Psoas syndrome

Introduction

Psoas syndrome, although often used to describe a series of symptoms related to the muscle of the same name, is not in itself a specific medical diagnosis. Rather, it serves to encompass various potential problems associated with the psoas muscle, located in the abdomen and hip region, playing a crucial role in the movements of the spine and hip.

One of the most common manifestations of psoas syndrome is muscle contracture or tension. Prolonged contraction or excessive tension of the psoas muscle can lead to pain in the lumbar and pelvic region. This pain, often felt as a constant discomfort, can interfere with the quality of daily life of the individual concerned.

Another aspect of psoas syndrome is iliac psoas syndrome. This condition occurs when the psoas muscle irritates the iliac nerve, causing localized pain and discomfort in the hip and lower back region. Symptoms can vary in intensity, from mild pain to more acute and persistent sensations.

Irritation or inflammation of the psoas muscle also represents a facet of the syndrome. This situation can arise from various causes such as injuries, repetitive movements or other triggering factors. When the muscle is irritated or inflamed, it can generate symptoms such as sharp pain, reduced mobility and increased sensitivity in the affected area.

Painful psoas syndrome is a separate condition within this category. Characterized by specific pain associated with the psoas muscle, this syndrome is often triggered by particular movements. Sufferers may experience localized pain during certain physical activities, which may impact their ability to perform normal movements and lead to a reduced quality of life.

Anatomy of the Psoas

The psoas is actually the union of the psoas major and iliac muscles or iliacus muscle, it is also called iliopsoas muscle or shorter psoas in the jargon of the therapy field.

Iliac muscle : The iliacus arises from the inner part of the pelvic bowl on the upper two-thirds of the iliac fossa and the upper lip of the iliac crest. The iliac muscle then descends into the pelvis and attaches to the lesser trochanter of the femur.
Psoas major muscle : This muscle arises on the front surfaces of the vertebral bodies, intervertebral discs, and transverse processes of the spine, from thoracic level 12 to lumbar level five. It then descends through the pelvis and joins the psoas minor and iliac to insert on the lesser trochanter of your femur.
Psoas minor muscle : The psoas minor arises from the vertebral bodies and discs of the dorsal D12 and lumbar level. It then inserts along the psoas major in an area called the pectineus line and iliac fascia.

Actions of the psoas

• Flex the hip (psoas major and iliacus)
• External rotation of the hip (major and iliac psoas)
• Trunk flexion (psoas major and iliac)
• Tilt the pelvis forward (psoas major and iliacus)
• Helps to laterally flex the lumbar spine (psoas major only)

Causes of Psoas syndrome

The causes of psoas syndrome, also known as psoas muscle syndrome, are varied and often linked to anatomical, muscular or even psychosocial factors. This syndrome occurs when the psoas muscle, a deep muscle located in the lumbar region, becomes tight, contracted or irritated, leading to various symptoms such as lower back pain, postural disorders and sometimes even digestive problems.

One of the common causes of psoas syndrome is incorrect posture. With modern life often favoring prolonged sedentary postures, the psoas muscle can become tight and contracted. Long periods of sitting, whether at a desk, in a car or in front of a screen, can contribute to muscle stiffness, triggering the syndrome. Prolonged sedentary activities also weaken surrounding muscles, adding additional strain to the psoas muscle.

Previous injuries or trauma can also cause psoas syndrome. Accidents, falls or sports injuries that affect the lumbar region can cause muscle tension and trigger the syndrome. Incomplete healing from previous injuries can create muscle imbalances, increasing the risk of developing psoas syndrome.

Overuse of the psoas muscle may also play a key role in the onset of the syndrome. Intense or repetitive physical activities, such as running or weightlifting, put a lot of strain on the psoas muscle. If these activities are not accompanied by adequate stretching and strengthening, the muscle can become tight, contributing to the development of the syndrome.

Psychosocial factors should not be underestimated in the etiology of psoas syndrome. Stress and anxiety can cause generalized muscle tension, also affecting the psoas muscle. The body’s response to stress can induce involuntary contraction of the muscle, contributing to the symptoms of the syndrome.

Additionally, postural imbalances caused by anatomical abnormalities may be an underlying cause of psoas syndrome. Structural differences in the spine, such as scoliosis, can lead to uneven load distribution on the lumbar muscles, including the psoas, thus favoring the development of the syndrome.

