Adductor-Related Pain examination
Inguinal-Related Pain examination
Psoas-Related Pain examination
The iliopsoas muscle is a flexor and external rotator of the hip. It is the most powerful flexor of the hip joint. As a result, it is a very important muscle for the kicking action. The muscle is most frequently injured acutely during kicking. It is generally the common “secondary” clinical entity in athletes presenting with groin pain. As a result, an assessment for psoas tightness, weakness and pain is an essential component of the assessment of all football players who present with groin pain. History The pain is localised more anteriorly in the groin when the iliopsoas is the cause of the long-standing groin pain. The complaint is much like that of adductor-related pain, but pain after sitting in a deep chair or walking upstairs is also common. It should also be considered as a differential diagnosis when hip-related groin pain is suspected. Examination Iliopsoas-related groin pain is characterised by pain at palpation of the iliopsoas in the lower abdomen and/or just under the inguinal ligament and pain with stretching the iliopsoas during the Thomas test. Also, decreased strength is often found with isometric testing in the inner range (90-degree hip flexion). The iliopsoas is located deep in the lower abdomen as it crosses under the inguinal ligament and down in front of the hip joint to insert at the lesser trochanter. The palpation is done with the patient supine and the legs extended. At the level of the anterior superior iliac spine (ASIS), medial to the rectus abdominis muscle, the fingers of both hands are gently pressed posteriorly, pushing the abdominal structures away to reach the iliopsoas muscle. It is important to get the patient to relax and give way in order to make it possible to get deep enough to reach the muscle. When the examining fingers are deep, the patient is instructed to raise the foot on the examined side 5cm from the couch. The muscle can then be felt and palpated. It is important to compare to the contralateral side as this test is uncomfortable for most people. The muscle can also be palpated just under the inguinal ligament medial to the sartorius muscle and lateral to the femoral artery. It is important to be lateral to the artery and the position can be confirmed by asking the patient to raise the leg so the muscle can be felt contracting. The test is positive if any of these palpations are painful. Another test indicative of iliopsoas-related groin pain is the Thomas test. It is done with the patient lying supine with both legs hanging from the end of the treatment couch. One hip is then flexed and the patient grasps the knee with both hands, pulling it down to the chest. The other leg is still hanging relaxed from the end of the couch. The examiner stands at the end of the couch supporting the position by pressing the side of his/her trunk against the foot of the flexed leg. The examiner then places one hand on the femur of the hanging leg just above the knee and presses the leg down to stretch the iliopsoas passively. The test is positive if this reproduces the known groin pain.