Nerve entrapment by the illio-psoas causing pain, tingling, and numbness in the groin, pelvic, abdominal, perenial, gential, and upper thigh area.

10/4/2013

An update from my blog written on Jan 2011

This is a follow up on my blog written some 2 years ago explaining my experience with nerve entrapment by the illio-psoas muscle. At the time I was uncertain what exactly the cause of my symptoms were. I was just very pleased they were going away. After doing some research and talking to other medical professionals, my experience describes the onset, symptoms, and recovery of a illio-psoas muscle strain and nerve entrapment.

Many of the replies to the previous blog appear to be suffering from the same condition. Some however appear to not quite line up with this exact condition. Again I am a personal trainer, not a doctor or physical therapist so I could never give a diagnosis based on a blog reply nor could any medical professional.

Other possible conditions and injuries
Many of these symptoms line up with other conditions where nerve aggravation is present, but not from muscles or fascia. Commonly these symptoms can be a result of a spinal disc injury. A herniated disc can cause a lot of these issues (http://www.mayoclinic.com/health/herniated-disk/DS00893) as well as other conditions (http://en.wikipedia.org/wiki/Cauda_equina_syndrome [rare]), reproductive issues, cysts or growths. A few replies sound a lot like ostetis pubis (http://emedicine.medscape.com/article/87420-treatment#aw2aab6b6b2) which is a groin injury and more specifically the inflammation of the pubis symphosis. I know personally because I am currently recovering from this caused by a combination of sprinting and being overly tight in the adductors and rectus abdominus. Another future blog will describe this. There is also the possibility of reproductive issues. As you can see, there are a lot of possible injuries/issues associated with these symptoms. Any doctor can start to rule out any of the obvious conditions by getting various tests done. An MRI for the spine would be important to rule out any disc injury or condition.

Comments and Replies
Some of the replies to my blog are from people who had many tests come back negative and with their doctors having no idea what was wrong with them. Some doctors may blame it on psychological factors or some may just say, “you probably pulled something. Give it some time to rest and it probably will just go away.”. Most of the people reading my last blog had done this already with no success. For those who have gone through multiple doctors and tests, you may want to start to look at a muscle strain of illiopsoas as the primary cause. Others may have this in addition to other injuries which commonly coincide with low back injury.

Illiopsoas muscle strain and nerve entrapment

The illiopsoas is a muscle that can often contribute to low back and pelvic pain. A strain in this muscle will cause it to tighten up, produce muscle spasms, and create knots/trigger points in the muscle itself or fascia. There is also the possibility of hematoma in the muscle causing issues due the inflammation and enlargement of the muscle.

Here are excerpts from Travell and Simmons, The Trigger Point Manual taken from, www.triggerpoint.ca/index.php?p=1_64_Travell-Simons-Trigger-Point ,which has a very good list of relevant excerpts:

"ENTRAPMENT may occur because of pressure by the palpable bands of taut muscle fibers that are associated with myofascial TrPs, when the nerve passes through the muscle between taut bands, or when it is compressed between such a band and bone. The cause of the neurological symptoms and signs of neurapraxia that result is easily misinterpreted if this mechanism of entrapment is not recognized."

Travell and Simons; Myofascial Pain and Dysfunction, The Trigger Point Manual; 1999; pg. 94.

On untrained physician’s diagnosis on an unrecognized condition.

"It is all too easy for the physician to blame the patient's psyche for the inability of the physician to recognize the muscular skeletal sources of the patients pain. This wrong assumption can be and often is devastating to the patient."

Travell and Simons; Myofascial Pain and Dysfunction, The Trigger Point Manual; 1999; pg. 220

Common for athletes and vigorous exercisers

“Good Sport” Syndrome

"The “good sport” syndrome is the opposite of hypochondriasis. The “good sport” has a stoical attitude and is determined to ignore pain. He or she charges forth engaging in activities with total disregard, if not outright defiance, of the pain, thereby overloading the muscles and aggravating trigger points. “Good sports” often believe that their pain is a sign of "weakness" and that they must push on to demonstrate their mastery of it. They must learn how this abuse of their muscles contributes to their pain, and how new ways of doing things can let them perform the activities important to them safely and comfortably."

Travell and Simons; Myofascial Pain and Dysfunction, The Trigger Point Manual; 1999; pg. 221

Depression and Pain

"A major, well recognized contributor to depression is chronic pain. On the other hand, pain may lower the pain threshold, intensify pain, and impair the response to specific myofascial therapy. Patients who have suffered myofascial pain for months or years are likely also to have developed secondary depression and sleep disturbances, and to have restricted their activity and exercise."

Travell and Simons; Myofascial Pain and Dysfunction, The Trigger Point Manual; 1999; pg. 110

Trigger Points and Nerve Entrapment by the Iliopsoas

Travell defined a trigger point as “a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. The spot is tender when pressed and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena.”

“Acute myofascial pain due to TrPs caused by a clearly identifiable strain on one muscle is, as a rule, able to be fully relieved and normal function restored.”

The strain of the illiopsoas muscle leads to the formation of trigger points. These trigger points can refer pain in the classic pattern as shown below.

My previous blog talks about nerve entrapment from trigger points. In this situation, the pain will follow along through the nerve pathway giving way to these mysterious pains of many areas. There are a number of nerves passing through and along the psoas that can be irritated.

Again www.triggerpoint.ca/index.php?p=1_64_Travell-Simons-Trigger-Point has a great list of excerpts and information regarding trigger points.

Iliopsoas Anatomy
The iliopsoas is comprised of three muscles. The illiacus, psoas major, and psoas minor. They are often grouped together as the iliopsoas muscles because they work together to perform the same functions. They work to perform hip flexion and external rotation, lumbar spine extension, same side rotation, and lateral flexion.

The illiacus originates from the iliac fossa and inserts to the lesser trochanter of the femur.

