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1

Origin and insertion of psoas

O = T12-L5 bodies/TPs

I = Lesser trochanter

2

Functions of psoas

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

3

What visceral structure is directly adjacent to the psoas muscle?

So?

Ureter

Kidney stone may cause psoas irritation

4

Viscerosomatic reflexes that can affect the psoas muscle

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

5

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

Increased lordosis = psoas pulling vertebrae/sacrum forwards

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

6

Special test for psoas syndrome

Thomas test

7

Osteopathic testing for psoas syndrome

Hip ROM
Tender points -- iliacus, low ilium, AL 1-5

8

Tight psoas b/l...expected SDs?

Treatments?

Type 2 dysfunctions

Passive (rolled towel)
Muscle relaxants

9

***Tight R psoas u/l...expected SDs?

Treatments?

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

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

10

Stage 3 of psoas syndrome?

***Finding (R psoas)


Treatment?

Sacral torsion

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

Treat the torsion

11

Stage 4 of psoas syndrome? Why?


Treatment?

CONTRALATERAL piriformis spasm - due to L pelvic side shift

Treat piriformis

12

Stage 5 of psoas syndrome? Why?

Positive test?

Treatment?

CONTRALATERAL sciatica (due to piriformis)

SLR (above 30º

Low dose steroid

13

Psoas syndrome...first treatment target?

ME technique? How to do it?

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

14

Psoas syndrome...CS points? Describe each

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

15

Psoas syndrome...psoas ME/stretch

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

16

Good NSAIDs for psoas syndrome

Good muscle relaxants for psoas syndrome

Naproxen, Ibuprofen, Meloxicam, Celecoxib

Metaxalone, Cyclobenzaprine, Baclofen, Carisoprodol

17

Psoas syndrome stretches (home)

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