Psoas syndrome is a rare condition, and it is often misdiagnosed. To many it appears as low back pain that remains even after treatment accompanied by other symptoms.
The condition occurs when we injure the psoas muscle, the long muscle (up to 40 centimeters) in the back. The psoas 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 toward the body.
The syndrome is a very rare condition compared to other conditions (herniated disc, arthritis, facet or sacroiliac pain) that are much more common. Unfortunately, anyone can get psoas syndrome, but athletes, runners, and those who perform plyometric jumping exercises are at higher risk for the condition.
What Causes Psoas Syndrome?
This syndrome may not have an identifiable cause. Care must be taken in immunosuppressed individuals to ensure that there is no related infectious cause or associated weakness in the psoas.
As for the symptoms that appear, they include:
- Low back pain is the most common symptom, although it can be symptomatic of many conditions.
- Pain in the lumbosacral region (the border between the lower spine and the buttocks that can radiate into the lumbar vertebrae or the sacrum) when sitting or changing position from sitting to standing.
- Difficulty or pain when trying to stand in a fully upright posture.
- Pain in the buttocks
- Radiation of pain along the leg.
- Groin pain
- Pelvic pain.
- Limping or shuffling when walking.
Many of these symptoms can mimic other more serious conditions. Hip arthritis, kidney stones, hernias, femoral bursitis, prostatitis, salpingitis, colon cancer, and colon diverticulitis can also cause severe back pain. If any of the above symptoms are noticed, it is important to consult a doctor.
In terms of diagnosis, psoas syndrome can be difficult to diagnose as many of the symptoms are similar to several more common conditions. If a doctor thinks you may have this condition, they will want to rule out other, more serious causes. It can usually be diagnosed with a combination of a physical examination of the spine, hip and leg, confirmed with advanced radiological imaging.
How is psoas syndrome treated?
Psoas syndrome is best treated with physical exercises. Logically, it must be a doctor or a physiotherapist who performs the therapy in a consultation or at home.
These exercises will include active and passive manipulation and stretching of the spine, hip joints, and psoas muscles. Exercises at home include low-impact “closed chain” static and dynamic stretches designed to stretch and strengthen the psoas muscle and allow the body to repair the injury. It is very important that these are done only with the guidance of a doctor so that we do not further injure the psoas or other muscles.
Stretch the iliopsoas and surrounding muscles
Stretching the hip and thigh muscles makes sense, as less muscle tension in these areas would reduce the strain on the iliopsoas. There may also be some direct benefit to gently stretching the injured muscle and tendon.
Professionals recommend that treatment for iliopsoas injuries should include stretching the hip flexors, piriformis, quadriceps, and hamstrings. For best results, all of these muscles should be stretched two to three times a day, for two sets of 30 seconds each.
Strengthening the hip rotators
Strengthening exercises should focus on the internal and external rotators of the hip. Hip instability, caused by poor hip rotational force, can cause excessive stress in the hip flexor area and injure the iliopsoas.
The rehabilitation program includes three stages. The first consists of a basic internal and external rotation exercise that can be easily performed with a table and an elastic resistance band. It should be done daily for three sets of 20 repetitions, on both sides, for two weeks. After two weeks, we should perform three sets of 20 clamshell leg lifts, using a resistance band wrapped around the knees.
How to run again?
As with other soft tissue injuries, scientific evidence suggests that a pain-mediated running program can be used. Logically, you have to give the hip flexor enough time to calm down. This may take a few days or weeks, depending on the age and severity of the injury.
Once we start running, we should gradually increase the intensity of the exercise, but if we have mild or moderate pain, it is not the end of the world. As long as it’s less than 5/10 on the pain scale, with 10 being the worst pain you’ve ever had and 0 no pain at all, you should be fine.
Also, the pain shouldn’t persist the day after running, and pain levels should improve week by week. However, avoid running faster for several weeks, and when you reintroduce it into the routine, do it gradually. If we cross-train to maintain physical condition, keep in mind that the hip flexors are activated strongly when we do other workouts such as swimming or running in the water, so it is a poor choice.
Cycling is likely the best option, although we will have to experiment to see how well tolerated by the hip flexors. With proper treatment and exercises, people with psoas syndrome should be able to regain a full range of motion and resume a very high level of physical function.