The psoas major originates from vertebraes T-12 to L-5 and joins the illiacus to insert into the lesser trochanter. Being that this muscle originates from the lumbar spine, there are many nerves that run in, around, and along the psoas muscle. Nerve roots exit the vertebrae and many branches of these nerves come in direct contact with the psoas. The lumbar plexus, which is a plexus of nerves that includes nerves L-1 through L4 are in fact formed through the psoas. Like all nerves they branch into smaller nerves as you trace it further from its origin.

From Travell and Simmons

Common Trigger Point Pain Pattern
Trigger points can refer pain or other symptoms to other areas as seen in image 2. This is the common referral pattern of the iliopsoas from trigger points. Symptoms can arise in other areas as many people experience.

As stated earlier, strain or trauma to the psoas can lead to “knots” or trigger points that irritate the nerves or create pain along the nerves pathway. Describing each possible nerve that could be affected and tracing its path is tedious and lengthy for most readers. Instead of writing on this, below are some possible and common nerves that can become entrapped by trigger points in the psoas muscle and cause pain described in my previous blog.

Possible nerves that can be entrapped by the psoas and pain symptoms:
Notice the areas that these nerves supply as those are commonly symptomatic areas.
From Primal 3D Human Anatomy Regional Edition

Iiliohypogastric Nerve:
Originates from the ventral ramus of the L1 nerve with a small branch from the ventral ramus of the T12 nerve. They "pass inferolaterally through psoas major to emerge from their superolateral border with or above the ilio-inguinal nerves and passes over the anterior surface of quadratus lumborum to pierce transversus abdominis above the iliac crest." It branches into the Lateral cutaneous and anterior cutaneous branches.

It supplies the transversus abdominis and internal oblique muscles as well as the posterolateral gluteal and suprapubic skin (the region on the upper/side glute and just above the pubic bone).

Ilio-inguinal Nerve:
Originates from the ventral ramus of L1 nerve and "emerge from the superolateral border of psoas major with or below the iliohypogastric nerves. Each ilio-inguinal nerve passes obliquely across quadratus lumborum and the superior part of iliacus to pierce the transversus abdominis and internal oblique muscles. Subsequently, ilio-inguinal nerves pass deep to the aponeurosis of external oblique to enter the inguinal canal." It Branches into the anterior scrotal branches for males and labial branches and for females.

It supplies the internal oblique muscle the skin of the superomedial thigh the root of the penis and the upper part of the scrotum in males, and the skin of the mons pubis and labium major for females.

Genitofemoral Nerve:
It originates from the ventral rami of the L1 and L2 nerves "and is formed in the substance of the psoas major muscle where it then emerges from its anterior surface, where it penetrates the psoas fascia. It divides into genital and femoral branches above the inguinal ligament."

Femoral Branch
It "enters the thigh behind the inguinal ligament" and "enters the femoral sheath lateral to the femoral artery, which it supplies. It then pierces the anterior femoral sheath and the fascia lata to terminate in the skin over the superior part of the femoral triangle."

It supplies the "femoral artery and the skin over the superior part of the femoral triangle."

Genital Branch
It descends "anterior to the external iliac arteries, which gives branches to, and enter the inguinal canals via the deep inguinal rings." In the male, "the genital branches emerge with the spermatic cord, to give off branches to the cremaster muscle, testicular autonomic plexus, and the skin of the scrotum adjacent to the thigh". In the female, they "accompany the round ligament of the uterus to terminate in the skin of the mons pubis and labium major."

It supplies the "external iliac arteries cremaster muscle, testicular autonomic plexus, and skin of the scrotum in males. It supplies the skin of the mons pubis and labium major in females."

In regard to all the nerves (iliohypogastric, ilio-inguinal, genitofemoral) above this was listed under pathology. The anatomy software had this exact excerpt under each of the three nerves, but I do realize it only menitons the genitofemoral nerve. It is possible this was a mistake in the software because I know there are a number of nerves that can be irritated by the psoas, not just the gentiofemoral nerve.
"Parathesis
• Because the genitofemoral nerve runs through and on the ventral surface of the psoas muscle, paresthesias of this nerve can result from psoas abscesses or hematomas involving the body of this muscle.
• Physically active patients on long term anticoagulation are susceptible to this kind of complication."

Other possible affected nerves: Femoral nerve, obturator nerve.

These nerves also pass through the psoas, so there is a possibility they can be affected by a psoas muscle strain and knots. I did not experience any symptoms from the areas that these nerves supply so therefore I did not include the details in this blog.

There is a possibility that I am missing other nerves or branches of nerves as this can be a complex system.

Nerves can be irritated anywhere along its path by a number of tissues. Again, this blog describes the psoas as the culprit. There are many other cases where another tissue can irritate one of these nerves.

I have come to the conclusion that my injury was a result of psoas muscle strain which lead to inflammation, hematoma, and/or trigger points. This injury is common to vigorously active exercisers including weight lifters, bodybuilders, American Football and rugby players. It seems as though many doctors would go with a disc injury diagnosis based on these symptoms which is understandable because they can match up. Some of the replies to the last blog strongly point to a disc injury. If the patient was the average sedentary person then most likely it would be a disc injury. Athletes and intense exercisers commonly have disc issues, but if the MRI comes back negative and the patient is goes through physical therapy with a diagnosis of a disc injury, they may be disappointed with failed results. Again, a number of issues have these symptoms but, a psoas muscle strain with these symptoms is quite common among vigorously active exercisers.

I suggest finding a doctor or therapist who is familiar with this condition if you suspect you have it. I would stay away from those who look perplexed when bringing up this issue or those who try to steer you in a different direction for recovery. Again, ruling out spine injury and other conditions with these symptoms is a very good idea.

In my next blog I will put together a more comprehensive program that I did to recover and what I would do now after discovering the nature of this injury.

My first blog exlaining my experience with this issue:
Pain, Pressure, Discomfort, Burning, Tingling, and Numbness in the Abdomen, Groin, Pelvic, Genital, and Upper Thigh Areas. My experience with these symptoms as the result of pinched nerves and other underlying issues.

