Psoas muscle, lumbar spine, pelvis & femur

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.

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.

Last reviewed by a Cleveland Clinic medical professional on 11/13/2018.

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. Accessed 11/14/2018.
  • Gharaibeh K, Lopez-Ruiz A, Yousuf T. Psoas Muscle Infiltration Masquerading Distant Adenocarcinoma. 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.
  • 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.
  • Karageanes SJ. Principles of Manual Sports Medicine. Lippincott Williams & Wilkins; 2005.
  • Chila AG. Foundations of Osteopathic Medicine. Lippincott Williams & Wilkins; 2010.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy