What is psoas syndrome?
Psoas syndrome is an uncommon and often misdiagnosed, condition that can appear as refractory lower back pain (pain that stays even after treatment) accompanied by other symptoms. The condition occurs when the psoas muscle—the long muscle (up to 16 inches) in your back—is injured. The psoas muscle is located in the lower lumbar region of the spine and extends through the pelvis to the femur. This muscle works by flexing the hip joint and lifting the upper leg towards the body. A common example of the movement created from this muscle is walking.
Psoas syndrome is a very rare condition. Other conditions—disc herniation, arthritis, facet or sacroiliac pain—are much more common. When those conditions are treated, often with physical therapy, the psoas muscle is also stretched and strengthened. This can help treat psoas syndrome without it ever being diagnosed.
Who gets psoas syndrome?
Anyone can get psoas syndrome, but athletes, runners, and those engaged in plyometric jumping exercises (short-term, high-energy exercises like jumping rope) are at higher risk for the condition, due to the nature of their activities.
What causes psoas syndrome?
Psoas syndrome may have no identifiable cause. Care should be taken in people who are immune-compromised (due to transplant, cancer, or infectious causes) to ensure that there is no infectious cause or associated myositis (weakness) in the psoas muscle that presents in a related fashion.
What are the symptoms of psoas syndrome?
Psoas syndrome can cause a variety of symptoms, including:
- Lower back pain, is the most common symptom, although this can be symptomatic of many conditions
- Pain in the lumbosacral region (the border between the lower part of the spine and the buttocks that can radiate up to lumbar vertebrae or down to the sacrum) when sitting or particularly when changing positions arising from sitting to standing
- Difficulty/pain when trying to stand in a fully upright posture
- Pain in the buttocks
- Radiation of pain down the leg
- Groin pain
- Pelvic pain
- Limping or shuffling stride when you walk
Many of these symptoms can mimic other, more serious conditions. Hip arthritis, kidney stones (ureteral calculi), hernias, femoral bursitis, prostatitis, salpingitis, colon cancer, and colon diverticulitis can also cause severe back pain. It is important to consult your doctor if you have any of the above symptoms.
Psoas Muscle Trigger Points
A psoas trigger point is a contracted area within the muscle or fascial tissue of your psoas that likes to stay tight and doesn’t seem to ever let go. Sometimes referred to as “muscle knots,” these trigger points can be the cause of your pain, tightness, and range of motion restrictions felt in your body.
Common symptoms of psoas trigger points
Trigger points can develop anywhere along the entire length of the psoas muscle. Common symptoms of psoas trigger points include both localized and referred pain patterns.
- Localized pain — felt in the immediate area surrounding the muscle knot.
- Referred pain — felt elsewhere in the body.
This concept of referred pain is exactly what may be contributing to your lower back pain!
Localized pain from psoas trigger points
Localized pain from psoas trigger points is typically felt deeper in the core (anywhere between the belly button and the anterior superior iliac spine, or ASIS, of the pelvis), at the front of the hip, and the inside of the groin.
Referred pain from psoas trigger points
Referred pain from psoas trigger points is commonly felt in the lower back muscles, like the spinal erectors and quadratus lumborum (QL).
Maybe it’s not disc pain
Since the psoas connects to the transverse processes of the T12 – L5 vertebrae, these pain referral patterns can be confused for issues with the discs or joints of the lumbar spine.
How is psoas syndrome diagnosed?
Psoas syndrome may be hard to diagnose since many of the symptoms are similar to several, more common conditions. If your doctor thinks you may have psoas syndrome, he or she will want to rule out other more serious causes.
Your doctor will usually be able to diagnose psoas syndrome with a combination of a physical examination of your spine, hip and leg confirmed with advanced radiological imaging.
How is psoas syndrome treated?
Psoas syndrome is best treated with physical exercise. These are often demonstrated by a doctor or physical therapist in the outpatient office and done at home.
These exercises will include the active and passive spine, hip joints, and psoas muscles manipulation and stretching. Exercises at home include stretching and lower-impact dynamic exercises “closed chain” designed to stretch and strengthen the psoas muscle and allow the body to repair the injury. It is very important that these be done only with the guidance of your doctor so that you do not further injure your psoas or other muscles. Additional treatments may include osteopathic manipulative treatment, ultrasound, and rarely, injections to muscle or associated tendon structures.
What is the prognosis for psoas syndrome?
With proper treatment and exercise, people suffering from psoas syndrome should be able to regain a full range of motion and resume a very high level of physical function.
WHAT IS THE PSOAS MUSCLE’S FUNCTION?
The 3 psoas muscles (or 2 for many people) are grouped together when referring to the function of the psoas. These muscles are also commonly referred to as the “iliopsoas”.
Here are the main functions:
- Flex the hip joint.
- Externally rotate the hip joint.
- Adduction of the hip…when the hip is already abducted or moved out to the side.
- Core strength and stability.
- Directly impacts the quality and fluidness of overall movement due to its relationship with our center of gravity.