For more information on this condition visit www.drgillick.com under clinical issues. He had the only detailed report that was searchable online which may or may not be currently available.

References:
1)Travell and Simons. Myofascial Pain and Dysfunction, The Trigger Point Manual. 1999.
2)John H. Gillick MD, MPH, FACA, FACP.. Iliopsoas Muscle Strain - The Filet Minion of Backaches. 2003. www.drgillick.com
3)Van Dyke, Holley, Anderson. Review of iliopsoas anatomy and pathology. Radiographics Jan 1987, vol 7, num. 1.
4)3D Human Anatomy: Regional Edition. Interactive Pelvis & Perineum. 2011.

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paris brenn

11/13/2013 05:53:39 am

After ALL the websites I've visited, yours had the info I've been looking for- I'm sure I have had an experience w/-nerve entrapment. My L4 &L5 are being treated w/ physical therapy, (det disc & herniated disc) but this morning I woke w/ an electrical type shock pain in my right groin. ouch. It only lasted a few seconds, and I wondered, -what now? At least it has a name and a perfect description here, thanks to you. I will be seeing my doctor soon..Thanks a lot.

Andrea

2/27/2014 01:35:18 pm

Wow! Oh my gosh! I practically want to speak with you if that's even possible! I am a 30 year old female runner and serious weight lifter. I have been diagnosed with meralgia paresthetica (thigh numbness tingling and burning). I felt it slowly come on doing leg press. Anyway, I have been researching like crazy for months and calling doctors and have no where to turn! I have been treated for a slight herniated disc (although there was no X-ray or MRI). Realignments, stim and acupuncture. Only thing that really helps is rest. Then once I do anything, I reaggravate it. Frustrating! I stumbled upon this but can't find your original blog about this from two years ago. Can you direct me to it? Also, if this is a psoas issue causing the nerve entrapment, what do you recommend me doing to treat this?! Please help! First thing I have found that sounds remotely similar to my issue!!! Thank you so much!!!

Jerry

2/28/2014 02:29:08 am

Hi Andrea,

I added the link to my first blog at the top and bottom of this blog. Looks like I missed that when published.

Regarding your symptoms, you are probably doing the right thing. Although it is possible you have this issue, I will say that the leg press is notorious for putting high amounts of direct force on the lumbar discs. I have a number of friends who had back issues after doing a lot of leg press which was a very popular exercise at the first gym I worked at.

If your psoas is causing some issues then I would recommend some soft tissue work on it by a qualified massage therapist who does Trigger Point Therapy or ART.

Also SLOWLY get back into your lifting and running. Hope that helps!

Y1985

4/10/2014 03:29:32 am

Hi jerry,
I would firstly like to thank you for sharing your experience and the informative subject matter provided thus far. I can relate to many of the symptoms that you have described pelvic and abdominal pain, numbness and also issues with the bowels. After exhausting the conventional medical route ie urologists and having mri scans to rule out any thing wrong with my spine I decided to see an oseteopath. I gained more results from the osteopath than any doctor that i had seen and from any drugs that they had perscribed. The doctors seemed dumbfounded by my symptoms and could not explain them I strongly believe that my issues are neuro musculo skeletal as i often experience relief when muscles are released. This relief is however short lived. I was a very active individual prior to these symptom, an avid gym goer but after, for about 4 years could not get back to being active as the pain would increase if i went for a jog. The muscles in my pelvis back and abs were chronically tense. Also suffer from anxiety and depression due to this problem which feeds the pain its like a vicious feed back loop. I have only very recently returned back to movements such as the squat and deadlift with very very light weight. Did you have issues with your urinary system and sexual dysfunction? as I also have these. from my understanding as a lay person not a professional in any way, the nerves for your digestive, urinary, sexual and bowel functions run along the same circuit, this would explain the different symptoms that I have experienced I strongly believe that this is a neuro musculo skeletal issue. Any advice would be great. I look forward to your next blog and thank you for the comprehensive information.

4/17/2014 09:09:07 am

Hello and thank you for your comment Y1985,

Back when I had this injury some 10 years ago, I did have bowel issues almost like Irritable Bowl Syndrome (IBS). I did not experience sexual or urinary dysfunction, but I hear it is common. I have believed in the past that this was due to the psoas as my blogs describe. This may have been the case.

Here is another thought: Luckily (sarcasm) I have had a pelvic injury for the past year which is finally being resolved. Ultimately it was an injury to the pubis symphosis. This may or may not be your injury, but it does bring up another possibility... Like the psoas (or any muscle) the pelvic floor muscles can have trigger points. Some people get these and experience the symptoms you described. There are treatments for these though it may be tough to find someone who does them. It is another option. The technique involves going in through the rectum to access the pelvic floor muscles. And yes, for women there are two possible entry points. Unpleasant it may be, it does help some people. I do not know anyone personally who has had them done.

Hope that helps.

Jonathan Steee, RN Holistic Nurse link

4/20/2014 08:56:20 pm

We have been doing an exhaustive data search on paresthesia and are glad to find this. We have started researching a treatment called the water cures protocol. It involves using unprocessed sea salt dissolved in the mouth and drinking an amount of water based on body weight.

With the low salt movement, it has been discovered that there is an increase in health complications. Now the CDC and JAMA both say we need more salt. We only recommend unprocessed salt, which has essential nutrients in it.

So far, in our initial research, the test subjects have found relief using the protocol. Next, a large clinical trial.

Note, this is not in place of what you have done, rather to be added to the therapies you used to eliminate the problem. This is a foundation treatment to make all other treatments work better.

There is more at WaterCures.org in the pain section.

