Iliopsoas Tenotomy

An iliopsoas tenotomy is a procedure where the surgeon will nick the iliopsoas (psoas) tendon to in effect lengthen a chronically contracted muscle.  This procedure is usually performed during surgery for an underlying hip issue.  Quite often the affected muscle has been so contracted for so long, it would be nearly impossible to resolve the issue through conventional stretching exercises.  Compound that with a irritated joint right under the psoas and the fact that the psoas is difficult to stretch out using conventional methods.  A surgical tenotomy is usually the most efficient recourse for a successful recovery.  

The reason that a psoas is chronically contracted in people with hip issues is because the body is attempting to protect the affected hip from further injury by keeping the femur tight in the pelvis.   The tightening of my psoas was so gradual over a period of at least a year that I never even noticed until it began ‘snapping’.

I was very concerned about tendinitis as a result of this procedure post surgery.  I went very easy on my psoas post op and was very careful with my excercises.  This continued until well into my recovery.  Even after the first few months when the discomfort of the tenotomy resolved, I found I my poas was still weaker than the rest of my surrounding muscles and it was very easy to push that too hard and wind up sore for several days.  

I did experience a level of discomfort post surgery where the tenotomy was performed whenever I contracted or stretched my psoas muscle.  It felt a bit like the sting from a battery on your tongue, or the sting of a needle when giving blood.  Fortunately, that resolved within eleven weeks.

One thing I noticed during recovery was that there would be periods where my psoas would feel completely stretched out without any discomfort.  After activity though, I would have to work very actively to keep it stretched out.  I had to carefully balance stretching with exercise during the course of my rehab.  This lessened significantly after around twelve weeks.  But I still had to work on stretching and strengthening my psoas and surrounding muscles during the entire rehab process.   I have a desk job at work and I was able to get a standing type desk setup.  I would stand nearly all day just stretching my psoas trying to keep it from tightening up.  I was told pre-surgery that I would need this type of work environment modification.  They weren’t kidding.  If I did sit for any longer than an hour I’d have to walk for several minutes just to get all my muscles loosened up again.

I’m told that there are no issues to be aware of regarding the tenotomy once the recovery phase has passed.  I asked about the most psoas loading exercise I could think of (snowshoeing) and I was told, sure thing – six months after surgery.

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