The psoas muscle connects the lumbar spine to the hip joint. The main role of the psoas muscle is as a hip flexor; however, it unfortunately puts tension on the lumbar spine due to its lumbar attachments. Psoas syndrome occurs when the muscle is either tight or in spasm.
What causes psoas syndrome?
Psoas dysfunction can occur as a result of chronic back problems as the psoas acts as a secondary stabiliser when the primary stabilisers are poor. The psoas could also be acutely over-stretched (as with sprinting athletes on the push off phase of running).Hip joint pathology will also irritate the psoas.
What can I do about it?
Psoas syndrome will respond in the short term to soft tissue treatment and massage to the psoas muscle transabdominally.
Stubborn psoas muscles may require a psoas sheath injection or even dry needling of the muscle. If the psoas has put enough tension onto the lumbar facet joints, these joints may need separate attention. Attention to the underlying cause of the psoas spasm needs to be addressed. The stabilising muscles (transversus abdominis and pelvic floor) need to be retrained to ‘off-load’ the psoas. A physiotherapist can teach you how to better recruit your core stabilising muscles.
What investigations are useful?
Diagnosis is usually made on a clinical basis. Investigations are done to exclude more sinister pathology if your general practitioner is concerned that you are not responding to physical therapy.
The psoas is at the front so how can it cause back pain?
The psoas attaches to the facet joints of the lumbar spine. Hence tension on the psoas can load the facet joints of the lumbar spine and also create shearing forces at the lower lumbar level and stress the lower discs. The psoas tension can cause asymmetry in the sacroiliac joint and cause sacroiliac pain.