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
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
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
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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Copyright © 2004 - 2012Taras V.
Kochno, M.D. All Rights Reserved
Board Certified in
Physical Medicine and Rehabilitation