Eldemire Fletcher, Goto Kiyomi K.
Penn State Health
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.
腰大肌综合征由髂腰肌功能障碍引起，会引发一系列症状，包括下背痛、腹股沟痛、骨盆痛或臀部疼痛。髂腰肌的主要作用是屈髋。因此，站立、行走或从坐姿变为站姿时可能会出现背痛。相关的臀部疼痛通常在对侧，可向下放射至膝盖。当髂腰肌腱经过骨性突起时，会在这些部位产生摩擦，发出“啪”或“咯嗒”声，导致一种称为跳跃性髋部或弹响髋的病症。然而，腰大肌综合征可独立于弹响髋而发生。腰大肌综合征常见于运动员，尤其是跳远运动员、舞者和跑步者，是该群体腹股沟疼痛的最常见原因之一。不过，由于腰大肌作为腿部屈髋肌和外旋肌的功能，过度使用也可能导致非运动员患上腰大肌综合征。治疗通常包括保守措施，如调整活动、物理治疗、手法治疗、非甾体抗炎药和皮质类固醇注射。如果保守措施无法缓解症状，可以考虑手术松解髂腰肌。本程序综述重点关注整骨手法治疗（OMT）在治疗髂腰肌功能障碍中的应用。将讨论的针对髂腰肌的两种特定整骨手法治疗方式是肌肉能量技术（MET）和对抗牵引（CS）。MET是一种直接技术，将肌肉或关节置于受限屏障处，并要求其对抗治疗师进行等长肌肉收缩。等长收缩后，肌肉放松，治疗师将功能障碍进一步带入受限屏障。最常见的MET方案，也是此处描述的方案，是进行三到五次等长收缩后放松的重复操作。CS是一种间接技术，定位一个压痛点并将其移动到舒适位置90秒，同时监测疼痛减轻和压痛点质地变化。肌肉或关节恢复到中立位置，松开压痛点，从而降低超敏反应和本体感觉活动。
