Have you ever come across psoas syndrome? If you’ve had lower back, hip, or groin pain that just won’t go away, this rare but often forgotten culprit could be the reason why.

So what exactly is psoas syndrome? Psoas syndrome is a strain, stretch, or tear of the psoas muscle that causes symptoms like pain, limping, and difficulty standing up straight.¹ These symptoms can be troublesome and painful and affect your ability to exercise and even live your day-to-day life.

In this article, we’ll find out more about what causes psoas syndrome and how it can be treated.

What causes psoas syndrome?

To wrap your head around psoas syndrome, it helps to know a bit about the muscle itself. 

The psoas muscles are two long muscles that begin at either side of the spine and travel down the body to the hip. Because the psoas muscles connect the upper body to the lower body, they are very important muscles. The psoas muscles allow us to bend our legs at the hip joint (you can try this by bringing your knee up to your chest) and turn our legs outwards at the hip joint (which you can do by bending your knee and putting the ankle of that leg onto the knee of the other leg). These movements are needed to walk, jump, and much more.¹ It’s easy to see why psoas syndrome can be so frustrating!

"Psoas syndrome" is when the muscle gets hurt in various possible places. This could be:  

• A strain or tear of the psoas muscle itself.
• An injury or inflammation of the psoas tendon (the part of the muscle that joins with the bone) - called psoas tendonitis.
• Inflammation of the psoas bursa (a sac underneath the muscle filled with fluid. This sac acts as a smooth base so that everything can slide freely without friction) - called psoas bursitis.

All three come under the umbrella term of ‘psoas syndrome’.²

Who gets psoas syndrome?

Although the psoas muscles are really important in the body, psoas syndrome itself is quite rare. Scientists don’t know exactly how common it is but they do know athletes are more likely to be affected than non-athletes. In fact, other names for psoas syndrome include ‘dancer’s hip’ or ‘jumper’s hip’.² These names give a handy clue about the groups of people more likely to get psoas syndrome. This is because movements like jumping and dancing can stress the psoas muscle. In one study, 6% of dancers were affected by psoas syndrome.³

 Psoas syndrome is also more common in females than males.⁴

It is also more common in teenagers because growth spurts result in the muscle being less flexible and so more prone to being strained.⁴

Psoas syndrome is more likely in people who have arthritis because their hip joints already have some damage so they are more likely to be injured.² As well as this, psoas syndrome can happen after a hip replacement operation (which is sometimes done for arthritis). In one study, scientists found that in 4% of people who had a painful hip after an operation, the cause of the pain was psoas syndrome.⁶ If you’ve had a hip replacement and you now have pain in your hip, back, groin, or bottom, psoas syndrome could be the cause.

How do I know if I have psoas syndrome?

So what symptoms do you get with psoas syndrome? Pain is usually what alerts people that something is wrong. The pain is usually in the lower back, the hip, the groin or the buttocks.²

Some people also mention a feeling of ‘catching’ in the groin, especially if the injury is in the psoas tendon.²

Another important point is that the pain tends to be worse when the muscle is used. People often find that their symptoms are worse with movements like walking, bending down, or standing up from a sitting position. Some people find it difficult to stand up straight at all.²

How is psoas syndrome diagnosed?

Because psoas syndrome is very rare and because the symptoms are quite general, it can be difficult to diagnose. Often, people are diagnosed with other things first before the right cause is found.⁷ The good news is that treating other causes of back pain with physiotherapy and exercises usually also strengthens the psoas muscle which means that psoas syndrome can be treated without having ever been diagnosed.

To diagnose you, your doctor will speak to you about your symptoms. They will want to rule out other, more serious causes of back pain - such as kidney stones, hernias, bowel or prostate issues, and cauda equina syndrome (a very serious condition where the bundle of nerves at the bottom of spine is compressed, leading to symptoms like leg weakness, reduced feeling in the legs and around the genitals, and affecting the bowel and bladder).^{2, 8}

They will also examine you to help determine where your pain is coming from.

