Lumbar syndrome is a rare condition and is often misdiagnosed. To many, it seems to be a pain in the lower back, which persists even after treatment, accompanied by other symptoms.
The condition occurs when we injure the psoas, a long muscle (up to 40 centimeters) of the back. The psoas muscle is located in the lower lumbar spine and runs through the pelvis to the femur. This muscle works by flexing the hip joint and lifting the hip towards the body.
The syndrome is very rare compared to other conditions (slipped disc, arthritis, facet or sacroiliac pain) that are much more common. Unfortunately, anyone can develop Psoas syndrome, but athletes, runners, and those who perform plyometric jumps are at higher risk for the condition.
What causes Psoas Lumbar Syndrome?
This syndrome may not have an identifiable cause. Care must be taken in immunocompromised individuals to ensure that there is no infectious cause or associated psoas weakness presenting as appropriate.
As for the symptoms that appear, they include:
- Low back pain is the most common symptom, although it can be a symptom of many diseases.
- Pain in the lumbosacral region (the border between the lower spine and the buttocks, which may radiate to the lumbar vertebrae or the sacrum) when sitting or changing position from sitting to standing.
- Difficulty or pain when trying to stand in a fully upright position.
- Pain in the buttocks.
- Radiation of pain down the leg.
- pain in the groin
- Pain in the pelvis.
- Limping or shuffling when walking.
Many of these symptoms can mimic other, more serious conditions. Hip arthritis, kidney stones, hernias, femoral bursitis, prostatitis, salpingitis, colon cancer, and colonic diverticulitis can also cause severe back pain. If you find any of the above symptoms, it is important to see a doctor.
Diagnostically, psoas syndrome is difficult to diagnose as many of the symptoms are similar to several more common conditions. If your doctor thinks you may have the condition, they will want to rule out other, more serious causes. It can usually be diagnosed with a combination of physical examination of the spine, hip, and leg, confirmed by advanced X-ray imaging.
How is lumbar syndrome treated?
Lumbar spine syndrome is best treated with exercise. It is logical that this should be a doctor or physiotherapist who conducts therapy in consultation or at home.
These exercises will include active and passive manipulation and stretching of the spine, hips, and psoas. Home exercises include static and dynamic “closed circuit” low-impact stretches designed to stretch and strengthen the psoas and recover from injury. It is very important that this is done only under the guidance of a doctor so that we do not injure the psoas or other muscles.
Stretch the iliopsoas and surrounding muscles
Stretching the hip and thigh muscles makes sense, as less muscle tension in these areas will reduce the load on the iliopsoas muscle. There may also be some direct benefit from gently stretching injured muscles and tendons.
Specialists recommend that the treatment of iliopsoas injuries include stretching the hip flexors, piriformis, quadriceps femoris, and hamstrings. For best results, all of these muscles should be stretched two to three times a day for two sets of 30 seconds each.
Strengthening the hip rotators
Strengthening exercises should focus on the internal and external hip rotators. Hip instability caused by insufficient rotational strength of the hip can put excessive stress on the hip flexor area and damage the iliopsoas muscle.
The rehabilitation program includes three stages. The first consists of a basic internal and external rotation exercise that can be easily done with a table and resistance band. You need to do three sets of 20 repetitions daily, on both sides, for two weeks. After two weeks, we should do three sets of 20 cot leg raises using an elastic band draped over the knees. Visit Can A Modern Ship Sink like the Titanic
How to run again?
As with other soft tissue injuries, scientific evidence suggests that a pain-mediated return to running program can be used. Of course, you must give the hip flexor enough time to settle down. This may take several days or weeks, depending on your age and the severity of the injury.
Once we start running, we should gradually increase the intensity of exercise, but if we have mild to moderate pain, it’s not the end of the world. As long as it’s less than 5/10 on the pain scale, where 10 is the worst pain you’ve ever experienced and 0 is no pain at all, you should be fine.
In addition, the pain should not persist the day after the run, and the pain level should decrease every week. However, you should avoid running faster for a few weeks, and when you re-introduce it into your daily routine, do it gradually. If we are doing cross-training to keep fit, keep in mind that the hip flexors are highly activated when we practice other exercises such as natación or water running, making it a poor choice.
It’s likely that cycling might be the best option, though we’ll have to experiment to see how the hip flexors handle it. With proper treatment and exercise, people with Psoas syndrome should be able to regain their full range of motion and resume a very high level of physical function.