Disclosures: Lane M. Lagattuta, DO: No financial relationships or conflicts of interest

Case Diagnosis: Psoas Dysfunction

Case Description: A competitive soccer player with history of right femoral neck stress fracture one year prior and treated conservatively with physical therapy (PT), is referred from primary care with right-sided low back pain radiating to the hip after MRI shows mild L5-S1 disc space narrowing. The pain limits his juggling and bringing down passes with his right leg. The patient is diagnosed with right psoas dysfunction and has improvement of symptoms after conservative treatment with PT.

Setting: Academic Quaternary Care University HospitalAssessment/

Results: History and exam demonstrating pain with ambulation and when passing/juggling a soccer ball led to the diagnosis. Notable exam findings include tight right lower lumbar paraspinals and gluteal complex, and notable pain and weakness with resisted hip flexion reproducing the low back pain radiating into the right hip ultimately suggesting psoas dysfunction as the primary diagnosis.

Discussion: Pain in lower abdominal quadrants that radiates to the groin is a common presentation of psoas dysfunction. Pain is worse with activity, especially hip flexion. The typical mechanism of injury is forced stretching of the iliopsoas when it is maximally flexed. In soccer this is seen when players abruptly accelerate with cutting, turning, and with eccentric loading while kicking the ball. The origin of psoas from T12-L4 allows for pain to present in the lumbar spine, potentially leading examiners to focus on spinal etiologies rather than the hip. The dysfunction in this case was likely related to his prior femoral neck stress fracture leading to loss of normal neuromuscular communication leaving the muscle vulnerable to eccentric injury. Return to play is pain-mediated, between 6-8 weeks.

Conclusion: Repetitive eccentric loading of the hip in soccer leaves both the hip and groin vulnerable to injury. It is important to remember the anatomy of affected structures and the potential impact of prior injuries on muscular dysfunction.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-soccer-player-who-couldnt-kick-psoas-dysfunction-presenting-as-low-back-pain/