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DR. DAVID ROSENTHAL |
The Psoas Syndrome
Happy new year to all. I hope you all had a wonderful holiday season.
I wanted to start the new year off with one of the most common sites of injuries for dancers. I am talking about the most powerful hip flexor in the body as well as a powerful trunk flexor, the ILIOPSOAS.
Injury, shortening and contracture of this muscle can cause lowback pain, hip pain, sacroiliac pain, mid back pain, clicking hip and pain down the leg. It is commonly misdiagnosed as a low back strain or a disc bulge or herniation.
It kind of makes you feel that you are off. You seem to walk unbalanced. Common causes of injury are repetitive hip flexion. sleeping in the fetal position, lifting incorrectly, and in a dancers case the constant hip flexion and external rotation seen in a grand plie and a demi-plie.
A brief anatomy lesson of the iliopsoas. The Iliopsoas is made up of the iliacus muscle and the psoas muscle. It attatches from the the lumbar spine and iliac fossa to the lesser trochanter of the hip. It actually connects to your lumbar spine. If this muscle is contracted and is pulling on your spine you can develop a low back pain syndrome.
One way which I check for psoas shortening is the following: You need 2 people for this. Have the patient lie on there back. Have them bring there hands above their head fingers touching. Usually the problematic side will show that one of your arms is shorter than the other. Your fingers won’t meet at the tips. The short side is the dysfunctional one. There are other orthopedic tests for the psoas but that is for the doctors office.
A common release stretch for psoas shortening.
This is a stretch I recommend to my patients for psoas dysfunction (this is not medical advice, please see your doctor before doing any of this)
What is the best treatment for a psoas problem?
The muscle is not outwardly palpable such as the hamstring or biceps muscle. You really need to dig deep to get to the psoas. Stretching helps but rarely eliminates the problem. I have found Active Release Technique to be the most successful treatment in the case of Psoas dysfunction. ART allows you to fully stretch the muscle while breaking down scar tissue and adhesions that develop from repetitive use.
IMPORTANT TIPS
Situps- Make sure to isolate your abs. Many times you recruit the hip flexor or psoas and it takes away from the Abs. This improper situp can cause injury to the psoas. How do I do that?
Place both feet on a wall and do a crunch. Feel the difference.
In cases of LOW BACK PAIN, MAKE SURE YOU GET YOUR PSOAS CHECKED. If you are being treated for Low back pain with adjustments, electric stim, ultrasound, pt, stretching, etc and you are not feeling better after 4 or 5 visits, LOOK TO THE GREAT PRETENDER, THE PSOAS.