Symptoms of Psoas Syndrome

Psoas syndrome, characterized by tension or irritation of the psoas muscle, presents with a diverse range of symptoms that can have significant implications on the quality of life of affected individuals. One of the most common signs of this syndrome is lower back pain, localized in the lower back region. This pain may be felt constantly or intermittently and may radiate to the groin or upper thigh. The feeling of stiffness in the lumbar region is also common, limiting mobility and contributing to difficulty in daily activities.

Another symptom associated with psoas syndrome is posture disturbance. Due to the deep location of the psoas muscle and its essential role in stabilizing the spine, its involvement can lead to postural changes. Sufferers may unconsciously adopt compensatory postures to relieve pain, which can lead to muscle imbalances and worsen symptoms of the syndrome.

Psoas syndrome can also manifest as digestive problems. Given the proximity of the psoas muscle to internal organs, its irritation can influence the functioning of the digestive system. Some individuals may experience complaints such as bloating, abdominal heaviness or intestinal problems, highlighting the complexity of the symptoms associated with this syndrome.

Impaired mobility is another significant symptomatic aspect of psoas syndrome. Affected individuals may experience decreased flexibility in the hip, which may result in difficulty performing movements such as bending or extending the leg. These limitations can impact daily activities, whether it’s climbing stairs, bending, or even walking comfortably.

Additionally, psoas syndrome can influence the emotional well-being of affected individuals. Persistent pain and disruption to daily activities can lead to stress and anxiety. Likewise, the physical restrictions caused by the syndrome can impact sleep quality, exacerbating emotional problems and creating a vicious cycle of pain and distress.

It is essential to note that the symptoms of psoas syndrome can vary from person to person in intensity and combination. Some individuals may experience primarily lower back pain, while others may experience a broader range of symptoms. Accurately diagnosing psoas syndrome requires a thorough evaluation by a healthcare professional, often an osteopath or physiotherapist, to design a personalized treatment plan.

Impact of Increased Psoas Tension on Lumbar Curvature

Increased psoas muscle tension can exert a significant influence on lumbar curvature, thus playing a crucial role in the development of various postural and lumbar problems. The psoas, a deep muscle located in the lumbar region, is essential for maintaining spinal stability and is directly related to the natural lumbar curvature. When this muscle becomes tight or contracted, it can cause an imbalance in the lumbar region, influencing the natural curvature of the spine.

Increased tension in the psoas muscle can lead to an anterior tilt of the pelvis, a phenomenon known as anterior pelvic tilt. This occurs when the psoas muscle pulls excessively on the pelvis, causing it to tilt forward. As a result, this anterior tilt can contribute to increased lumbar curvature, creating excessive lordosis.

Excessive lordosis, characterized by an accentuated curvature in the lumbar region, can lead to significant postural and lumbar problems. In addition to lower back pain, this increased curvature can affect load distribution across the spine, increasing stress on the spinal discs and lumbar joints. This can contribute to the development of conditions such as herniated discs and spinal stenosis.

The impact on lumbar curvature can also influence overall posture. Excessive lordosis can result in forward projection of the shoulders, increased thoracic curvature, and a forward positioned head. These compensatory adjustments can lead to a range of postural problems, affecting not only the spine but also the joints of the upper limbs.

Increased psoas tension can also affect opposing muscles, such as the abdominal muscles. Due to the antagonistic muscular relationship between the psoas and the abdominals, a tight psoas can weaken the abdominal muscles, further worsening the muscle imbalance. Decreased abdominal strength can compromise core stability, contributing to excessive lumbar lordosis.

The consequences of increased psoas tension go beyond the physical aspects. Psychosocial implications may also arise, as chronic low back pain and postural alterations can affect quality of life and emotional well-being. Individuals may experience stress, anxiety, and limitations in daily activities due to pain and movement restrictions.

To counter the negative influence of psoas tension on lumbar curvature, targeted treatment approaches are necessary. Psoas stretching and release techniques can be used to relieve muscle tension. Strengthening the abdominal muscles and core stabilizing muscles can help restore muscular balance, promoting healthy posture.

1. Anterior Pelvic Tilt: When the psoas is tight, it can pull on the spine, causing an anterior pelvic tilt. This can accentuate the natural curve of the lumbar region, leading to excessive lordosis, also called hyperlordosis.
2. Postural Compensation: Increased psoas tension can lead to postural compensation. To counter psoas pull, the body may respond by increasing lumbar curvature, creating an unbalanced posture.
3. Stress on Intervertebral Discs: Increased lumbar curvature due to increased psoas tension can place additional pressure on the intervertebral discs in the lumbar region. This can potentially contribute to problems such as lower back pain, degenerative discs, or other spinal-related disorders.
4. Altered Pelvic Alignment: The psoas is attached to the pelvic region, and excessive tension can influence pelvic alignment. This can disrupt the muscular balance around the lumbar spine, contributing to excessive curvature.