Tom

4/22/2014 06:11:33 am

Wow, ok, I believe this is me too. I am 49 years old and have been competing in triathlons for the last 6 years. 10 days ago I did a short triathlon as a start to my season. The run was only a 5K however it was extremely hilly with many steep descents. I did well, went hard, and was completely fine for the rest of the day and night. However, I awoke at 4am to some severe hip pain and I could barely walk or stand the next day! After researching, it did appear that there was some damage to the illiopsoas muscle because it was very tender but also pain and numbness referring down the inside of the thigh, and moving all over the place. It is amazing how different the pain and sensations have felt over the last 10 days. So I guess I am looking for what to expect. I have had acupuncture which seems to have helped but also seems to be a temporary for pain and not for healing. Icing frequently also seems to help relieve pain. My drug of choice has been Aleve which did help but now I am off of that. I am still feeling the tingling, numbness, pain and other sensations down the leg so that is why I kept searching. This blog explains alot. Jerry is there anything more you suggest I do? I do have a great ART Dr near me, Dr Glass in Lake Forest. Maybe I show him this blog? Thanks in advance.

tati

5/12/2014 02:29:23 pm

hi, im an aerial yoga teacher, and the past months i´ve had three students that have experienced numbness on the thighs after a certain pose we practice. this pose is like down dog but we hang from a hammock, the hammock is placed right at the hips, and it very intensely stretches the psoas.
i wonder if it could be somewhat like the condition that you describe, the numbness goes away after a few days, but only after massage and using a foam roller and such.
could it be that from pressing on the psoas the nerve is pressed and the fascia contracts or spasms?

5/16/2014 03:52:54 am

Hi Tati,

If I am understanding correctly, your hips are in flexion while in this position? In order to stretch the psoas you have to bring your hips into extension while simultaneously keeping your back straight and arm(s) overhead. If this pose is similar to a down dog position, then what you may be experiencing is increased nerve tension. This position can create a high amount of nerve tension and irritation especially if someone already has a back issue.

I would say it is more likely this cause than pressing on the psoas causeing the numbness.

Hope that helps

marco

11/9/2014 11:57:03 am

Hi there I been reading every story I been some seem similar to wat I'm going thru I don't get pain in my growing I get pain on my right side kinda back side of my hip tingling sensation also everytime I go to the gym I suffer from crazy insane pain thought it was my kidney went got blood work and urine sample everything seems fine went to a natural doctor he said I had 2 pinched nerves by my lower back some pain went away but still suffering pain and tingling feeling on my right side doctor just gives me pain meds but I'm depressed have anxiety shortness of breath cause of the pain I need your help what do u suggest I do sometimes I feel like I'm dying if any of u have any info on this injury can you please share or inform me thank u I will appreciate any advice gos bless

Moiz

12/7/2014 05:49:51 pm

Hi,

I've faced similar sort of problem since the past 2 months. I've been walking/running periodically for the last 6 months. I've never had any problems while walking running, and everything was perfectly fine. I am not a heavy lifter/ nor do I go to a gym for a workout. I only use to walk in a nearby park for 5 kms a day (run 1 km in between)

It all started in October, when I started having continuous pain at the tip of the penis (scissor like), had burning effect while I urinated, and my right leg felt slightly numb when I pulled up approx 20 liters of water bottle daily (once) for 3 days up to my residence on the 2nd floor. The pain was very bad and it lasted for approx a month. I went to the general physician, who suggested I might have passed a kidney stone. He suggested me antiseptic medicines, and cranberry extracts (to have with water everyday), and asked me to get my Urine DR and creatinine. The reports turned out to be clear and nothing was wrong, so he suggested me to have as much water I could, and continue the medicine for 10 days.

During this time, I had a major discomfort while driving my way to office, and coming back during traffic times. I've been avoiding walking, and been resting as much as I could since the past 1.5 months. I also got done with an ultrasound for bladder and kidneys; there was nothing alarming in the reports - the doc said its most probably a muscle pull and will heal automatically - usually takes weeks to recover.

At present, the pain on the tip of the penis has slowed down, the burning effect is gone, but it has not completely disappeared. I feel the same pain when I work for long, stay in a lean position for a long time, or even during sitting in my office. My lower back seems to be stretched out completely, and I feel tired even after standing for 15 - 20 mins or even while sitting continuously. However, I can walk properly, and the right leg numbness has very much reduced.

Please suggest me what could I do to reduce this irritating pain at the tip of the penis, and my lower back, which gives a stretched out feeling completely.

Leo

1/5/2015 09:01:05 pm

Hi there I wounder if u could help I'm going nuts,two weeks ago I help a friend move lots of boxes I'm only 165 cm 55 kg ok just last week I had to go to the hospital my lower abdominal pain and really sore testicals more on the right tho.ok so they did a urine test and a blood test all clear they did a ultra sound all clear and a ct scan as well all clear and for sti all clear i have been back a couple of times because of the pain it's like Iv been hit in the nut 24/7 and the pain travels to my lower abdominal it's uncomfortable so all Iv been doing is resting like they the said to do take ibuprofen witch I'm doing walking around doesn't help either I'm so confused all test I had done all come back negative witch is good but they did not give me a answer but they it could be a groin strain I have no bruising on my right leg but my groin dose hurt along with my testicals there so sensitive especially underneath please can someone give a answer I'm so not happy with this it's taking over me.

Jerry Yuhara

1/6/2015 12:01:53 pm

Hi Leo,
That is good that you ruled out a few issues already. This saves a lot of headache and worry. If it is in fact a musculoskeletal issue then some possibilities are: Groin strain along with injured muscles which can create trigger points that refer pain to this area, of course the psoas issue as in this post, and asymmetrical pelvis which can create a groin strain or pelvic pain indirectly (chiro can help with this), possible spinal issues from lifting boxes, osetitis pubis which is a injury to the pubis symphosis (less common, but it happens, I know).

I would go see a sports med doctor who would know more about musculoskeletal issues and they can diagnose you. If they can't figure it out, find someone who can, and if no one can, then you might go straight to a physical therapist, chiro, massage therapist, etc.

Sorry for the general recommendation, but it is all I can do not being a doctor and over the computer

Best,
Jerry.

