Rafael Nadal Pulls Out of the Madrid Masters Due to an Iliopsoas Injury

Nadal wants to make it to Roland Garros, but his iliopsoas injury has put him in doubt. What's in store for him in the coming weeks?

Written and verified by the doctor Leonardo Biolatto.

Last update: 24 April, 2023

Rafael Nadal has announced he is pulling out of the Madrid Master tournament and there’s concern because of an iliopsoas muscle injury. Will he make it to Roland Garros, his favorite tournament? Will he be able to recover in time?

When he was competing in the second round of the Australian Open 2023, an apparent hip problem contributed to his defeat and took him out of the tournament. As the days passed and medical tests were performed, the diagnosis was certified as a grade 2 strain of the left iliac psoas muscle.

We analyze the injury and what lies ahead for Nadal in the coming weeks. How serious is his condition?

What is the iliopsoas muscle and where is it?

While it’s a muscle that athletes recognize, not everyone is clear on where it’s located and what anatomical function it serves. In concrete terms, the iliopsoas is the combination of two muscles that work together: the psoas and the iliacus.

They’re located deep in the abdomen, near the back, but pass between the abdominal organs. They arise from the spine, cross the pelvis on each side of the body and insert into the femur.

Their main function is to make the connection between the trunk and the lower limbs. With the psoas iliacus we flex the thighs, rotate the back, maintain an upright posture and rotate the hip, according to information from Statpearls. Without this structure, we wouldn’t be able to climb stairs, for example.

To achieve the movements executed by this muscle, in general, it works together with another muscle, forming the hip flexor group. The usual companion is the rectus femoris, which is found in the quadriceps (in the thighs).

One of its peculiarities is that it shortens and lengthens in the opposite way compared to most other muscles. When it’s at rest, it measures less in length. On the contrary, when we make it work, it lengthens.

What is the iliopsoas strain that Rafael Nadal has?

Like any muscle, if the iliopsoas muscle is overstretched, it runs the risk of distending or rupturing. In the case of a specific rupture of fibers, we speak of a tear.

Strains are classified into three degrees of severity:

• First degree: Only a few fibers are affected. It’s usually a minor stretch that causes discomfort, but heals with rest.
• Second degree: This would be Rafael Nadal’s confirmed injury. There is a loss of some functions because a number of fibers were broken and another group was stretched. It isn’t a complete tear, but it limits the activity of the muscle and causes pain.
• Third degree: This is a complete tear. The cross-section of the muscle ruptures most of the fibers and a hematoma may form in the middle, i.e. a collection of blood. Functionality is limited to the maximum and it’s even difficult to walk.

What are the symptoms?

Rafael Nadal won’t play in the Madrid Masters this year due to his iliopsoas injury. His grade 2 strain prevents him from performing at his best. In addition, if he wants to play in the Roland Garros, he’ll have to work on his rehabilitation.

The most frequent symptoms of an injury to this muscle are the following:

• Pubalgia
• A sensation of relief when taking the fetal position
• Pain when wanting to lift the leg on the affected side
• Hypersensitivity in the thigh or back, with certain sensations of pain on palpation of these areas

How can the iliopsoas get injured?

In the case of Rafael Nadal, the iliopsoas injury seems to have a logical explanation: there was an overexertion that resulted in an overstretching of the muscle. This is a common cause, according to scientific studies.

As far as we know from experience and from what’s described in sports medicine publications, this condition is common in athletes who have to perform sprinting movements, or who have to raise their legs above hip level, such as:

• Tennis players
• Cyclists
• Karate players
• Soccer players
• Climbers
• Hurdle jumpers

On the other extreme, very sedentary people can also suffer from this problem. The process is explained by the permanent sitting position that weakens the muscle and then, when you want to make a certain effort, the fibers don’t respond.

Obesity is also a risk factor. Of course, this isn’t the case with Rafael Nadal! But it is true that being overweight increases the load on the iliopsoas muscle, due to the anatomical position it occupies.

Treatment for Rafael Nadal’s iliopsoas injury

The approach to a grade 2 strain in the iliopsoas muscle is based on physiotherapy. Exercises supervised by kinesiotherapy professionals should be performed to accelerate recovery.

In theory, without such treatment, the injury would resolve itself in 40 days. However, the situation is different for Nadal and his high-level demands in elite tennis. Therefore, in this context, it’s difficult to know if he’ll make it to Roland Garros.

In addition to rehabilitation exercises, another option is the use of an orthopedic brace. This device is intended to stabilize the muscle in order to reduce its movement and allow it to heal with rest.

The injection of platelet-rich plasma is another therapeutic option that is still less well founded, although research is being carried out to determine its viability. This plasma would stimulate the healing of damaged tissue, speeding up healing times.

We all want to see Nadal at Roland Garros

Rafael Nadal has a long injury history, but he has always come through with flying colors. He has suffered from Müller-Weiss syndrome since 2005, suffered wrist injuries on both sides, was sidelined for 7 months due to a ruptured tendon in one of his knees, and suffered stress fractures in his ribs.

We assume he’ll now recover as he did before. We all want to see Nadal’s magic at his favorite tournament every year. For now, time and rehab have the last word.

Main image by EFE.