The iliopsoas (ILP) is the reunification of two strong muscles serving several important functions around the hip joint. Due to its anatomy and relationship to the hip, it can be a cause of groin pain. For this reason, its anatomy, biomechanics, and pathology should be well known by orthopedic surgeons and sports specialists in their practice. ILP strain is a common sport-related injury in athletes engaging in sports requiring repetitive hip flexion and extreme range of motion. Although the diagnosis is mainly clinical, imaging can give further information on the natural course of the disease. Magnetic resonance imaging (MRI) allows differentiation between muscle-strain and peritendinous type of injury that have different prognosis in terms of time to return to sport. Both variants respond well to a conservative treatment regimen consisting of inciting activities avoidance, nonsteroidal anti-inflammatory drugs (NSAIDs), and dedicated physiotherapy programs. Iliopsoas impingement (IPI) is a quite common and debilitating complication in total hip arthroplasty (THA) patients. Recently, IPI has also been described for native hips in the presence of ILP-related symptomatology and a distinct labral injury pattern. Its etiology remains unclear. Again, the diagnosis is mainly clinical with imaging being used to rule out other possible pathologies. IPI management starts with a trial of conservative treatment. Activity-specific rest, NSAIDs, and stretching focused on the ILP muscle. If pain persists over 6 months, ILP tenotomy remains a successful strategy.