Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure - Psoas Muscle Procedures

Psoas syndrome results from dysfunction of the iliopsoas muscle and causes a constellation of symptoms, including low back pain, groin pain, pelvic pain, or buttock pain. The primary action of the iliopsoas muscle is hip flexion. Therefore, back pain may occur with standing, walking, or changing position from sitting to standing. The associated buttock pain is often on the contralateral side and can radiate down to the knee. When the iliopsoas tendon passes over a bony prominence, it can cause rubbing at these points that produce a “pop” or “snap,” leading to a condition called Coxa Saltans or snapping hip. However, psoas syndrome can occur independently of snapping hip.  Psoas syndrome is commonly seen in athletes, especially jumpers, dancers, and runners, and is among the most common causes of groin pain in this group. However, psoas syndrome can occur in non-athletes due to overuse, given its function as a hip flexor and external rotator of the leg. Treatment typically consists of conservative measures such as activity modification, physical therapy, manual therapy, NSAIDs, and corticosteroid injections. If conservative measures do not relieve symptoms, surgical iliopsoas release can be a consideration. This procedure review focuses on the use of osteopathic manipulative treatment (OMT) to treat iliopsoas dysfunction. The two specific osteopathic manipulative treatment modalities for the iliopsoas that will be discussed are muscle energy treatment (MET) and counterstrain (CS). MET is a direct technique where the muscle or joint is taken into a restrictive barrier and asked to provide an isometric muscle contraction against the provider. Following the isometric contraction, the muscle is relaxed, and the provider takes the dysfunction further into the restrictive barrier. The most common MET protocol, and the one described here, uses three to five repetitions of isometric contraction followed by relaxation. CS is an indirect technique where a tenderpoint is localized and moved into a position of ease for 90 seconds while monitoring for the reduction of pain and change in the texture of the tenderpoint. The muscle or joint returns to a neutral position, and the tenderpoint is released, resulting in a decrease in hypersensitivity and proprioceptive activity.