Iliopsoas Bursitis: What Is It and Why Does Your Hip Flexor Hurt?

The iliopsoas is a powerful hip flexor muscle. It runs from the lower spine, through the pelvis, and attaches to the top of the thigh bone. A bursa (a thin, slippery cushion) sits between the muscle's tendon and the bone to reduce friction. When that bursa becomes irritated and swollen, the result is iliopsoas bursitis.

This condition is sometimes called hip flexor bursitis. It can overlap with iliopsoas tendinitis, where the tendon itself is inflamed, or with iliopsoas syndrome, a broader term covering pain from the muscle, tendon, or bursa. In some people, the tendon flicks over a bony prominence and produces an audible click. That is known as snapping hip syndrome.

What does iliopsoas bursitis feel like?

Iliopsoas bursitis typically produces a deep, nagging ache in the groin or the front of the hip. The pain is often hard to pinpoint with one finger. It can be sharp when you first stand up after sitting, then settle into a dull throb as you keep moving.

What causes iliopsoas bursitis?

Iliopsoas bursitis is usually caused by repetitive friction between the iliopsoas tendon and the front of the hip joint. Anything that increases that friction, whether it is overuse, alignment imbalance, or a change to the joint itself, can trigger it.

Because the iliopsoas crosses both the spine and the hip, problems further up or down the body can contribute. A leg-length difference, a stiff lower back, or a rotated pelvis can all shift how the muscle loads during movement. That is why looking at one area in isolation sometimes misses the bigger picture.

How does a standing scan help with anterior hip pain?

A standing, weight-bearing scan shows your bones and joints in the position that actually causes symptoms. When you lie down for a conventional X-ray or CT, gravity is removed, muscles relax, and small alignment shifts can disappear. That means the scan may look normal even when something is clearly wrong when you are on your feet.

EOS imaging captures a full-length view from your ankles to your skull in a single standing exposure, using about 90% less radiation than a standard X-ray, around ten times less. The image reveals how your spine, pelvis, hips, and legs relate to each other under real load.

For someone with iliopsoas bursitis, that whole-body view matters. If a pelvic tilt is putting extra strain on one hip flexor, or if a subtle leg-length difference is forcing one side to overwork, those patterns show up on a standing scan. A scan of the hip alone, taken lying down, may miss them entirely.

What can be done about iliopsoas bursitis?

Treatment for iliopsoas bursitis is managed by your GP, physiotherapist, or orthopaedic specialist. ScanAlign does not provide treatment. What it does provide is the detailed alignment information that helps those clinicians make better decisions.

Common approaches include physiotherapy to stretch and strengthen the hip flexor, activity modification to reduce irritation, and sometimes guided injections. If the bursitis has developed because of an underlying alignment problem, addressing that root cause is often key to lasting improvement.

For people experiencing iliopsoas bursitis after hip replacement, standing alignment imaging can help the surgical team assess whether the new joint's position is contributing to the tendon irritation. This is information that a lying-down X-ray may not capture accurately.

Understanding how your whole body lines up, from your feet through your knees, hips, pelvis, and spine, gives your treatment team a clearer starting point. Pain in the front of the hip does not always start at the hip. Learn more about how hip alignment assessment works.

Frequently asked questions about iliopsoas bursitis