Psoas Syndrome Flashcards
What were some of the bolded etiologies of Psoas syndrome?
- Flexion stress of lumbar spine (prolonged sitting/bending over)
- sit-ups
- deadlifts/squats
- quick elongation of psoas
- arthritis of the hip
- viscerosomatic reflexes (lower GI/GU)
What are some organic causes of psoas syndrome?
- Ureteral calculi
- appendicitis
- salpingitis
If a patient doesn’t improve with OMT or has recurrent psoas issues, what diagnoses do we look for?
- colon cancer
- Diverticulitis
- femoral bursitis
- hip arthritis
- prostatitis
- salpingitis
- ureteral calculi
- herniated disk
Common patient complaints for psoas syndrome
- difficulty sitting or standing upright
- may walk flexed forward and to one side
- difficulty lying prone
- Pain: thoracolumbar, lumbosacral, SI, Gluteal, pain down leg stopping at knee, pain at belt line
Physical exam findings in psoas syndrome
- cervical and lumbar lordosis changes
- abdomen protuberant
- tight iliopsoas and hamstrings (trying to counteract hip flexion)
What happens to the lumbar spine when the psoas muscles shorten?
-increased lumbar lordosis
What is a good simple test to screen for tight psoas muscles?
-thomas test
Osteopathic testing for psoas syndrome
- hip flexion/extension ROM
- screen for innominate df, sacral df, and lumbar df
- Tenderpoints in iliacus, low ilium, and AL1-5
What are the key dysfunctions associated with psoas syndrome?
- Tight psoas
- L1 flexed rotated and sidebent to the side of the tight psoas
What is stage one of the progression of psoas syndrome?
-bilateral spasm
what do we not use at stage one?
- direct stretching or diret ME in acute setting (may make worse)
- Heat (unique to this dysfunction)… DON’T USE HEAT*****
What is Stage 2?
-Unilateral spasm
What is the key dysfunction for Stage 2 unilateral spasm?
- L1F RR SR
- there might also be L2-5 NRLSR
What will we find on exam on stage 2?
- R psoas
- R short leg***
- R hip external rotation dyfunction
Where is the pain site for stage 2?
- R belt line
- + lateral flexion test…. cannot sidebend left
Tx for stage 2
- 1st: L1
- 2nd: L2-5
- Psoas stretch
- Muscle relaxants + NSAIDs
What is stage 3?
-Add sacral torsion
Key dysfunction for stage 3?
- L on R sacral torsion: axis on side of df
- L pelvic side shift: away from side of df, sidebending to the right
What will we find on exam stage 3?
- R sacral sulci deep
- L ILA posterior/inferior
- spring test
Where is the pain site at stage 3?
-lumbosacral junction at side of sacral axis
Tx for stage 3
- treat torsion
- ME, HVLA, etc.
What is stage 4 psoas syndrome?
-Add piriformis spasm on opposite
Dysfunction for stage 4?
- L piriformis spasm (opposite side from psoas df)
- L piriformis TP
What will we find on exam for stage 4 psoas syndrome?
-L foot external rotation
Where is the pain in stage 4?
- L pelvic side shift
- L fluteal, SI, hip
Tx for stage 4
- treat piriformis
- counterstain, spray and stretch, trigger point injection
What is stage 5 psoas syndrome
-add sciatica
Dysfunction for stage 5
- L sciatic nerve irritation
- can follow quickly after S4
Exam for stage 5
- L left paresthesias ( stop at knee)
- no neural deficits, muscle atrophy, negative EMG, neg nerve conduction study
- str8 leg raise (>30 degrees)
Pain site for stage 5
- L gluteal, SI hip
- radiates down L leg to knee
Tx for stage 5?
-add low dose steroid
What OMT do we do for psoas syndrome
- L1 and L2 first: ME, ST/MFR, Still’s, FPR, Counterstrain, HVLA
- Psoas muscle: ME, still’s, counterstrain
- Piriformis: ME, FPR, Counterstrain
- Sacrum: ME, HVLA, Still’s, FPR, Counterstrain
- Innominate: ME, HVLA, Still’s, Counterstrain
- Hip: ME
What do we do for Pharmacotherapy?
- treat underlying cause
- NSAIDs: Naproxen, Ibuprofen, Meloxicam, celecoxib
- Muscle relaxants: Metaxalone, cyclobenzaprine, baclofen, carisoprodol
Do’s of this lecture
- passive stretch with rolled towel TID
- Active stretch
- Supine leg lift
- Push-ups
- Swimming
- Report any change in condition
What are the do NOT’s of this lecture?
- Sleep on stomach
- Use heat to treat
- Slump/slouch when sitting
- Bend forward
- Lean toward painful sidebending
- Perform sit-ups
- Lean backward when standing
What was the main conclusion from this lecture?
- Do not over treat
- Presentation as high stage: avoid HVLA, Instructions and medications, Counterstrain/myofascial/ME
- If symptoms recurrent, don’t delay: look for viscerosomatic reflex, work up for particular organ