Syndrome du Psoas vs Syndrome myofascial du psoas

“Psoas syndrome” and “psoas myofascial syndrome” are terms that can sometimes be used interchangeably, although their meaning can vary depending on the context and understanding of those using them.

1. Psoas Syndrome: This term is often used generally to describe symptoms related to the psoas muscle. Symptoms may include lower back pain, hip pain, difficulty walking, and other discomforts associated with this muscle. However, it may be a generic term used to describe various psoas conditions without specifying a particular cause.
2. Psoas Myofascial Syndrome: Myofascial syndrome generally refers to trigger points in the muscle and connective tissue (fascia) that can cause pain and tension. Thus, “psoas myofascial syndrome” could indicate a condition where trigger points in the psoas muscle lead to specific symptoms. Trigger points can be hypersensitive, knotty areas in the muscle that can cause pain locally or refer to other areas of the body.

In summary, “psoas syndrome” is a general term to describe various symptoms related to the psoas muscle, while “psoas myofascial syndrome” may indicate a specific condition characterized by trigger points in this muscle and surrounding connective tissue.

Exploring Liz Koch’s Insights on the Psoas

Liz Koch, an American movement expert and author, has distinguished herself for her extensive work on the psoas. His fame stems from his exploration of the role of the psoas in physical and emotional well-being. Through her book titled “The Psoas Book,” she generously shares her knowledge about this muscle, highlighting its crucial impact on posture, movement and overall health.

The psoas, often referred to as the ”  muscle of the soul  ” or the ”  muscle of emotions “, depending on certain contexts, is at the heart of Liz Koch’s concerns.

She puts forward the idea that this muscle can play a role in releasing emotional tension stored in the body.

Focusing on the connection between the psoas and the nervous system, she points out that tension in this muscle can be linked to past emotional experiences.

Liz Koch’s suggestions include techniques and exercises aimed at increasing awareness of the psoas, releasing tension and promoting natural movement of the body. His ideas have had a significant influence on many movement practitioners, particularly in the fields of yoga, dance and kinesiology.

It is essential to note that although Liz Koch’s perspectives on the psoas and its connection to emotions may be considered alternative medicine, they are not necessarily validated by conventional scientific evidence. Despite this, his work has captured attention and helped raise awareness of the importance of the psoas in physical and emotional health. If these concepts intrigue you, exploring the writings and teachings of Liz Koch might offer a deeper understanding.

“The only muscle that connects your spine to your leg, the psoas, is much of the source of lower back discomfort and anxiety with orgasmic pleasure. “ 

Liz Koch,

She adds:

 » A tight psoas can disrupt digestion, reproduction and create a host of other discomforts. “ 

Psoas syndrome is characterized by pain in the lower back, which radiates down one leg, making it difficult to maintain correct posture. Although this syndrome is often found in those suffering from low back pain, it is largely forgotten by therapists.

The Visceral Connection of the Psoas

The visceral psoas connection refers to the relationship between the psoas muscle and the internal organs of the body, particularly the organs located in the abdominal cavity. The psoas is a deep muscle that extends from the spine to the thigh, crossing the abdominal cavity. Due to its anatomical position, it is in close contact with several internal organs.

Some experts, including Liz Koch, have proposed the idea that the psoas may have links to the autonomic nervous system and be influenced by emotional and stressful responses. Koch and other practitioners believe that tension in the psoas may be linked to emotional experiences stored in the body.

However, it is essential to note that formal scientific research into the specific visceral connection of the psoas and its link to emotions is still limited and that these concepts may be considered in some circles to fall under alternative medicine.

The psoas plays an important role in spinal stabilization and hip movement, but its precise influence on internal organs and the autonomic nervous system is an evolving area of ​​research. If you are interested in these ideas, it is recommended that you consult a variety of sources, including health professionals and movement practitioners, keeping in mind that some perspectives may be based more on individual experiences than on established scientific evidence.

Exploring the Emotional Aspect of the Psoas

The emotional aspect of the psoas, often referred to as the “emotion muscle” in some contexts, is a perspective developed by some practitioners, including movement expert Liz Koch. Although this notion is not necessarily validated by conventional scientific evidence, it is explored within alternative medicine and some holistic approaches to wellness.