Jason

1/10/2016 09:34:26 am

Damn, it sounds way too familiar. Mine started with the sensation of a groin pull. No specific activity I can think of to cause it. While driving I was getting a stabbing pain in my hip flexor and in the pubis area. Over the next two days (almost three weeks now) the pain would move from my upper abdomen to my left testicle. It was either in one spot or the other.

I've spent almost three weeks with the pain I can only describe as someone squeezing my left testicle at the same time as pulling down on it when the pain is not in my abdomen.

Had to go to the ER the pain was so bad. I had an x-Ray looking for Ostio Pubis, negative. I don't also had a CT and MRI, both came back clean. All my blood work is perfectly fine. I've been experiencing occasional shoot pain down the medial (inside) of the left leg. It moves from the inner thigh to the calf and sometimes to the high part of the arch of my foot. Sitting in a chair, driving, moving from sitting or standing (or vise versa), picking things up off the ground and worst of all, vibrations (especially speed bumps).

I tested my own range of motion by standing and raising my left leg, knee to waist height...when lowered my leg I get a very loud audible pop. I'm looking into snapping hip syndrome. While researching this I found this site: http://hipdysplasia.org/adult-hip-dysplasia/related-adult-hip-disorders/impingement

It has a test for impingement. Not only did it give me instant pain, I've been in agony for a day since.

I just hope to get this figured out so I can go back to work and start living my life again.

I'm going to see a Physio who specializes in pelvic issues.

Roseann

3/3/2015 10:23:41 pm

I too have had the burning and tingling in my thigh and weakness in lower back. I have a great pT and stopping going due to me feeling good also insurance reasons a. I was doing stretches got up to 7 1/2 miles and bang back to where I started from but with much more lower back pain. I have an appointment with PT today's, will let you know what happens

Jane Kerlin

3/18/2015 09:47:13 pm

This is an in depth analysis of psoas injury. I am five years on with mine. For 7months I have been getting help from a talented osteopath. I need advice on exercises for recovery. I had two caesarians also before my injury. I am on the mend but have some way to go.

Dottie

3/23/2015 03:39:29 am

My PT diagnosis was iliopsoas strain, and says that my back problems DJD and Spinal Stenosis is not causing my pain. My question is will the numbness go away??

5/6/2015 08:42:17 am

Hi Dottie,

It is hard to say if it will go away or not. For myself and many others is does. Many, like myself, will get it here and there if we do the wrong things or if we don't do the right things like proper exercise and stretching consistently enough.

Jerry

Abby

4/12/2015 02:12:13 pm

Hi Jerry,

My symptoms are similar to the ones mentioned in your blog. in your blog you have stated that ...."In my next blog I will put together a more comprehensive program that I did to recover and what I would do now after discovering the nature of this injury."

Can you please direct me to this information? I'm keen to learn form your recovery experience.
Cheers Abby

4/19/2015 03:34:56 am

Hi,

I have still yet to write a "Recovery blog", sorry! The reason for waiting so long to write it is not only needing a ton of extra time to do so, but also the correct information to best help and guide you and the rest of my readers. I have been meeting with other health professionals to help me better understand this injury.

I plan to have one written in the next 6 months. I know that sounds like a while from now, but I want to make sure it is accurate before I publish. I am also loaded up with work from clients, multiple certifications, massage classes, and all the other work needed to keep my business humming.

Thank you for your patience! All of you.

Jerry

Albert

4/12/2015 06:25:29 pm

Thanks Jerry for coming up with a good write-up explaining your symptoms and experiences. A small ray of hope after seeing this blog, when I almost gave up with similar pains. In addition to the pain you mentioned, I have pain in the left hand, and coccyx as well.

At the end of this blog you have mentioned about a comprehensive program that you practiced to recover in your next blog. I tried searching for it in this site. However, I couldn't find. Can you please share any useful links?

nigel hatton

4/29/2015 05:29:47 pm

Dear jerry,
I am a 51 yrs, 6'2" and 230lbs former powerlifting champion, totaling 2100 lbs.
My last comp 2000 then I took up sea kayaking but continued weight training.
A few weeks ago I wore some denim shorts under my jogging bottoms to give support and lift in the bottom of the squat, just one workout with 165kgs for 11 reps.
Next day I woke with cross skin bruising, like I used to with a squat suit years ago, and tho but nothing of it. However, after a week or so I had pins and needles in my left groin and running a pen across the area I could feel very little. My left testicle was painful and after walking for 30 minutes I had pain in the left groin till I lay down. In bed I have no pain and nothing when I wake up. I went to a surgeon at the local hospital and he thinks I have a strain to my abdominal tendon at the pelvis and said to rest. But I can do crunches with a frame, I can flex my thighs to my body and my addicted and abductees cause no pain when on their respective machine.
After days of research I have come to the conclusion it all started from the time I work the denim shorts and the waist band button area was pushed very hard into the groin area squashing a nerve.
I would welcome your opinion though?
Blogs like your jerry give hope and I understanding to thousands of people, well done.

4/29/2015 06:52:37 pm

Jerry,
I have stood in front of a mirror in the last ten minutes and looked at the painful area of my groin. When I lean back there appears to be some diagonal swelling that is tender to touch. The swelling is not on the abdominal muscle. Could it be I have a strained/ torn fascia?

5/6/2015 08:53:04 am

Hi Nigel,

Thanks for your submission.

Most likely if it is tender and swelling is present than there was trauma to the tissues locally. Sorry I can't be more specific, as I am not a doctor.

Pain can radiate out from areas of trauma and it sounds likely that this is what happened and is not what I describe in this blog of nerve entrapment from the iliopsoas muscle. I suppose it is possible that a nerve could be irritated from the trauma. I would suspect your condition would heal quickly.

I've heard of situations like yours before and although they can be painful they are typically not serious and heal relatively quickly.

Good Luck,
Jerry

5/6/2015 08:58:54 am

Hi All,

Some comments are not posting even after approving. Sorry if yours was not!

I am trying to solve this issue.

Thank you for your comments,
Jerry

Simon Byrne

6/2/2015 12:51:52 am

Hi Jerry

Thanks for you article and information. I found it very helpful and interesting as I have had a very similar experience and as of yet have been undiagnosed.

