I recently attended the American Physical Therapy Association's Annual Conference. I had the opportunity to attend a lecture given by Nancy Bloom, PT, DPT, MSOT. Her lecture was entitled, "Iliopsoas Syndrome in Young Adults and Individuals After Total Hip Arthroplasty or Resurfacing: Diagnosis and Conservative Treatment."
Her lecture provided invaluable information regarding iliopsoas syndrome and indications for treatment. Dr. Bloom presented the material systematically, which can allow a practitioner to make treatment decisions based on the patient's movement impairments and muscle length.
In my opinion, the most important piece of information that she provided was regarding the evaluation of the iliopsoas. The length of the iliopsoas should be evaluated using the 2-joint hip flexor test. If the iliopsoas is truly shortened in length, then the muscle should be stretched. Often times, the iliopsoas can be elongated, which can can cause "iliopsoas syndrome" symptoms. In these cases, stretching is absolutely contraindicated. Often times when patients and practitioners see "iliopsoas syndrome" written on a prescription, the tendency is to stretch the muscle. Stretching an elongated muscle can created excessive anterior glide of the femoral head, resulting in soft tissue impingement. Excessive anterior glide of the femoral head can cause groin pain with hip flexion or standing. Often times, the iliopsoas and gluteus maximus can be weak.
As a result, it is imperative for a practitioner to analyze movement patterns and potential muscle imbalances. I strongly recommend the following book as a reference:
Sahrmann, SA. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: Mosby, Inc, 2002.