quadratus lumborum plus piriformis and psoas syndrome

Question 1

quadratus lumborum

Answer 1

origin-@ iliac crest and iliolumbar ligament

insertion-12th rib, iliac crest, and TP of L1-4

functions with respirations, stabilizes the origin of the diaphragm

innervation T12, L1-3
bilateral extension
unilateral extension and ipsilateral sidebending

Question 2

quadratus lumborum spasm

Answer 2

low back pain
referred to the hip and groin
exhalation 12th rib dysfunction
diaphragm restriction
differentiate from renal disease

Question 3

psoas syndrome

Answer 3

a spasm and/or an irritation of the psoas muscle

usually develops as a bilateral spasm but then concentrates more on one side

key somatic dysfunction is a non-neutral dysfunction of L1 or L2

Question 4

psoas

Answer 4

origin-L1-4 (L5)
extends over the superior pubic ramus and under the inguinal ligament
inserts-less trochanter on the medial side of the femur

innervated by L2/3

flexes trunk on thigh, flexes lumbar spine, and laterally flexes lumbar unilaterally

shortens and externally rotates the leg

Question 5

key lesion of any psoas syndrome

Answer 5

L1 or L2

Question 6

left psoas spasm

Answer 6

induces left sidebending, induces a non-neutral sacral response

left oblique axis is engaged
sacrum rotates right
shallow right sacral sulcus (deep left)
prominent ILA on the right

Question 7

more left psoas spasm

Answer 7

pelvic side shift occurs to the opposite side
opposite piriformis spasm occurs
get sciatic nerve irritation same side as piriformis

gluteal muscular and posterior thigh pain that does not go past knee (opposite side)

Question 8

left soas sydrome symptoms

Answer 8

pain sitting straight
vague pain in lumbar or lumbosacral area
key lesion pain moves down to right sacroiliac joint
left leg short and externally rotated

Question 9

weak psoas

Answer 9

allows excessive backward bending of lumbar spine because of strong back muscle

increase lordosis, protruding abdomen

Question 10

piriformis syndrome

Answer 10

peripheral neuritis of the sciatic nerve caused by an abnormal condition of the piriformis muscle

Question 11

piriformis

Answer 11

origin-anterolateral border of the sacrum at the sacroiliac joint capsule. also anterior portion of the sacrotuberous ligament

insertion-superomedial aspect of the greater trochanter of the femur

Question 12

sciatic nerve tract

Answer 12

passes through the greater sciatic foramen
under the piriformis
posterior thigh

Question 13

causes of irritation for sciaitca

Answer 13

piriformis muscle spasm
piriformis contracture
local trauma to the buttock
repeated mechanical stressors
sacral base unleaveling
pelvic instability 
excessive local pressure
anatomic cariation
local perineural inflammation

Question 14

sciatic nerve variations

Answer 14

common peroneal and tibial components remain separate in 10% (one of them passe through the piriformis)

piriformis arises from 2 tendinous origins with the sciatic nerve passing between them in 10%

Question 15

sciatica symptoms

Answer 15

easily confused with herniated disk disease or facet joint pathology

hip and buttock pain radiating down the posterior thigh

sometimes to the calf or foot