I had the same loud pop and shot of electricity in m rt groin and lower abdomen while bending and twisting about 8 months ago. I have been checked by a surgeon with a CT for hernia (turned up negative) ,an orthopedic Dr. ordered MRI Arthrogram for hip which turned up a slight labrum tear, but a diagnostic steroid seemed to rule that out as a causal factor.

The first mention of anything specific by anyone I'd seen was by my current PT who focused on my psoas by palpitating it. The other Dr's had no clue for my pain and just gave the old groin strain diagnosis.

I read your blog and was wondering how you were specifically diagnosed. By a sports doctor? Were any images taken? I would love to find someone in my area that would take the lead and actually know what I am going through and have a confident course of action. If you have any leads in the St Louis area I would greatly appreciate them!

Much obliged!

Simon B

6/3/2015 05:08:51 am

Hi Simon,

I'm glad this information can potentially help.

That's good you got checked out for the common injuries like hernia and other issues. Labrum tears seem to be very common with everyone suffering with these issues. Often a tight/disfunctional iliopsoas can be a cause of it. Then again many people may just have labrum tears from use of any kind.

I was originally diagnosed by a sports medicine doctor with nerve entrapment from the abdominal muscles. Later I discovered how tight my left iliopsoas was and the pain that is produced by palpation through a chiropractor. It had seemed like there was a nerve entrapment issue there, but hard to say for sure.

Years later I was reinjured. This time to the pubis symphosis and groin in general from the subluxation of that area. Tendonopathy lasted a long time and it still an issue, but gets less over time.

Unfortunately I do not have any contacts in your area. A few good places to get help are sports medicine doctor, chiropractor, well trained massage therapists, physical therapist who understand pelvic issues, and trigger point therapist that can help release trigger points (knots) in the pelvic region.

Hope that helps, and I wish the best of luck with your recovery.

Jerry

8/14/2015 03:09:09 pm

Were you thoroughly checked for muscle tears/sports hernia? CTs missed my abdominal tears 5 times, MRIs 3. Just wondering. I had a labral hip tear repaired, but the psoas was the main issue and still is. There is a center in Philadelphia that handles surgery for these issues and can more accurately image them.

Paul

6/26/2015 10:34:22 am

Ok so I experienced this on my left leg about two months ago. It's finally better, but definitely still somewhat numb and tingling to the touch. Then while doing yoga of all things (I'm a CrossFitter so yoga is considered active recovery), I lifted my right leg to feel a twinge in my right groin. Felt fine all day but then got home from work and after standing up from my kitchen table, felt extreme numbness.

I reviewed this and saw it could be a herniated disc that happened over time. When I was recovering from the first injury, the chiro said it was nerve entrapment, but for this to happen To both legs now makes me concerned it could be a disc issue. I've been icing a ton and using a stim unit, but still feel complete numbness whenever I rub my right thigh.

Do you happen to have any advice, wisdom, etc? Or maybe even some rehab protocol you followed.. I tried some light swimming today and it felt pretty good actually but was wondering what your approach was. Thanks in advance!

Cheryl link

8/11/2015 03:07:00 am

Jerry

I am a 52 year old woman who competes in Ironman races. I had a total hip replacement in September, anterior approach. All is well, back to light training no weights though. Anyway I have a trapped lateral cutaneous nerve which aches not pains after exercise. As a result my psoas is weak on that leg. Are there any stretches for this nerve? I have had acupuncture which has helped somewhat but not cured the situation. I can walk stairs, swim, jog ....as I said it is a mild ache but I want it to go away. It is affected whenever I engage my core say during sit-ups, planking not cycling.

8/11/2015 11:54:50 am

Oops forgot to say thanks for any suggestions you might have....I have also been doing "flossing" exercises and using the large yoga therapy balls for working out the hip flexors, glut med etc.

12/30/2015 10:16:43 am

Flossing is a great way to get the nerve to move within its sheath. Sometimes this type of entrapment can cause similar symptoms as we have all described.

8/14/2015 03:03:06 pm

Hello, very glad I found this. I was injured in a ground fighting exercise in martial arts after returning with an undiagnosed hip injury, which caused the psoas to spasm. Not realizing this, I put myself into massive back extension and developed a condition that keeps mystifying my doctors. My deep muscles (TA, obliques, often pelvic) gave out, like nothing could hold my body normally, and my back was arched for 6 solid months. My rectus ab eventually tore off from this forced position, which nothing could seem to alleviate. Surgery to correct the injuries was successful, but once I began to work the back again (and fell on the hip, bringing the psoas back into play, likely re-injured the hip) it has all come raging back. HELP!

I keep coming back to the psoas, despite the fact that a shoulder and two disc injuries have been found, the starvation of supply to the abdominals is crushing. And if they come on, they spasm and I feel like I'm being crushed, or they spasm hard enough to bend into excessive lumbar lordosis. No amount of PT has alleviated or strengthened me back, and I was a bodybuilder. They can even do EMG tests on my abs and I don't even feel it. Can the iliohypogastric be damaged and entrapped in the psoas that badly? I had more relief with a cortisone shot to the psoas than surgery, and it keeps coming back with any extension. Feels like breathing with a broken rib on the side with the injuries, and the transverse abs and most deep local muscles just won't come back. They fail once a day and I lose feeling from ribs to pelvis at this point, especially if I walk, which I love to do. I don't get stronger now, just weaker and weaker.

Who helps such a severe situation? And how do you get people to stop telling you to accept it all (being unable to use your TORSO) instead of diagnosing you and trying to fix the problem? I am getting medical help, just slow, especially after 2 years.

bri

12/28/2015 11:13:44 pm

I know a fabulous sports ND who works with many Olympians and sports stars in Vancouver, BC. He is extremely talented and not overly priced...his name is Dr Jonathan Berghamer. If traveling is not an option, find somebody in your area who does prolozone or PRP reconstruction. All the best.