A healthy psoas will allow you to move with greater ease and have better posture and comfort.
IMPORTANCE OF STRETCHING AND STRENGTHENING PSOAS MUSCLE
A tight psoas can have a lot of negative effects on us. Most commonly, the tight psoas will lead to postural problems. A tight psoas will pull the low back vertebrae down and forward which results in an overarching of the lumbar spine. The result will be low back and pelvic pain and stiffness. Without addressing this, it can eventually lead to arthritis in the lumbar facet joints. Moreover, it can cause harmful and unwanted imbalances.
A tight psoas muscle is said to cause:
- Hip pain (this one makes perfect sense)
- Abdominal pain
- Knee pain
- Ankle pain
- Neck pain
- Groin pain
- Bowel problems
- Anxiety
- Stress
Plus-
- The psoas muscles are made of both slow and fast-twitch muscle fibers. The fiber type composition of the psoas major muscle indicates its dynamic and postural functions, which supports the fact that it is the main flexor of the hip joint (dynamic function) and stabilizer of the lumbar spine, sacroiliac, and hip joints (postural function).
- The cranial part of the psoas major muscle has a primarily postural role, whereas the caudal part of the muscle has a dynamic role.
Origin
- It originates from the T12 and L1 to L4 vertebrae, The transverse processes of lumbar vertebrae L1 to L5.
Insertion
- inserts at the lesser trochanter of the femur
Nerve Supply
- Branches from the ventral rami of lumbar spinal nerves (L1, L2, and L3) before they join to form the lumbar plexus.
Function
- Flexion of the thigh at the hip
- Minimal action in lateral rotation and abduction of the thigh
- Stabilizes the lumbar spine, maintains erect posture when working in reverse action
- Externally rotate the hip joint.
- Adduction of the hip…when the hip is already abducted or moved out to the side.
Causes of Psoas syndrome
- Psoas syndrome may have no identifiable cause. Care should be taken in people who are immune-compromised (due to transplant, cancer, or infectious causes) to ensure that there is no infectious cause or associated myositis (weakness) in the psoas muscle that presents in a related fashion.
symptoms of Psoas syndrome
- Lower back pain, is the most common symptom, although this can be symptomatic of many conditions
- Pain in the lumbosacral region (the border between the lower part of the spine and the buttocks that can radiate up to lumbar vertebrae or down to the sacrum) when sitting or particularly when changing positions arising from sitting to standing
- Difficulty/pain when trying to stand in a fully upright posture
- Pain in the buttocks
- Radiation of pain down the leg
- Groin pain
- Pelvic pain
- Limping or shuffling stride while walking
Diagnosis of Psoas syndrome
- mostly diagnosis based on the physical examination by the physiotherapist and by advanced radio-imaging technique.
Physiotherapy Management of Psoas syndrome
- physiotherapy treatment will be focused on the
- To relieve pain
- To maintain and improve strength
- To improve gait pattern
- To improve functional mobility
- To enhance the activity of daily living
pain will be relived by modalities
- Ultrasound: ultrasound is a therapeutic modality that generates ultrasound and causes deep heat, which provides micro-massage to soft tissue, increases flexibility, promotes healing of tissue as well improves localized blood supply to the area. and ultimately pain relief.
- TENS: transcutaneous electrical nerve stimulation is an electrical modality that provides pain relief by providing pain modulation.TENS closes the gate mechanism at the anterior grey horn in the spinal cord. also stimulates the endogenous opioid system which prevents the release of substance p at the anterior grey horn.
- transverse friction massage: transverse friction massage to psoas will relax the muscle, improves blood circulation, and removes waste products.
- stretching will be done to release the tight muscle, cautions will be taken overstretching of psoas muscle may hamper daily activities.
- passive as well as self-stretching will be beneficial to release tight muscle
- foam roller should also be used to manipulate the psoas muscle.
- active exercise of the hip, knee and lumbar region will be beneficial to maintain mobility.
- gait training will be more beneficial to prevent re-occurrence and will help to achieve maximum mobility.
Psoas Muscle Strengthening Exercises:
- Lying single Leg Raises
- Lying Leg Raises
- Resistance Band Hip Flexor March
- Lying Banded Hip Flexion
- Stability Ball Passes
- One-Legged Plank Pose
- Hanging Leg Raises
- Hanging Leg Isometric Hold
- Hanging Leg Raises with Knees Bent
more info at:
https://www.ncbi.nlm.nih.gov/books/NBK551701/
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://corewalking.com/wp-content/uploads/2018/07/psoas-release-exercises.pdf
http://chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.diderikfinne.com/psoas.pdf
https://www.alethahealth.com/post/psoas-trigger-point
*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
The information provided is for educational purposes only and is not intended as a diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. These statements are not expressions of legal opinion relative to the scope of practice, medical diagnosis, or medical advice, nor do they represent an endorsement of any product, company, or specific massage therapy technique, modality, or approach. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.
