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Psoas Minor Strain


The psoas minor muscle has been clinically ignored as a functional hip flexor.  Functional anatomy books state that, “unlike the psoas major, the psoas minor has little, if any, functional significance in hip motion”.


In reviewing the anatomy of the psoas minor, this muscle lies anterior to the muscle belly of the psoas major.  Psoas minor muscle attaches proximally between the 12 thoracic and 1st lumbar vertebrae and inserts distally to the pelvis at the midpoint of the superior pubic ramus.  This muscle functions as an extension of the psoas major muscle.


A former professional golfer, three elite football players and an athletic senior male presented with similar clinical signs and symptoms of hip flexor strain.  The clinical presentation was similar in complaints of pain in the anterior inguinal area extending upward deep along the midline abdominal wall and downward toward the testicles.  This pain interfered with their ability to run, jump or rotate on their hip.


The physical examination was consistent in all five athletes in that they demonstrated an extremely limited Thomas test on the affected side of the strain.  The Thomas test of the affected hip flexors affected demonstrated a reduction of over 50% of expected range of motion when compared to the non-affected side.  Pain was reproduced by deep palpation in the psoas minor attachment along the rim over the superior pubic rami.  Tenderness to palpation was noted in the superficial inguinal ligament.  Subluxations were noted at T12-L1 vertebrae posteriorly, as well as, the sacrum subluxed on the affected side.


In approach to treating the psoas minor strain, first reduce any subluxation of the vertebral column especially along T12-L1 using either an osteopathic or chiropractic compression.  Secondly, provide adjustment of the sacral and iliac bones at the sacroiliac junction.  Once proper spinal and pelvic alignment is corrected then the deep hip flexors – psoas major, minor and iliacus muscles are positioned anatomically properly for a myofascial stretch.


The psoas major and iliacus muscles are most effectively stretched using Aaron Mattes® technique of Active Isolated Stretch.  This technique identifies the muscle attachments and assists the patient in stretching the  myofascial tissue within its functional anatomical plane.


Secondary muscles commonly associated with this clinical condition include the quadratus lumborum, multifidus, adductors brevis, longus and pectineus,  the gluteus medius, minimus and piriformis muscles.  Active isolated stretch has been shown in my experience to be the best myofascial technique to promote restoration of flexibility and range of motion of the muscles.


Two patients with a chronic psoas minor condition had similar findings that both patients developed avascular necrosis of the superior aspect of the femur.  This finding may be coincidental, but a clinical question arises to whether a vascular supply could be compromised by the psoas minor muscle strain.


The other three patients without avascular necrosis underwent physical therapy consisting of myofascial release and manual adjustments and were able to return to full activity within a few  sessions.


Again, the psoas minor muscle is not well understood functionally nor clinically.  Hopefully my experience of evaluation and treatment of the psoas minor muscle strain can assist other clinicians in helping their patients with a similar condition.



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