Chris

8/19/2015 01:30:13 am

Hello, I injured myself over 3 years ago doing insanity asylum. I have had every test know to mankind and nobody can find anything wrong with me. Immediately after the injury I had pain just left of the navel and it radiated down the left side through the groin into the upper thigh. The pain is and always has been an annoying dull ache. I still have the same pain today just with doing day to day stuff... I have given up all exercise now because the pain is just to bad. I am wondering now if this whole injury could be from the left psoas? maybe a nerve issue? I live in the los Angeles area... just trying to figure this thing out! I have hit my limit with it. Thanks

Paul Fletcher

9/5/2015 05:33:17 pm

Hi Jerry , I had illio femoral bypass surgery , 10 days ago I have all the symptoms described , pain is unbearable , can you suggest any suitable , thing's that I can do to relieve the pain , I have been prescribed Gabapentin , pain is from my abdomen down to my knee , especially sore , inner thigh Many Thanks Kind Regards Paul

Dave

9/11/2015 12:48:14 pm

hi Jerry

I have had femoral nerve pain when sitting for 6 years now. I had an l4 herniation, got cortisone shots and they helped short term. However the pain is back. Latest lumbar MRI indicates the herniation is almost gone. It's not the spine. I was very active and this occurred after a long hike where I my stride was very long, and my legs were pulling back. No one knows what's going on. The trigger point and pain fits one of your diagrams. Pain on front part of hip where femoral nerve exits, and nerve pain down the front of both legs when sitting. From what I have read due to my anatomy, it might be femoral nerve entrapment under the illiopsos ligament. This case study seems similar to my case. http://www.scielo.org.za/scielo.php?pid=S1681-150X2012000200006&script=sci_arttext I am in San Jose CA. Is there a way I can get in contact with you or dr Gillick?

Jake

9/26/2015 09:19:56 pm

For years I've gotten this burning pain in my stomach when I run. It gradually went away when I was at my peak, running half to full marathon distance. But I recently had to stop running for 2 months due to an unrelated running injury, and since I started running again, the pain is back with a vengeance. It starts about 10 minutes into a run and gets progressively worse, and the intensity of the pain is proportional to my running effort. The instant I stop and walk the pain stops.
Does this sound like anything to do with the iliopsoas muscle? I also experience low back pain from time to time.
Thank you in advance

Lou Gallagher

10/19/2015 05:20:10 pm

Hi Jerry.
Thank you for building and monitoring this website.
I am in my third week of not being able to work or exercise after a climbing accident. 30 hours after the injury I was admitted to the hospital with pain that exceeded child birth and compound fracture to the lower leg. The hospital released me after clean X-rays and much morphine, 18 hours later.
Thank you especially for the "good sport" analogy which is my biggest problem. I want to work and get SOME exercise. All to no avail. My life is still a wall of pain, and my attempts to be a normal person take me back to unmanageable pain pretty quick.
I normally do a lot of yoga and cycling, some running, some hiking, not much climbing. I've noticed large bruises on my buttocks that seem to come and go with activity but never go completely, and I've had psoas pain after my yoga workouts for the last few years.
Never put it all together.
Thanks to your website, it's starting to make sense in terms of psoas injury. I still have no feeling in my left thigh.
Acupuncture is the only thing that helps for more than 4 hours at a time.

L

Henry

11/16/2015 06:39:54 am

Hi Jerry,

I just wanted to drop you a note of thanks for the high quality information and pics.

I'm 99% certain the nerve pain I've been having is a result of the significant quadratus lumborum tear I sustained earlier this year which I didn't treat properly and actually led to significant swelling in the opposite QL/psoas, which is where my nerve pain seems to be coming from.

My pain has been subsiding since I've started regularly stretching both the QL and psoas on both sides. I'd be really interested to know what else you did to help the pain go away.

Best,
Henry

P.S. saw numerous doctors and pain specialists about this and all of them were bewildered once disc issues were ruled out. Their only advice now is for me to continue what I'm doing!

12/28/2015 11:09:05 pm

I had tears in illio-limbar, and several SI ligaments on right side from a horse fall. It took a year and a half to diagnose and finally repair with prolotherapy. During that time I had constant neuropathy. Now with it fixed, I still have muscle imbalances and easily rotated vertebrae and joints. Also I have Snapping psoas on both sides, especially left side and very tight glutes. I now have decreased feeling and occasionally numbness in groin/genitals on right side...any ideas and routes to take?

12/30/2015 10:22:27 am

Hi Bri,

Yes, after an injury like yours there is most certainly muscle imbalances. So anything you can do to loosen up those tight muscles (rolling tight muscles with a roller, ball, or other implement), getting a therapist to release your psoas and other muscles in the vicinity, and strengthening the glutes always helps.

12/29/2015 04:16:20 pm

Hi Jerry, I have sensory nerve issues (tingling, deep pain, skin sensations) from the front part of my hip straight down to the top of the knee. I know that front part of the hip flexor is a trigger point. I have had the pain for 6 years now. I did acquire lyme in 2013 which makes the pain very intense. In 2009 I was initially diagnosed w restless legs, then they found b12 deficiency. High dose methylcobalamin b12 shots helped a lot back then. However with the lyme it's now worse than ever. It's the worst while sitting, hence the initial restless leg diag. In 2013 the did find herniation at l4. However a recent MRI done a few months ago revealed no serious lumbar spine issues. It all started after a vigorous hike with very heavy boots that I was not used to with steep inclines. It's bilateral, and I had one dr say it could a
Be my anatomy. I'm male and have narrow hips.

I live very close to you in tha Bay Area. I have felt that the femoral nerve is entrapped for a long time. It's deep sensory pain on the front of the thigh. It's not on the side. So it's not malagia parestethia. It's bilateral, but my lumbar spine MRI is clean. Could I give you a call? I'm live very close by. Thanks

12/30/2015 10:30:50 am

D,

As you probably know an L4-L5 is very common and the resulting compensations by muscles can cause issues. That is great you had a recent MRI. So if it is not the disc that is causing nerve issues, then yes you would want to look to the muscles as the possible cause. Trigger point referrals can have very similar symptoms. As I tell many people, you need to get rid of the trigger points (or best that is possible) and strengthen the weak muscles (likely glutes, and abdominal).

