Psoas Syndrome Flashcards
What is the cause of psoas syndrome?
- A forward bending (Flexion) stress of the lumbar spine
- Sit-ups
- Trauma
- Spasm secondary to chill or draft
- Viscerosomatic irritation from pelvic/abdominal organs
- Flattened A-P curvature of lumbar spine (decreased lumbar lordosis)
What is the origin and insertion of the psoas muscle?
ORIGIN : Anterior surface of T12-L5 transverse processes
INSERTION : lesser trochanger of femur
What is the action of the psoas muscle?
Major: Flexion thigh at high
Minor: lateral rotation of thigh
What is the origin and insertion of the iliacus muscle?
ORIGIN: inner portion of each ilium, the iliolumbar ligaments, and the anterior ligaments of the sacroiliac joints
INSERTION: lesser trochanter of the femur (through the common tendon of the psoas muscle)
What is the function of the iliopsas?
Walking, Flex Femur unilateral and bilateral Flex lumbar spine Unilateral lumbar sidebending Support pelvis on head of femur
What is a typical patient presentation of psoas syndrome?
When a patient walks through the door, the patient leaning forward and slightly to one side, unable to stand up straight.
One leg may be short (side of spasm) and one leg externally rotate (opposite side of spasm)
The patient will complain of pain in the waist/low back, thoracolumbar junction, lumbosacral junction, sacroiliact joints, gluteal region, or down the leg (STOPPING at the knee)
What is the fundamental disturbance in a psoas syndrome? What does this look like?
a loss of the normal lumbar lordotic curve.
This is seen as the UPPER lumbar spine to be fixed in a flexion; restricted in backward bending
If a patient is referred to you by another physician with psoas syndrome, and demonstrates the ability to bend backward, what is this not a case of?
psoas syndrome
What is the diagnostic test for a tight iliopsoas? How is the test performed?
Thomas Test;
Have patient lay supine, flex both knees to chest, grab legs.
Allow one leg to fall toward table top, measure distance from posterior surface of leg to table.
Repeat with other leg and compare distances.
If a Thomas test is performed and the distance to the table on the right leg is greater than the left leg, what does this mean?
Either the right psoas muscle is tight or the left psoas muscle is weak/lax.
How many stages are there for psoas syndrome?
5
What does a stage one psoas syndrome case look like? Where is the dysfunction and pain?
A patient will present with a flattened lumbar lordotic curve, positive Thomas test bilaterally; and pain and restriction on hip extension. It will look like a BILATERAL spasm.
The dysfunction is that the lumbar spine is flexed.
The pain will be at the belt line bilaterally.
What does a stage two psoas syndrome case look like? Where is the dysfunction and pain?
A patient will present with side bending to one side. There is pain when attempt to bend to the side contralateral to spasm. It will look like a UNILATERALLY dominant Spasm
The dysfunction is that T12, L1, or L2 is flexed in non-neutral position with the remainder of the spine below curving with the concavity toward the site of the spasm.
The pain will be at the belt line, on the side of the unilateral spasm.
What does a stage three psoas syndrome case look like? Where is the dysfunction and pain?
A patient will present with side bending to one side. There is pain when attempt to bend to the side contralateral to spasm. Plus, the findings of a backward torsion (positive Spring test; positive backward bending test). It will look like a UNILATERALLY dominant spasm WITH SACRAL TORSION.
The dysfunction is that T12, L1, or L2 is flexed in non-neutral position with the remainder of the spine below curving with the concavity toward the site of the spasm. PLUS, engagement of a sacral axis on the side of the unilateral spasm. Usually this is a BACKWARD sacral torsion and the pelvis shifts to SIDE CONTRALATERAL to spasm.
The pain will be at the lumbosacral junction, on the side of the unilateral spasm.
What does a stage four psoas syndrome case look like? Where is the dysfunction and pain?
The patient will present with stage three psoas syndrome findings [side bent and sacral torsion] plus foot externally rotated on side of the piriformis spasm and tenderness in buttocks on side of piriformis spasm.
The dysfunction will be a stage three dysfunction plus CONTRALATERAL piriformis spasm.
The pain will follow the pelvic shift and move to the side of the piriformis spasm at the SI joint, hip and buttocks.
What is the origin and insertion of the piriformis?
ORIGIN: lateral sacrum, capsule of SI joint and sacrotuberous ligament
INSERTION: Superior greater trochanter
What does a stage five psoas syndrome case look like? Where is the dysfunction and pain?
The patient will present with a stage four psoas syndrome [side bent, sacral torsion and contralateral piriformis syndrome] PLUS parenthesias in the leg on side of piriformis spasm. There should be no muscle atrophy or neurological deficits of leg.
The dysfunction will be a stage four dysfunction + pain down the leg to the knee on the side of the piriformis spasm. [sciatic pain]
The pain will be all along the side of the spiriformis spasm: gluteal pain, hip pain, SI joint paint and pain down the leg to the knee.
A patient presents with psoas spasm with sacral torsion and contralateral piriformis spasm, what do they have?
Stage 4 psoas syndrome
A patient presents with psoas spasm with sacral torsion (possibly a backward sacral torsion), what do they have?
Stage 3 psoas syndrome
A patient presents with pelvic side shift (to side contralateral to unilateral psoas spasm), what do they have?
Stage 3 psoas syndrome
A patient presents with unilaterally dominant spasm (psoas), what do they have?
Stage 2 psoas syndrome
A patient presents with bilateral spasm (psoas), what do they have?
Stage 1 psoas syndrome
A patient presents with psoas spasm with sacral torsion, contralateral piriformis spasm and contralateral sciatic nerve irritation, what do they have?
Stage 5 psoas syndrome
OMT wise, the primary regions to be treated in Psoas syndrome are…?
lower thoracics and upper lumbars
If you finish psoas muscle treatment on the patient and see no effect, what likely occured?
You forgot to treat the KEY LESION or Dysfunction (T12,L1,L2). Psoas muscle treatment should always be last.
What are examples of passive and active psoas exercises
Passive: Have patient lay back down with rolled up bath towel at thoracolumbar junction for 15-20 minutes 2-3 daily.
Active: swimming, pushups, extension stretch (5-20x/day)
What should a patient NOT do when having a psoas syndrome?
- Sit-ups
- Sleep on back or stomach
- Use heat to treat
- Slump or slouch when sitting
- Bend forward to touch toes, tie shoes or pull up pants
What is the muscle energy technique to treat for psoas spasm?
Treat in same position as Thomas Test*
Take leg that is greater distance from the table and push knee towards table (to barrier)
Brace patient’s opposite foot against doctors leg
Have patient attempt to FLEX the involved hip
Repeat isometrically 3-5 times
What are some differential diagnosis of psoas syndrome?
- Prostatic cancer
- Disease of sigmoid colon
- Disease of ureters (eg. kidney stones)
- Arthritis of the hip
- Femoral bursitis
- Appendicitis
- Diverticulitis
- Inguinal hernia
- Abdominal Aortic Aneurysm
What is the most common misdiagnosis concerning Psoas Syndrome? How can you tell the difference?
Lumbar Radiculopathy. In lumbar radiculopathy, pain goes all he way to the foot. In Psoas syndrome, pain only goes to knee.
What percentage of lower back pain is psoas syndrome?
20%
True/False: Piriformis syndrome can lead to psoas syndrome.
False: Psoas syndrome can lead to Piriformis syndrome.
