Psoas Syndrome

Psoas Syndrome
What is psoas syndrome? Psoas syndrome is an uncommon and therefore often misdiagnosed condition that can present as refractory lower back pain accompanied by other symptoms. The condition occurs when the psoas muscle, the long muscle (up to 16 inches), is injured. The psoas muscle is located in the lower lumbar region of the spine and extends through the pelvis to the femur. The psoas muscle’s job is to flex the hip joint and lift the upper leg towards the body, as in walking. Who gets psoas syndrome? Anyone can get psoas syndrome, but athletes, runners, and those engaged in plyometric jumping exercises are at higher risk for the condition, due to the nature of their activities. What causes psoas syndrome? Psoas syndrome may have no identifiable cause. Care should be taken in people who are immune-compromised (due to transplant, cancer, or infectious causes) to ensure that there is no infectious cause or associated myositis in the psoas muscle that presents in a related fashion. What are the symptoms of psoas syndrome? Psoas syndrome can cause a variety of symptoms, including: Lower back pain, the most common symptom, although this can be symptomatic of many conditions Pain in the lumbosacral region (the border between the lower part of the spine and the buttocks that can radiate up to lumbar vertebrae or down to the sacrum) when sitting or particularly when changing positions arising for sitting to standing Difficulty/pain when trying to stand in a fully erect posture Pain in the buttocks Radiation of pain down the leg Groin pain Pelvic pain Limping or shuffling stride when you walk Many of these symptoms can mimic other, more serious conditions. Hip arthritis, kidney stones (ureteral calculi), hernias, femoral bursitis, prostatitis, salpingitis, colon cancer, and colon diverticulitis can also cause severe back pain. It is important to consult your doctor if you have any of the above. How is psoas syndrome diagnosed? Psoas syndrome may be hard to diagnose since many of the symptoms are similar to several, more common conditions. If your doctor thinks you may have psoas syndrome, he or she will want to rule out other more serious causes. Your doctor will usually be able to diagnose psoas syndrome with a combination of a physical examination of your spine, hip, and leg, confirmed with advance radiological imaging. How is psoas syndrome treated? Psoas syndrome is best treated by exercises. These are often demonstrated by a doctor or physical therapist in the outpatient office and done at home. These exercises will include active and passive spine, hip joints, and psoas muscles manipulation and stretching. Exercises at home include stretching and lower-impact dynamic exercises “closed chain” designed to stretch and strengthen the psoas muscle and allow the body to repair the injury. It is very important that these be done only with guidance of your doctor so that you do not further injure your psoas or other muscles. Additional treatments may include osteopathic manipulative treatment, ultrasound, and rarely injections to muscle or associated tendon structures. What is the prognosis for psoas syndrome? With proper treatment and exercises, people suffering from psoas syndrome should be able to regain a full range of motion and resume a very high level of physical function. References: Tufo A, Desai GJ, Cox WJ. Psoas syndrome: a frequently missed diagnosis. J Am Osteopath Assoc. 2012 Aug;112(8):522-8. Agar M, Broadbent A, Chye R. The management of malignant psoas syndrome: case reports and literature review. J Pain Symptom Manage. 2004 Sep;28(3):282-93. Edelstein J. Rehabilitating psoas tendonitis: a case report. HSS Journal. 2009;5(1):78-82. Stevens MJ, Gonet YM. Malignant psoas syndrome: recognition of an oncologic entity. Australas Radiol. 1990 May;34(2):150-4. Stevens MJ, Atkinson C, Broadbent AM. The malignant psoas syndrome revisited: case report, mechanisms, and current therapeutic options. J Palliat Med. 2010 Feb;13(2):211-6. Ferguson LW, Simons D. Hip and groin pain: the disordered hip complex. In: Ferguson LW, Gerwin R. Clinical Mastery in the Treatment of Myofascial Pain. Lippincott Williams & Wilkins; 2005. Karageanes SJ. Principles of Manual Sports Medicine. Lippincott Williams & Wilkins; 2005. Chila AG. Foundations of Osteopathic Medicine. Lippincott Williams & Wilkins; 2010. © Copyright 1995-2014 The Cleveland Clinic Foundation. All rights reserved. This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/1/2015...#15721 Original article and pictures take http://my.clevelandclinic.org/health/articles/psoas-syndrome site