According to this perspective, the psoas, as a deep muscle located in the abdominal region, is considered to be linked to emotional responses and tensions stored in the body. Some practitioners argue that the psoas may reflect past emotional experiences, contracting or relaxing in response to stressful or emotional situations.

The central idea is that the psoas is connected to the nervous system and can act as a reservoir of emotional memory. Tension built up in this muscle could be associated with past trauma, emotional stresses, or other experiences that have left an emotional imprint on the body.

Some practitioners use approaches such as myofascial release, mindful bodywork, or relaxation techniques to help release presumed emotional tension stored in the psoas. These methods aim to promote muscle relaxation, with the idea that this could have a positive impact on overall emotional well-being.

It is important to note that this perspective is more in the realm of individual feeling and holistic approach to body and mind, rather than strict scientific validation. Individuals interested in this approach may choose to explore these ideas with the guidance of a qualified professional in the field of emotional well-being and movement.

Clinical Presentation of Psoas Syndrome

Patients often complain of back pain in the lumbosacral region. Radiation downward into the sacrum or upward into the lumbar vertebra may occur – the location of the pain is described as buttock pain, pelvic pain or groin pain. The patient may report a catching or sliding sensation in the groin when their knee is flexed 90 degrees. Pain and a “blocking” sensation in the groin when the knee is flexed to 90 degrees suggests a labral tear but may also be seen in iliopsoas tendinopathy.

The patient is bent forward, leaning to the left side and the left foot is turned out.
include:

1. Non-neutral key somatic dysfunction in L 1 or L2 which is curved laterally to the left,
2. Marked spasm of the left psoas muscle.
3. Rotation of the sacrum on a left oblique axis (often of the non-neutral type).
4. Right pelvic lateral shift.
5. Right piriformis spasm
6. Pain in right hip, back of right leg, but not usually past knee.

Differential diagnoses of Psoas syndrome

1. Tendonitis or Muscle Injury: Damage or inflammation to other muscles in the abdominal area or hip can lead to symptoms similar to psoas syndrome.
2. Appendicitis: Inflammation of the appendix can cause pain in the right abdominal area, sometimes confused with symptoms of psoas syndrome.
3. Renal Colic: Kidney stones can cause sharp pain in the lower back and abdominal area, resembling that of psoas syndrome.
4. Inguinal Hernia: An inguinal hernia can cause pain in the groin and lower abdomen area, sometimes overlapping with the symptoms of psoas syndrome.
5. Endometriosis: In women, endometriosis can cause pelvic pain that can be confused with symptoms of psoas syndrome.
6. Colitis: Inflammatory bowel diseases, such as colitis, can cause lower abdominal pain similar to psoas syndrome.
7. Spinal Problems: Spinal disorders, such as herniated discs or joint problems, can also cause pain in the lumbar region.
8. Irritable Bowel Syndrome (IBS): IBS can cause abdominal pain, bloating, and changes in bowel habits, which can be confused with symptoms of psoas syndrome.

Assessment Tests for Screening Psoas Syndrome

Thomas’ test

The Thomas test, also known as the psoas test, is an orthopedic examination that aims to assess the length and flexibility of the iliopsoas muscle. This test is often used in the medical and physical therapy fields to evaluate potential dysfunctions of the psoas muscle.

Here is how the Thomas test is typically performed:

1. The patient lies on an examination table with his back against the table.
2. Both of the patient’s knees are pulled toward the chest, allowing the back to make full contact with the table.
3. One knee is then released to hang along the side of the table, while the other knee remains pulled toward the chest.
4. The practitioner observes the position of the hanging thigh to assess for the presence of deviations or elevations, which may indicate tension or contraction of the iliopsoas muscle.

If the hanging thigh shows significant elevation relative to the table, this may suggest contraction of the psoas muscle. Abnormal results may indicate restricted mobility or imbalances in the psoas muscle.

