Psoas Syndrome Flashcards
Five functions of psoas muscle. (Action, what orientation does it maintain, and what 3 actions?)
Walking
Flexion of femur, pelvis; lumbar spine
Maintains orientation of pelvis during erect posture
Medially rotates hip when laterally rotated
Laterally rotates hip when medially rotated
Action of LR psoas.
Medially rotates hip
Action of MR psoas.
Laterally rotated hip
Etiologies of Psoas syndrome
- Flexion stress of lumbar spine (prolonged sitting/bending over)
- Flat lumbar lordosis
- Sit‐ups
- Trauma
- Pregnancy
- Short leg syndrome
- Diaphragm restriction
- Lumbar disc impingement
- Postural changes (e.g. **Thoracic Outlet Syndrome)
- Emotional stress
- Metastatic cancer
- Arthritis of hip
- Femoral bursitis
- Viscerosomatic reflexes
Viscerosomatic reflexes/organic causes as etiologies of Psoas Syndrome
Diverticulosis of the colon Ureteral calculi Prostatitis Cancer of the descending/sigmoid colon Salpingitis Psoas abscess Appendicitis
Symptoms of Psoas Syndrome
Difficulty sitting or standing upright - May walk flexed forward and to one side.
Difficulty lying prone
Pain: Thoracolumbar, Lumbosacral, Sacroiliac, Gluteal (contralateral), Pain down leg, stopping at knee (contralateral), Pain at belt line
On PE, suspect psoas syndrome when:
Abdomen is ___.
___ and ___ mm are tight.
Lordosis changes to ____ and _____ spine.
Abdomen is PROTUBERANT.
ILIOPSOAS and HAMSTRONG mm are tight.
Lordosis changes to CERVICAL and LUMBAR spine
Tender points seen in psoas syndrome
iliacus, low ilium, AL1-5
Exam findings: Flat lordosis, Unable to return from flexed
posture, + Thomas test, Pain on hip extension.
What is the dysfunction, pain site, and treatment?
Stage One: Bilateral Spasm
Dysfunction - Lumbar spine flexed, regionally Type II
Pain site at the Belt line
Treatment: Passive exercise (rolled towel TID) and Muscle relaxants
Exam findings: R Psoas spasm, R short leg, R external rotation
dysfunction.
What is the dysfunction, pain site, and treatment?
Stage Two - Unilateral Spasm Dysfunction - KEY LESION: L1 F RR SR (toward psoas spasm). L2‐5 N RL SR
Pain site - R belt line, + L Lateral Flexion test
Treatment: 1st: L1 2nd: L2‐L5 Psoas stretch Muscle relaxants + NSAIDS
Exam findings: R sacral sulci deep, L ILA posterior/inferior, + Spring test
What is the dysfunction, pain site, and treatment?
Stage Three - add sacral torsion + stage 2
Dysfunction: L on R sacral torsion, L pelvic side shift (backward sacral torsion w/axis being the side of spasm - so this is a R psoas spasm. SB R, so pelvis goes left)
Pain site: Lumbosacral junction at
side of sacral axis
Treatment: Treat torsion
Exam findings: L foot external rotation
What is the dysfunction, pain site, and treatment?
Stage Four - add piriformis spasm on CL side
Dysfunction - L piriformis spasm and L piriformis TP
Pain site - L pelvic side shift –> L gluteal, SI, hip
Treatment - Treat PIRIFORMIS 1st : counterstrain, spray and piriformis stretch, trigger point injection
Exam findings: L leg paresthesias (stop at knee), No neural deficits, muscle atrophy, negative EMG, + straight leg raise (> 30 degrees)
What is the dysfunction, pain site, and treatment?
Stage Five - add sciatica on the piriformis spasm side
Dysfunction: L sciatic nerve irritation
Pain site: L gluteal, SI, hip, Radiates down L leg to knee
Treatment: Low‐dose steroid
Name the OMT treatments (in order?)
- Treat L1 and L2 first - Muscle energy, ST/MFR, Still’s, FPR, Counterstrain, HVLA
- Psoas muscle - Muscle energy, ST, Still’s, Counterstrain
- (c/l) Piriformis - Muscle energy, FPR, Counterstrain
- Sacrum - Muscle energy, HVLA, Still’s, FPR, Counterstrain
- Innominate - Muscle energy, HVLA, Still’s, Counterstrain
- Hip - Muscle energy
Avoid what type of treatment in high stage of psoas?
HVLA
do Counterstrain, MFR, etc
