Psoas Syndrome - Lecture

Question 1

Origin and insertion of psoas

Answer 1

O = T12-L5 bodies/TPs

I = Lesser trochanter

Question 2

Functions of psoas

Answer 2

• Walk
• Flex femur/pelvis/lumbar spine
• Maintain pelvis when standing
• Return hip to neutral when rotated (either direction)

Question 3

What visceral structure is directly adjacent to the psoas muscle?

So?

Answer 3

Ureter

Kidney stone may cause psoas irritation

Question 4

Viscerosomatic reflexes that can affect the psoas muscle

Answer 4

• Diverticulosis
• Ureter stone
• Prostatitis
• Descending colon cancer
• Salpingitis
• Psoas abscess
• Appendicitis

Question 5

How can psoas syndrome and lumbar lordosis be related? Causes of each?

Answer 5

Increased lordosis = psoas pulling vertebrae/sacrum forwards

Decreased lordosis = tight hamstring/gluteus maximus/abdominals = pulling inominate posteriorly and psoas superiorly

Question 6

Special test for psoas syndrome

Answer 6

Thomas test

Question 7

Osteopathic testing for psoas syndrome

Answer 7

Hip ROM

Tender points – iliacus, low ilium, AL 1-5

Question 8

Tight psoas b/l…expected SDs?

Treatments?

Answer 8

Type 2 dysfunctions

Passive (rolled towel)
Muscle relaxants

Question 9

***Tight R psoas u/l…expected SDs?

Treatments?

Answer 9

***L1 F RR SR
L2-5 N RL SR

Fix SDs (L1, then others)
Psoas stretch
Muscle relaxants/NSAIDs

Question 10

Stage 3 of psoas syndrome?

***Finding (R psoas)

Treatment?

Answer 10

Sacral torsion

***L on R sacral torsion
L pelvic side shift

Treat the torsion

Question 11

Stage 4 of psoas syndrome? Why?

Treatment?

Answer 11

CONTRALATERAL piriformis spasm - due to L pelvic side shift

Treat piriformis

Question 12

Stage 5 of psoas syndrome? Why?

Positive test?

Treatment?

Answer 12

CONTRALATERAL sciatica (due to piriformis)

SLR (above 30º

Low dose steroid

Question 13

Psoas syndrome…first treatment target?

ME technique? How to do it?

Answer 13

L1 flexion

FDDR (Long Lever) – LR, PTP down, shoulder to table, flex H/Ks then straighten lower leg, ABD upper leg, Pt ADDs down toward table against resistance

Question 14

Psoas syndrome…CS points? Describe each

Answer 14

Iliacus - 1-2in medial to ASIS, deep in fossa – frog leg w/ ankles on doc’s knee

Piriformis - 1/2 to 2/3 from ILA to GT – prone, flex leg over table, ABD and ER hip

Question 15

Psoas syndrome…psoas ME/stretch

Answer 15

Extend leg over table, stabilize opposite ASIS, patient flexes against doc

Question 16

Good NSAIDs for psoas syndrome

Good muscle relaxants for psoas syndrome

Answer 16

Naproxen, Ibuprofen, Meloxicam, Celecoxib

Metaxalone, Cyclobenzaprine, Baclofen, Carisoprodol

Question 17

Psoas syndrome stretches (home)

Answer 17

Psoas – Kneel on 1 knee, IR back hip (moving ankle out to side), posteriorly rotate pelvis

Piriformis – supine, F/ER, pull knee/ankle towards head

Lumbar – child’s pose, happy baby pose