Psoas Syndrome

What is psoas syndrome?

Psoas syndrome is painful irritation or an injury in one of your psoas muscles. Healthcare providers sometimes call psoas syndrome iliopsoas syndrome. Psoas is pronounced SO-ezz.

The psoae (the plural form of psoas) are a pair of long muscles that run from your lower back to the top of your hips on either side of your spine.

Psoas syndrome causes pain in your lower back, hips or groin. Visit a healthcare provider if you’re experiencing pain that doesn’t get better in a week.

How common is psoas syndrome?

Psoas syndrome is rare. Many people who have it never get it diagnosed because symptoms usually get better before they visit a healthcare provider.

Experts think psoas syndrome is often misdiagnosed or underdiagnosed because it shares so many symptoms with other injuries or health conditions. The good news is that, in most cases, the same treatments that manage other, similar issues also treat psoas syndrome.

What are psoas syndrome symptoms?

Psoas pain is the most common psoas syndrome symptom. You might feel:

• Lower back pain — especially in the border between the bottom of your spine and your butt (the lumbosacral region).
• Stiffness or tightness in your lower back.
• Butt pain (pain in your buttocks).
• Groin pain.
• Hip pain.
• Pelvic pain.

Psoas syndrome pain may get worse in certain positions or during physical activities. The pain might spread (radiate) down your legs or get worse when you try to stand up straight. You might notice pain that’s bad enough to make you limp or shuffle your feet when you walk.

What causes psoas syndrome?

Overusing your hips and sports injuries are the most common causes of psoas syndrome.

Some cases of psoas syndrome happen without an obvious cause (idiopathic psoas syndrome).

Rarely, psoas syndrome happens when infections or cancers spread to your psoae.

What are the risk factors?

Anyone can develop psoas syndrome, but athletes are the most likely to have it. Sports that put a lot of repeated stress on your hips can increase your risk, including:

• Dance.
• Running.
• Track and field sports (especially high jump and hurdles).
• Hockey.

Teens and children who play sports may have a higher risk because their bodies are changing and developing quickly, which can make their muscles more susceptible to injuries or irritation.

People who’ve had recent hip surgeries (especially hip replacement) may experience psoas syndrome as a temporary side effect.

What are the complications of this condition?

Psoas syndrome doesn’t usually cause complications. Severe cases may make it painful or difficult for you to stand, walk or move, but these symptoms usually get better when you start treatment.

How do healthcare providers diagnose psoas syndrome?

A healthcare provider will diagnose psoas syndrome with a physical exam. They might also use some imaging tests.

Your provider will examine your hips, legs and spine. They might ask you to move or sit in different positions. Tell your provider when you first noticed pain or other symptoms, and if certain activities or times of day make the symptoms worse (or better).

Diagnosing psoas syndrome is usually a differential diagnosis. This means your provider will rule out other, more common injuries or conditions that might cause similar symptoms before diagnosing psoas syndrome.

Some musculoskeletal issues that cause similar symptoms include:

• Adductor muscle strains.
• Hernias.
• Trochanteric bursitis.
• Hip labral tears.
• Hip growth plate fractures (in kids and teens).

Health conditions that aren’t injuries can also share symptoms with psoas syndrome, including:

• Arthritis.
• Kidney stones.
• Prostatitis.
• Rarely, certain kinds of cancer or muscle infections.

Psoas syndrome tests

Your provider might use a few different types of imaging tests to take pictures of your spine, hips and the areas around them, including:

• Spine X-rays or hip X-rays (to look for arthritis).
• Ultrasound.
• Magnetic resonance imaging (MRI).
• Blood tests (to check for signs of infections).

How do you treat psoas syndrome?

A healthcare provider will suggest treatments for psoas syndrome depending on what caused it. The most common treatments include:

• Rest or taking a break from the activity that caused psoas syndrome.
• Physical therapy.
• Osteopathic manipulative treatment (OMT).
• Cortisone shots.

What are psoas stretches?

Psoas stretches are specific stretches or posture changes that target the psoas. People also sometimes call them psoas releases.

Even though you can do these stretches safely at home, make sure you talk to a healthcare provider or physical therapist before starting any new exercise routine, especially if you think you have a specific injury like psoas syndrome. They’ll tell you the best stretches for your specific needs and show you how to perform them safely. Never try to self-diagnose a health condition or injury.

Core stabilization for psoas syndrome

Your physical therapist might prescribe a core stabilization program. These are exercises designed to strengthen your core muscles and improve how well you can move your core between your spine and pelvis.

Can I prevent psoas syndrome?

Stretching and warming up before exercise or physical activity are the best ways to prevent all types of muscle injuries. Increasing your overall flexibility will also protect your muscles from injuries. Your physical therapist can help you modify (change) your posture when you’re sitting, exercising or doing other physical activities to prevent irritating your psoae.

Increase your activity level gradually. Don’t suddenly ramp up your training intensity or start exercising way more often than you usually do. Some people with psoas syndrome need to temporarily change how they exercise. You might need to stick to shallower weightlifting positions or exercise ranges, for example. Some people need to avoid running on inclines (hills).

Does psoas syndrome go away?

Psoas syndrome usually goes away with treatment and exercises. You should be able to regain a full range of motion (how far you can move parts of your body) and resume your usual level of physical activities.

How long does it take to recover from psoas syndrome?

It usually takes a month or two to recover from psoas syndrome. The pain should start getting better gradually after you start physical therapy or OMT. Your provider will tell you when it’s safe to resume training or intense physical activities.

When should I see my healthcare provider?

Visit a healthcare provider if you feel pain, stiffness or other symptoms that don’t get better after a week of rest. Talk to your provider or physical therapist if it feels like your physical therapy or exercises aren’t managing your symptoms — or if you feel like the pain is getting worse or changing.

What questions should I ask my provider?

You may want to ask your provider:

• Do I have psoas syndrome or another issue?
• Will I need any imaging tests?
• Which treatments will I need?
• How long should I avoid training, practice or working out?
• Which physical activities are safest for me to do while I recover?

A note from Cleveland Clinic

Psoas syndrome is a rare pain in the butt, sometimes literally. It happens when the psoas muscles on either side that extend from the bottom of your ribs to the top of your hips are injured or irritated. This can cause pain in your lower back, hips, groin or butt.

It can be annoying to have to change how you exercise or do other physical activities. Especially if you have to take a break and avoid them entirely for a while. But it’s worth the wait. You should be able to resume all your usual workouts and routines once your psoae heal.