A Frequently Missed Diagnosis. J Am Osteopath Assoc ; 8: Psoas syndrome is an easily missed diagnosis. However, it is important to consider this condition as part of the differential diagnosis for patients presenting with low back pain—particularly for osteopathic physicians, because patients may view these practitioners as experts in musculoskeletal conditions.
After the correct diagnosis was made, he was treated by an osteopathic physician using osteopathic manipulative treatment, in conjunction with at-home stretches between office treatments.
At his 1-month follow-up appointment, he demonstrated continued improvement of symptoms and a desire for further osteopathic manipulative treatment. Report of Case Comment Conclusion References. Desai, DO ; W. Address correspondence psoas muscle and kidney cancer Gautam J. You will receive an email whenever this article is corrected, updated, or cited in the literature.
You can manage this and all other alerts in My Account. Psoas syndrome may manifest as any of a variety of clinical scenarios involving low back pain and often poses a diagnostic challenge. However, many patients have certain symptoms in common, including pain in the lumbosacral region when sitting or standing, delay or difficulty in achieving a fully erect posture, pain in the contralateral gluteal region, and radiation of pain down the opposite leg generally stopping proximal to the knee.
It is important to remember the existence of fascial connections when treating patients with psoas syndrome. Fascia envelops the psoas muscle and kidney cancer muscle as well as the adjacent viscera, and it connects to the internal crus of the diaphragm. Thus, passage of a kidney stone through the ureter may cause irritation of the psoas muscle. Dysfunction of the psoas severe allergies and menopause can cause restriction of the diaphragm, and, conversely, a restricted diaphragm has potential to cause psoas muscle dysfunction.
Other anatomic considerations include the parietal peritoneum, psoas muscle and kidney cancer, which covers the psoas muscle as well as the appendix.
Therefore, an inflamed appendix can cause signs of irritation of the psoas muscle. In the present article, we describe the case of a year-old man with a history of low back pain in whom the diagnosis of psoas syndrome was initially overlooked. After the correct diagnosis was made, osteopathic manipulative treatment OMT was used to treat the patient, psoas muscle and kidney cancer, in conjunction with at-home stretches.
A year-old white man presented with a 6-month history of low back pain. The pain, which shifted back and forth from his psoas muscle and kidney cancer to left lumbosacral region, was described as aching, psoas muscle and kidney cancer, and fluctuating in intensity.
He also had occasional bouts of pain and numbness that radiated into his buttocks and down to his knees, with the right lower extremity being more frequently affected. His back felt stiff and he had an especially hard time achieving a fully erect posture after prolonged sitting. He found a position of ease by lying flat on his back with his hips flexed, knees extended, psoas muscle and kidney cancer, and legs resting against a wall.
He believed that this position stretched the tight muscles in his legs. The patient denied a history of trauma or increased pain with coughing or sneezing.
He also denied any bowel or bladder dysfunction. In addition, he had been prescribed cyclobenzaprine hydrochloride, but he did not like the groggy feeling caused by the drug, so he discontinued its use. Physical examination revealed a well-nourished individual with no signs of acute distress. He had decreases in normal passive ranges of motion as follows: An osteopathic structural examination revealed, in addition to the previously mentioned findings, an anterior rotation of the right innominate bone; a left-on-right backward sacral torsion; lumbar vertebrae L1-L2 flexed, rotated left, and sidebent left; and L3-L5 neutral, rotated right, and sidebent left.
Figure 1 lists diagnostic findings gathered during an osteopathic structural examination that may be suggestive of psoas syndrome. Osteopathic structural examination findings that are suggestive of left psoas syndrome. The key dysfunction in this syndrome is considered to be lumbar vertebrae L1 or L2 rotated left and sidebent right. The patient was treated by an osteopathic physician using the OMT technique of muscle energy for his lumbar dysfunction, innominate rotation, and sacral torsion, psoas muscle and kidney cancer.
Articulatory techniques were used to release sacroiliac joint restriction affecting the sacrum and innominate region. Finally, a high-velocity, low-amplitude technique was used to correct the somatic dysfunction in his lumbar spine.
The patient underwent about 3 sessions of these treatments over a period of 4 weeks. The patient was instructed to perform exercises at home between his OMT sessions, including lunge stretches to stretch his iliopsoas muscle Figure 2 and external rotations of the hip to stretch his piriformis muscle Figure 3.
The lunge stretches involved the patient stepping forward with 1 foot while the opposite foot remained flat on the ground. He was instructed to keep his torso erect and to not bend over the front leg.
He was told to then lean forward until he could feel the stretch in his back leg. To stretch his piriformis muscle, he was instructed to place the lateral aspect of his leg on the edge of a bed with the knee bent. He was to then drop his hips down and lean forward over the bed until a stretch was felt in the leg. The patient was asked to repeat both stretches 10 times bilaterally, psoas muscle and kidney cancer, twice a day, and to hold each stretch for 30 seconds.
Modified version of the lunge stretch exercise that was assigned to the patient with psoas syndrome as a home stretch exercise. The lunge stretch involved the patient stepping forward seminars for nutrition and cancer 1 foot while the opposite foot remained flat on the ground.
