Clinical Kit - Iliopsoas Trigger Points
Here are a couple of iliopsoas trigger point case studies that you may find interesting that were treated with dry needling. Places are available in both Advanced Lower Quadrant Courses in Perth and Adelaide.
A 35-year-old woman presented with LBP in the midline low lumbar area, with pain radiating to both posterior thighs, not below knees. Previous chiropractic + massage treatments and three months of bed rest had resulted in no improvement. A prior LS CT revealed left L4 to SI herniated discs, which had been surgically treated 12 months before presentation. Pain was reduced by 50%, but ADLs were limited and she was unable to return to work. Repeat LS CT revealed no additional changes.
Physical examination revealed limited back extension with back pain NPRS 4/10 on left hip extension, bilateral IP trigger points, and left para-vertebral trigger points L45S1. Other movements were near normal. Isometric hip flexion was weak on L. Neural tissue provocation tests (NTPT) and neurological examination was normal.
Bilateral dry needling of the IP and para-vertebral trigger points was provided. Back extension was initially mildly improved. On review NPRS was 2/10 and treatment was repeated 3 days later and a home program of hip extension and lumbar mobility and stretches exercises was taught. Two weeks later the client reported 90% improvement. Physical examination revealed full spinal extension and no residual trigger points. She returned to work, and reported no pain on phone-call follow-up.
A 40-year-old dancer instructor with LBP was unable to teach for several months. No specific incident precipitated onset. Pain intensified, despite massage, chiropractic intervention, and complete rest. She could not walk more than 300m; supine lying with knees flexed or side lying was most comfortable.
LS spine x-rays was normal. LS CT scan showed a R) L5S1 IVD protrusion without nerve compression. Physical examination findings showed limited lumbar extension with a R bias. A positive R Thomas test and prone knee bend NTPT were present. Isometric testing showed mild right IP weakness. Trigger points were palpated in right IP, TFL, RF and QL L3.
The client received trigger point treatment to bilateral IP, right TFL and RF. After initial treatment she had normal lumbar extension and hip extension immediately. She commenced passive and active hip extension stretch exercises. Follow-up 3/7 showed 80% to 90% reduction in pain and ability to walk a couple of kms. Her R IP was only active trigger point on review. Dry needling was repeated, resulting in complete symptom relief. She returned to dancing over a period of 1/12, while maintaining her program of hip extension.
You can see a short video example of the iliopsoas jump sign here.
Some Key Points
- Trauma may not be a precipitating cause
- Trigger points can be found long after lots of other treatment
- Trigger points persist with bed rest treatment
- Mixed findings related to IP dysfunction are present - lack of ROM, strength, palpation pain
- Treatment is directed at the motor point in groin rather than abdomen
- Combination of treatment is provided based upon examination findings
Case studies and detailed examination are part of all our Dry Needling Clinical Program courses. If you are interested in this information and would like to know more, have a look at our upcoming Introductory Course or Advanced Lower Quadrant Course.
All the best,
Dr Doug Cary
Specialist Musculoskeletal Physiotherapist