Psoas Syndrome

Overview

What is psoas syndrome?

Psoas syndrome is an uncommon, and often misdiagnosed, condition that can appear as refractory lower back pain (pain that stays even after treatment) accompanied by other symptoms. The condition occurs when the psoas muscle—the long muscle (up to 16 inches) in your back—is injured. The psoas muscle is located in the lower lumbar region of the spine and extends through the pelvis to the femur. This muscle works by flexing the hip joint and lifting the upper leg towards the body. A common example of the movement created from this muscle is walking.

Psoas syndrome is a very rare condition. Other conditions—disc herniation, arthritis, facet or sacroiliac pain—are much more common. When those conditions are treated, often with physical therapy, the psoas muscle is also stretched and strengthened. This can help treat psoas syndrome without it ever being diagnosed.

Who gets psoas syndrome?

Anyone can get psoas syndrome, but athletes, runners, and those engaged in plyometric jumping exercises (short-term, high-energy exercises like jumping rope) are at higher risk for the condition, due to the nature of their activities.

Symptoms and Causes

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 (weakness) 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 upright 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 symptoms.

Diagnosis and Tests

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.

Management and Treatment

How is psoas syndrome treated?

Psoas syndrome is best treated with physical 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.

Outlook / Prognosis

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.

Last reviewed by a Cleveland Clinic medical professional on 11/12/2018.

References

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  • Gharaibeh K, Lopez-Ruiz A, Yousuf T. Psoas Muscle Infiltration Masquerading Distant Adenocarcinoma. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189767/) Case Reports in Gastrointestinal Medicine. 2014:986453. Accessed 11/14/2018.
  • Stevens MJ, Gonet YM. Malignant psoas syndrome: recognition of an oncologic entity. Australas Radiol. 1990 May;34(2):150-4.
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