What tests can be done for psoas syndrome?

In most cases, your doctor will be able to diagnose and suggest treatment for you without needing any scans. However, there are cases where a scan can be helpful such as if your pain isn’t going away with treatment.

In these cases, X-rays are not usually helpful. This is because X-rays are designed to look at bones and can’t pick up soft tissue (muscles, tendons, bursa) very well.⁹ X-rays also involve a small amount of radiation exposure.¹⁰

An ultrasound scan can be useful to establish whether the cause of the pain is coming from inside the hip joint or outside of it. An ultrasound is also helpful because it can show swelling in the psoas tendon or bursa which are good pointer that the psoas muscle is the cause of the pain.^2,4

MRI scans are the “gold standard” test because they are the most detailed method to look at your hip and back.¹¹ An MRI has the added benefit of not exposing you to any radiation. However, there are some disadvantages to an MRI scan: namely that some types of metalwork in the body mean that an MRI can’t be done for safety reasons. Some people also find MRI scans loud and claustrophobic.

How is psoas syndrome treated?

Simple measures and exercises

Thankfully, psoas syndrome is very treatable and most people eventually go back to their usual level of functioning.

Making sure that you are comfortable and not in pain is an important aspect of treatment. This can be done with painkiller medications (like paracetamol and ibuprofen) as well as general measures like applying ice packs to the area.⁴

Exercises focusing on strengthening the hip and spine muscles are the main way to treat psoas syndrome. Your physiotherapist will give you a tailored exercise regime to follow at home.²

In one study, 100% of dancers said that their symptoms went away with just these treatments.³

Steroid injections

In cases where exercises are not alleviating symptoms, steroid injections into the tendon can calm down the inflammation and ease the pain.²

Surgery

In cases where symptoms are not going away even with treatment, your doctor will speak to you about the next steps. They may suggest surgery. By this point, a specialist like an orthopaedic surgeon will likely be involved in your care. An operation will focus on the psoas tendon, either by surgically lengthening it or releasing it, depending on what your surgeon thinks is best. They will speak to you about the pros and cons of an operation.²

Steroid injections or an operation are more likely to be needed if the psoas syndrome has happened after an operation (like a hip replacement) than if it happened as a result of an injury.²

How can I prevent psoas syndrome?

As the saying goes, prevention is better than cure, and this is certainly true for psoas syndrome. So what can you do to prevent it from happening in the first place? Regular exercise makes sure that your muscles are strong and flexible and in turn less likely to be injured. You should also follow health and safety procedures when doing things like lifting heavy objects as these movements can put stress on your body. Keeping an eye on your posture is also a good idea to make sure that none of your muscles work harder than they need to.

When should I see my GP?

If you have back hip or groin pain that is affecting your day-to-day life or that is not going away after a few weeks or that is getting worse, you should see your healthcare provider. If you notice a lump in your groin, you should also see your GP straight away.¹²

What are the warning signs I should look out for?

Although psoas syndrome isn’t serious, other more serious conditions can cause similar symptoms. If you have any of the symptoms listed below¹² you should speak to a doctor straight away:

• Severe pain
• Any pain or swelling of the testicles
• Feeling that your legs are weaker than usual
• Feeling unsteady on your feet
• Not being able to put weight onto your leg
• A feeling of numbness or pins and needles in the legs
• Not being able to pass urine or control your bladder
• Not being able to poo or control your bowels
• A sensation of numbness when wiping after going to the toilet ‘saddle anaesthesia’
• Feeling feverish or ill
• Unexpected weight loss

Summary

We have spoken about what causes psoas syndrome, who is more likely to get psoas syndrome, and how it is treated.

The good news is that psoas syndrome isn’t a dangerous condition (although it is a frustrating one!) and, with the right treatment, you should be able to go back to your regular activities.

Listen to your body, speak to your doctor if needed, and take positive steps toward a pain-free and active life. Here's to unlocking the potential for a healthier, happier you!