 10 days initially.

2. Muscle Relaxants

Used when there is significant muscle spasm or tightness.

Examples:

Tizanidine
Baclofen
Cyclobenzaprine

How They Work:

Reduce muscle spasms
Relieve tightness in the pelvis and lower back
Improve range of motion

3. Simple Pain Relievers

Used in mild cases or as supportive treatment.

Example:

Paracetamol (Acetaminophen)

Benefits:

Relieves mild pain
Relatively safe for the stomach
Can be combined with other medications if needed

4. Local Injections (For Severe or Chronic Cases)

Used when the condition does not respond to conventional treatment.

Types:

Cortisone injections into the inflamed area or tendon
Sometimes combined with a local anesthetic

Benefits:

Rapid reduction of inflammation
Temporary pain relief that helps patients begin physical therapy

Important Notes:

They are not a permanent solution.
They should be performed by a specialist in orthopedics or interventional physical therapy.

5. Supportive Nutritional Supplements (Not a Primary Treatment)

These may help reduce symptoms:

Vitamin D if deficiency is present
Omega-3 as a natural anti-inflammatory
Magnesium to help reduce muscle spasms

Surgical Treatment for Iliopsoas Syndrome

When Is Surgery Needed?

Surgery is considered only in the following situations:

Pain persists for more than 3 to 6 months without improvement
Failure of all conservative treatments, including medications, physical therapy, and injections
Severe and painful snapping hip syndrome
Chronic inflammation of the tendon or surrounding bursa
Significant difficulty with movement and walking

Types of Surgery for Iliopsoas Syndrome

1. Iliopsoas Tenotomy

This is the most common surgical procedure.

The Idea:

Part of the iliopsoas tendon is cut or released to reduce tension and friction inside the hip joint.

Procedure Methods:

Hip Arthroscopy

This is currently the most commonly used technique. Very small incisions are made, and a tiny camera with specialized instruments is inserted to release or cut part of the tendon.

Open Surgery

This method is less commonly used today. It involves a larger surgical incision and is usually reserved for complicated cases.

Expected Results:

Reduced pain
Improved hip joint movement
Reduced friction

2. Tendon Lengthening

Instead of completely cutting the tendon, it is surgically lengthened.

The Idea:

The tendon is carefully lengthened to reduce tension while preserving part of the muscle’s function.

Advantages:

Partial preservation of muscle strength
Lower risk of weakness in hip flexion after surgery

3. Iliopsoas Bursectomy

This procedure is used when the main problem is inflammation of the bursa.

The Idea:

The inflamed bursa located between the muscle and the bone is removed.

Procedure:

Usually performed arthroscopically
The area is cleaned, and inflammation is reduced

4. Partial Tendon Release

In this procedure, only a small part of the tendon is released.

Goal:

Reduce friction while preserving as much muscle function as possible.

Commonly Used For:

Athletes
Individuals who need to maintain muscle strength

5. Arthroscopic Surgery Combined with Hip Joint Treatment

In some cases, multiple procedures are performed during the same surgery, such as:

Treating hip impingement
Repairing cartilage damage
Treating iliopsoas tendon inflammation

Surgical Procedure Steps

Before Surgery

Performing an MRI scan
Evaluating muscle strength and range of motion
Trying conservative treatment first (medications, physical therapy, and injections)