Keeping the torso erect and not bending over the front leg, the patient leaned forward psoas muscle and kidney cancer he could feel the psoas muscle and kidney cancer in the iliopsoas muscle in his back leg.
Home exercises were used as treatment in addition to psoas muscle and kidney cancer sessions of osteopathic manipulative treatment. The type of at-home exercise used by the patient with psoas syndrome for external rotations of the hip to stretch his psoas muscle and kidney cancer muscle. He placed the lateral aspect of his leg on the edge of a bed with the knee bent. At 1-month follow-up, improvement was noted in both the subjective report by the patient and the objective physical and osteopathic structural examination findings.
The patient stated that after an initial, brief flare of symptoms on the first day of receiving OMT, he had a few virtually pain-free days. He added that there was ultimately a resolution of the pain and paresthesias down his legs, followed by gradual recurrence but not to the level of the initial presentation. The patient reported faithfully performing his assigned stretches, in addition to the core-strengthening exercises recommended by his previous, chiropractic provider.
His external hip rotation was no longer restricted on either side. Osteopathic manipulative treatment was repeated with the same protocol as the previous visit, and the patient continued to improve. The psoas major muscle attaches to the TL4 vertebral bodies and the L1-L5 transverse processes at its origin. Its primary role is to flex the hip, but it also plays a role in sidebending the spine.
The psoas minor muscle assists the psoas major muscle in flexion of the hip and lumbar spine. In most people, the iliopsoas muscle is slightly hypertonic. In athletes, such as runners, who frequently use the psoas major muscle, a hyperlordosis may be observed. The Thomas test can be used to help identify patients with psoas muscle spasm.
In this test, patients lie supine with their legs hanging off the end of a table. The patient then slowly extends 1 leg. The osteopathic physician may place his or her hand under the lumbar spine during the test to monitor the tissue for increased lordosis.
In a negative test result, B the supine patient can fully extend the leg to the table while the other leg is flexed. Psoas syndrome may be confused with snapping hip syndrome, with which there is some overlap of symptoms. A recent study 9 found that the most common cause of snapping hip syndrome is the iliopsoas tendon slipping over the psoas muscle and kidney cancer muscle, which occurs most frequently when the hip is moved from flexion, abduction, and external rotation into extension.
Typically, the snap is painless, but occasionally pain will be felt in the anterior hip, psoas muscle and kidney cancer. After visceral causes of psoas syndrome have been ruled out by means of patient history and physical examination, the osteopathic physician can focus on treatment, keeping the fascia in mind, psoas muscle and kidney cancer. In addition to treatment directed at the psoas muscle, OMT techniques should also be directed at regions of fascial attachments.
For example, because the fascia overlying the psoas muscle extends superiorly to connect with portions of the diaphragm, treatments directed at this region may help achieve the goal of relieving spasm of the psoas muscle.
In this technique, the patient lies in the supine position, and the osteopathic physician places his or her thumbs just inferior to the anterior costal margin bilaterally, applying a firm posterior and cephalad pressure.
This technique is repeated after respiratory cycles until treatment goals are achieved. If a patient with a psoas muscle spasm is left untreated, the body attempts to compensate for the change in structure, potentially causing several additional somatic dysfunctions that lead to additional symptoms. With the lumbar spine sidebent to the left, the pelvis shifts to the right, creating an additional strain on the right piriformis muscle. The piriformis muscle is 1 of the primary external rotators of the hip when the leg is extended.
When the leg is flexed, the piriformis muscle becomes responsible for hip abduction. The close approximation of the sciatic nerve is the reason that increased tone of the piriformis muscle could psoas muscle and kidney cancer irritation to the sciatic nerve.
Irritation to the sciatic nerve in patients with left psoas syndrome often causes pain that radiates down the back of the right leg and stops at the knee. Nonsteroidal anti-inflammatory drugs, moist heat, and injections of local anesthetic, corticosteroids, or botulinum toxin have also demonstrated benefits in treatment. Our patient did not follow the typical compensation pattern of sacral dysfunction.
Typically, psoas muscle and kidney cancer, the sacrum rotates on a left oblique axis in patients with left psoas syndrome. Our patient, however, had a left rotation on a right axis. To relax and lengthen the psoas muscle, OMT should be used as a treatment modality. In shrimp and cholesterol study in which OMT—in the form of counterstrain; high-velocity, low-amplitude; muscle energy; and myofascial release—was used to treat patients with acute low back pain, the researchers used functional magnetic resonance psoas muscle and kidney cancer to evaluate low back muscles and compare transverse relaxation time before and after OMT.
This result means that the asymmetry in muscle activity was decreased with OMT. Muscle energy can be particularly useful human sperm semen antibacterial help the psoas muscle relax. This treatment can be performed with the patient lying prone and the osteopathic physician standing at the side of the table Figure 5A. The patient is asked to push the leg back down to the table using isometric contractions.
A psoas muscle and kidney cancer is held for 3 to 5 seconds, and then the patient is asked to relax. During the period of postisometric relaxation, the osteopathic physician moves the leg further into extension. This procedure is repeated until improved hip extension is achieved. The application of muscle energy technique to A a patient lying prone, with the osteopathic physician standing at the side of the table. During postisometric relaxation, the osteopathic physician moves the leg further into extension.
The same treatment can be performed with B the patient in a supine position.