Psoas Syndrome: A Frequently Missed Diagnosis

Abstract

Psoas syndrome is an easily missed diagnosis. However, it is important to consider this condition as part of the differential diagnosis for patients presenting with low back pain--particularly for osteopathic physicians, because patients may view these practitioners as experts in musculoskeletal conditions. The authors describe the case of a 48-year-old man with a 6-month history of low back pain that had been attributed to "weak core muscles." The diagnosis of psoas syndrome was initially overlooked in this patient. After the correct diagnosis was made, he was treated by an osteopathic physician using osteopathic manipulative treatment, in conjunction with at-home stretches between office treatments. At his 1-month follow-up appointment, he demonstrated continued improvement of symptoms and a desire for further osteopathic manipulative treatment.

Previously Unreported Variation in the Innervation of the Psoas Major Muscle

“…The proximal attachments of the psoas major involve the transverse processes of all the lumbar vertebrae and the vertebral bodies of T12-L5 [1][2][3]. The muscle descends along the pelvic brim, continuing posterior to the inguinal ligament and anterior to the capsule of the hip joint.…”

“…In addition to its primary role in the flexion of the hip joint, the psoas major serves several important functions such as balancing the trunk while sitting, lateral rotation of the hip joint, and maintaining an upright vertebral column [1,3,7]. The proximal attachments of the psoas major involve the transverse processes of all the lumbar vertebrae and the vertebral bodies of T12-L5 [1][2][3].…”

“…Its primary function is flexion of the hip joint [2,3]. Within the abdominal and pelvic cavities, the muscle is surrounded by many important structures.…”

Immediate effect of contract-relax antagonist-contract method on iliopsoas muscle and hamstring muscle stretching in chronic non-specific low back pain

“…[13][14][15] This psoas syndrome resulted in LBP with an anterior pelvic tilt and excessive lordosis in the lumbar spine. [6,9,10] The contractrelax (CR) method and CR-antagonist-contract (CRAC) method of proprioceptive neuromuscular facilitation (PNF) are the two techniques seen in literature more frequently than other techniques. The method of CRAC follow the literal procedure as method of CR, however, continued more.…”

“…[4] These symptoms might imitate those of a herniated nucleus pulposus. [5,6] Psoas syndrome is usually commenced as spasm in bilateral iliopsoas muscle, which ultimately becomes more prominent on one side. [5] According to previous studies, [7,8] the shortening of the iliopsoas muscle induced abnormal loading on the lumbar spine and mainly caused increased lumbar lordosis and anterior tilting of the pelvis.…”