That is interesting you added that your doctor mentioned it could be a result of having narrow hips along with high activity I assume. I also have narrow hips. Yet I'm sure there are many people that have these issues who's hips are not narrow. Send me an email and we can talk further since you are near by. Hope this helps.

12/30/2015 10:48:08 am

Hi Everyone,

Thank you for posting your experience and special thanks to those who have come here with additional information. I have seen many common issues and diagnosis related to nerve entrapment by the psoas. I apologize for my untimely blog approvals and replies. It's tough to find time to have thoughtful and accurate replies after a day a of training clients and managing everything else that goes with running a business.

For now, find those trigger points and do your best to release them using your fingers, rollers, balls, or other specialty devices. But be careful of how you do this as the position you get yourself into may cause issues. Same goes for stretching. With that said stretch your hip flexors, psoas, glutes, piriformis, hamstrings. Be careful of back stretches as they are not always needed and many times can cause harm.

Strengthen your glutes and abs! But do it properly. Start with floor bridges, clam shells, bird dogs, and planks.

I am currently compiling videos of all my most used stretches and exercises on Youtube. My goal is to have 200 in a year or two. https://www.youtube.com/channel/UCqwDqFU5DtRtVbXKHOicL5g

Good Luck!

Margaret

1/13/2016 10:45:58 am

Hi Jerry,
This sounds so much like psoas muscle causing my problem. l have had a misaligned vertebrae since September due to lifting a heavy bag. I have had 5 manipulations, acupuncture, electric treatment, massage and physiotherapy all from a qualified osteopath .......who was excellent. The psoas muscle is not one they seem to know a lot about, or rather it is a no go area for treatment.

I am on a tablet 3 times a day ( Lyrica ) it work on the nerves although it an antidepressant it has helped the back pain, but I still have numbness and tingling and stabbing pains next to my groin. I do not want to be on these tablets all the time. Your article was very good I feel so frustrated at times I was nursing but I feel I am getting no where fast.I have been told this nerve could take up to a year too heal.

They do not know what nerve it is. GP's do not know enough about this.

Harry

2/11/2016 04:45:37 pm

Thank u, thank u n thank u. I feel like crying from this information I have found. It's hit the nail on the head. STILL NOT SURE WHAT EXACTLY I HAVE THOUGH N WHO TO GET HELP FROM. I have had many issues with my groin, testicles, lower abs n more. I've had two key hole surgeries, which was for a mesh n both my testicles. I have been suffering now for over 14 years. It all start with hard use of amphetamines n I noticed a big change down below n that's when all problems started. A Physio told me I was full of pressure points n adviced me to do yoga coz need lots of stretching. She said I was full of pressure points, full.... There is nerve damage also I'm sure. I've tried swimming, biking, pull up bar, karate n much more but still have problems n it's always there. Now I've stopped doing everything so I can see what is going on. Reflexology also helped me but have not done it for years. The only thing I cN think of that will help is yoga m reflexology. If u need more info to better advise me then please let me know. Thanks

2/22/2016 03:26:26 pm

Harry,

I am glad to hear that you have found others with similar issues. So if your physio found many pressure points did he or anyone else work to treat them? As in manual soft tissue work? A well trained trigger point therapist can help with this. Trigger points in the legs and abdominals can create this pain. Sometimes it is caused by ones in the pelvic floor which are usually accessed internally. Though this can be unpleasant, people do get relief from it. I have not had this treatment, but have heard of others that have.

Hope this short reply helps.

Tammy Morgano

3/30/2016 09:08:45 am

Two years ago in February I had a pelvic ultrasound done due to a burning crampy feeling in my lower abdomen and irregular periods. I had cyst on my ovary and was told to watch and wait. Two days later I was in excruciating pain and went back in a week and had another ultrasound and the cyst had grown but was told that should not be causing the pain. I went to another obgyn and was told due to the size and pain I was in I should have it laparoscopically removed. The sugery was in April 2014. They removed the cyst and my Fallopian tubes and the pain was still there. Since then I have had a colonoscopy. X-rays and MRI's, countless bloodwork, pudental and superior hypo gastric nerve blocks, Ovarian vein embolization, done three rounds of PT and seen three chiropractors and the pain is still there. I've been on gabepentin and lyrica which helps. I've also had some luck with dry needling but my physical therapy visits ran out already. From all the posts I've read and reading your information I believe this is what the problem could be. The original pain started with a knot like feeling pulling above the pubic bone and below the belly button front and back and radiating down through my thighs. It never felt muscular until it spread all through my whole trunk back and front. I use a hot tub and hydromassage 5 to 6 days a week to try and get some relief. Not one doctor has suggested this problem.,.
How do you find a doctor who can test this? I believe I have this and possible ACNES. So do you have any suggestions for a doctor in the Cleveland area that I can see??? Please help!

Christian

3/31/2016 01:48:46 pm

Dear Jerry
First is your recovery blog out now? Have been fighting with psoas for 6 months not being able to sit due to strong pain. Second is it possible to pay for a consultant with you on the phone?
Sincerely yours,
Christian from Copenhagen

4/7/2016 09:29:34 am

Hi Christian,

My recovery blog is still in the works as I want to make sure it covers all possible sources of pain and the best approach to the readers. I do phone consults. Which I had added to my lists of services, but for some reason it did not publish. Fixed now, thanks. I do 30 minutes for $40 and an hour for $75.

Owen

7/13/2016 11:41:34 pm

I have your symptoms in addition to facial numbness and spasms throughout body. Are there enough nerves down there to account for that too?

7/14/2016 03:31:13 pm

Hi Owen,

No, these nerves if irritated will only go to the described regions explained above. Thank you for your input.

Jerry

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