Psoas major and its controversial rotational action

Skyrme, A; Cahill, Declan; Marsh, Howard; Ellis, Henry B.

doi:10.1002/(sici)1098-2353(1999)12:4<264::aid-ca4>3.0.co;2-l

Cited by 25 publications

(18 citation statements)

References 5 publications

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“…With the hip joint in the abducted position, the psoas major muscle produces flexion, adduction, and lateral rotation of the femur at the hip joint (Skyrme et al. ). This muscle is the largest muscle in cross section at the lower levels of the lumbar spine (McGill et al.…”

Section: Discussionmentioning

confidence: 99%

Changes in the macroscopic morphology of hip muscles in low back pain

Pourahmadi

Asadi

Dommerholt³

et al. 2019

Journal of Anatomy

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Low back pain is a major health issue affecting the lumbopelvic muscles. Morphological changes in hip muscles, such as alterations in the muscle cross‐sectional area and muscle volume, may occur in patients with low back pain. This systematic review was conducted to investigate whether patients with low back pain have macroscopic changes in their hip muscle morphology compared with asymptomatic, healthy individuals, based on current evidence. The electronic databases of PubMed/Medline, Ovid, Scopus, Embase®, and Google Scholar were searched from the inception to August 31, 2018. We only included full texts of original studies regarding macroscopic morphological alterations, including atrophy and fat infiltration, in hip muscles of patients with low back pain compared with asymptomatic controls. The quality of the included studies was determined using an assessment tool based on the Newcastle–Ottawa Scale. The scale was modified for the purposes of this study. Sixteen comparative observational studies were found eligible to be included in this review. Eleven were classified as high quality and four as moderate quality. The morphological changes in the psoas major, gluteus maximus, gluteus medius, gluteus minimus, and piriformis muscles were assessed in the primary studies. All selected studies were considered B level of evidence studies. The strength of conclusions for the psoas major, gluteal, and piriformis muscles was moderate. The results revealed that there is substantial controversy about the morphological changes in hip muscles in patients with low back pain; however, the majority of high‐quality studies concluded that atrophy of hip muscles is evident in patients with low back pain. The psoas major muscle was the most commonly investigated hip muscle for morphological changes. Major methodological limitations of the included studies were identified and discussed. The present systematic review does not include a formal meta‐analysis because of very significant differences in the primary studies in terms of study populations and methodologies. Finally, in clinical practice, it is recommended that physical therapists develop exercise programs to improve hip muscle function in patients with low back pain.

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Section: Discussionmentioning

confidence: 99%

Changes in the macroscopic morphology of hip muscles in low back pain

Pourahmadi

Asadi

Dommerholt³

et al. 2019

Journal of Anatomy

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“…Arthroscopic image after release of the iliopsoas tendon which now only demonstrates the labrum (black arrowhead) and capsule (white arrow) because the iliopsoas tendon has retracted to determine the rotatory influence of the iliopsoas at the hip joint and concluded that the spiral course of the tendon insertion around the medial femur makes the iliopsoas an external rotator [26]. However, more recent cadaveric studies have supported Hooper 's original conclusion that the iliopsoas acts as a hip flexor but does not have a significant rotational effect [33]. This conclusion is further reinforced in a study by Delp et al which used a computer model to measure the variation in rotational moment arms with hip flexion [9].…”

Section: Discussionmentioning

confidence: 99%

Iliopsoas Impingement: A Newly Identified Cause of Labral Pathology in the Hip

Domb¹,

et al. 2011

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Labral tears typically occur anterosuperiorly in association with femoroacetabular impingement or dysplasia. Less commonly, labral pathology may occur in an atypical direct anterior location adjacent to the iliopsoas tendon in the absence of bony abnormalities. We hypothesize that this pattern of injury is related to compression or traction on the anterior capsulo-labral complex by the iliopsoas tendon where it crosses the acetabular rim. In a retrospective review of prospectively collected data, we identified 25 patients that underwent isolated, primary, unilateral iliopsoas release and presented for at least 1 year follow-up (mean 21 months). Pre-operative demographics, clinical presentation, intra-operative findings, and outcome questionnaires were analyzed. The injury was treated with a tenotomy of the iliopsoas tendon at the level of the joint line and either labral debridement or repair. Mean post-operative outcome scores were 87.17, 92.46, and 78.8 for the modified Harris Hip Score, activities of daily living Hip Outcome Score, and sports-related score, respectively. The atypical labral injury identified in this study appears to represent a distinct pathological entity, psoas impingement, with an etiology which has not been previously described.

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“…Hooper 55 suggested that the iliopsoas plays no significant part in the rotation of the femur. However, Skyrme et al 56 found lateral rotation of the femur with the hip in abducted position, which was shown by traction of the muscle in cadavers and supported by the findings of Le Floch-Prigent. 57 Because the psoas occurs from the lumbar spine, it implies that it also might have an action on the lumbar spine.…”

Section: Morphology and Functionmentioning

confidence: 99%