QL, Psoas, Piriformis Flashcards
What are the origins and insertions of the quadratus lumborum?
origin: iliac crest and iliolumbar ligament
insertion: 12th rib, iliac crest, and transverse process L1-L4
How is the quadratus lumborum involved with respirations?
It stabilizes the origin of the diaphragm
What are the innervations of QL?
T12-L3
What are the two functions of QL?
- Bilateral extension
2. Unilateral extension and ipsilateral sidebending
What are 4 ways that QL spasm would present?
- low back pain
- referred pain to hip and groin
- exhalation 12th rib dysfunction
- diaphragm restriction
How does psoas spasm/irritation develop?
It usually develops as a bilateral psoas spasm, but then concentrates more on one side
What levels are the key somatic dysfunctions of psas?
L1 or L2 - may be seen in acute or chronic stage
Describe the origin and insertion of the psoas muscle.
Origin: L1-L4
Extends over the superior pubic ramus and under the inguinal ligament
Insertion: lesser trochanter on medial side of femur
What innervates psoas muscle?
lumbar nerves 2 and 3
What are 4 functions of the psoas muscle?
- flexes trunk on thigh
- flexes lumbar spine
- laterally flexes lumbar unilaterally
- shortens and externally rotates leg
How does the psoas muscle often go into spasm?
When a person sits in a flexed/bent over position for a long period of time and then rapidly returns to a neutral spine
What vertebral levels are key lesions of psoas syndrome?
L1/L2
How would the spine present in a left poas spasm?
L1 or L2 will rotate left, then sidebend left.
Then the rest of the spine sidebends left. The other vertebrae act according to Type I (sidebend left, rotate right).
What is the difference between neutral and non-neutral sacral torsions?
neutral: sacrum is flexed, lumbar is extended
non-neutral: sacrum is extended, lumbar is flexed
If a spastic left psoas carries through to the sacrum, the left sidebending induces a _________ sacral response which means lumbar _______.
1: non-neutral
2. flexed
What muscle may spasm on the opposite side of psoas spasm?
piriformis
What nerve would be irritated on the opposite side of psoas spasm?
sciatic n.
Where does pain present in psoas spasm?
gluteal muscular and posterior thigh pain that does not go past the knee on the opposite side of the psoas
What side does the hip shift in a left psoas spasm?
hip shifts R and irritates piriformis which irritates sciatic n.
What are Sx of left psoas syndrome?
- pain when pt sits with straight spine
- vague pain in lumbar or lumbosacral area
- soon key lesion pain leaves and moves down and over the right sacroiliac joint
- now pt is bent forward and to the left but doesn’t have much pain
- left leg is short and externally rotated
- right piriformis is involved so pain includes gluteal area on right
- then sciatic irritation occurs
- pain develops down posterior though
What can happen to a spasmed psoas if left untreated?
muscle may get fibrosis
What test do you use to test for a tight psoas?
Thomas Test
What does weak psoas lead to?
- allows excessive backward bending of the lumbar spine because of strong back muscles
- increase lordosis, prodtruding abdomen
What is the definition of Piriformis Syndrome?
peripheral neuritis of the sciatic nerve caused by an abnormal condition of the piriformis muscles