Check the strength of your psoas

If you are able to raise your knee 90 degrees, your psoas is working well

Therapeutic Approaches

1. Counterstrain psoas major

To treat the psoas major muscle with the Counterstrain technique, the practitioner will often follow these steps:

1. Patient Positioning: The patient is placed in a specific position that allows the psoas muscle to relax. Often this involves placing the patient on their side with their knees bent, so as to minimize strain on the psoas.
2. Trigger point identification: The practitioner uses a palpatory technique to identify sensitive trigger points in the psoas major muscle.
3. Muscle positioning: The practitioner positions the muscle in a position where it is shortened and relaxed, which can help reduce tension.
4. Maintaining the position: The practitioner holds the position for a short period of time, usually 90 seconds to a few minutes. This allows the muscle to relax and reduce tension.
5. Gradual return to neutral position: The practitioner then guides the patient gradually to return to a neutral position.

2. Counterstrain psoas minor

Ipsilateral hip flexion

3. Iliac

Place the unaffected leg on top of the affected leg, flex both legs at the hip, externally rotate both legs, lower the knees (frog legs).

Muscle stretching

Start with a kneeling psoas stretch.

• Drop your left knee underneath you, with your left leg extending away from your body and your toes touching the floor.
• Place your right leg in front of you (your foot flat on the floor), so that your right leg forms at a 90-degree angle.
• Using the strength of your buttock, gently bring your left knee back. As you do so, maintain good posture with your shoulders high and your head straight. Hold this position for 30 seconds, then repeat on the opposite leg.

Bridge installation

Bridge pose, also known as Setu Bandhasana in yoga, can be beneficial for stretching and strengthening the psoas muscle. Here’s how to perform bridge pose to target psoas stretching:

1. Starting position: Lie on your back with your knees bent and your feet hip-width apart. The arms should be alongside the body, palms down.
2. Foot placement: Position your feet so that they are in line with your knees, with your toes pointing forward.
3. Abdominal Engagement: Activate your abdominal muscles by pressing your lower back into the floor. This will help stabilize the spine.
4. Hip Raise: As you inhale, begin to slowly raise your hips toward the ceiling, pushing through both your feet and arms. Continue to press your lower back into the floor.
5. Forming a straight line: Form a straight line from the shoulders to the knees when the hips are up. Avoid arching your back too much.
6. Maintain posture: Hold the position for 30 seconds to 1 minute, breathing deeply and continuing to activate the abdominal muscles.
7. Lower yourself slowly: Exhale and slowly lower your hips downward, vertebra by vertebra, until your back is completely on the floor.

Additional Tips:

• Avoid overextending your neck by keeping your chin toward your chest.
• For a more pronounced psoas stretch, you can try gently walking your feet forward while maintaining bridge pose.

This pose helps open and stretch the muscles in the front of the thigh, including the psoas. As with any yoga practice, listen to your body, don’t force it, and adapt the pose according to your needs and comfort level. If you have back problems or other medical concerns, consult a healthcare professional before practicing this pose.

Warrior pose

Warrior Pose (Virabhadrasana) is a yoga posture that can help stretch the psoas muscle, in addition to strengthening the legs, arms and core. Here’s how to do Warrior Pose I, which specifically targets the psoas:

1. Starting position: Start in a standing position with your feet together.
2. Spread your feet: Spread your feet about hip-width apart.
3. Feet orientation: Orient the right foot forward and the left foot slightly inward (approximately 45 degrees).
4. Hip Alignment: Make sure your hips are facing forward.
5. Knee Flexion: Bend the right knee, ensuring that the knee is directly above the ankle.
6. Psoas Stretch: As you bend your right knee, you should feel a stretch along the psoas on your left side.
7. Arms straight: Extend your arms overhead with your palms facing each other.
8. Hold the pose: Hold the pose for 30 seconds to 1 minute, breathing deeply.
9. Switch sides: Return to the starting position and repeat on the other side, bending the left knee.

Advice :

• Keep your trunk straight and engage your abdominal muscles to maintain stability in the posture.
• Make sure the flexed knee is aligned with the ankle to avoid unnecessary stress on the knee joint.
• Breathe deeply to help relax and stretch the psoas.

Warrior Pose is a powerful pose that can also strengthen the legs, improve balance and boost energy. However, if you have knee, hip, or back problems, consult a healthcare professional or yoga instructor for modifications tailored to your physical condition.

External rotation of the femur

Simply internally rotating your back leg while doing the half-kneeling psoas stretch works your entire psoas muscle more effectively.
To use this modification, move the foot of your back leg toward the other side of your body. Your back leg should be diagonally behind you rather than straight back. This will rotate your leg inward.
Hold the stretch for 30 seconds, then switch to the other side.

Combine the psoas stretch with the quadriceps stretch

Lift the foot of your back leg toward your butt as you stretch the psoas to half-kneeling.

References

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