A Pain in the Psoas
A few weeks ago, I felt a “ping” in my lower back and knew I was in trouble. I already have two herniated discs and several other chronic back problems, so I knew the “ping” did not bode well. To make matters worse, I was already dealing with severe shoulder pain from a flare-up around c-5 and c-6, and my entire left arm was killing me. Sure enough, after a short time, the excruciating pain and numbness in the leg so familiar from previous bouts of sciatica was joining the shoulder pain in driving me crazy. Any sleeping position which gave relief in the neck and shoulder irritated the hip, and visa-versa. When I got up, I couldn’t stand straight and I couldn’t walk. I could barely limp. And, if I lost my balance and tried to steady myself, pain shot through my shoulder. Worse, no prescription anti-inflammatory or pain medicine helped, nor did the medical cannabis I used to control chronic back pain.
An “urgent” referral from my GP got me sympathy from the secretary at the HMO and appointments for physiotherapy and my orthopedist—in three months. Such is the state of socialized medicine in Israel.
Excruciating pain and numbness in the leg, any sleeping position which gave relief in the neck and shoulder irritated the hip, and visa-versa. When I got up, I couldn’t stand straight and I couldn’t walk. I could barely limp. Worse, no prescription anti-inflammatory or pain medicine seemed to help.
Not being enthusiastic about writhing in pain for three months, I found a well recommended, reasonably priced, private osteopath only 10 minutes from home, and made an appointment for the next morning.
After half an hour of poking prodding twisting and pulling, I asked the osteopath what was with the hip (Also the shoulder, but this is about the hip).
“It’s the so-ass muscle”, she said.
The what”? I asked.
“The psoas. With a silent ‘P’”, she explained. “When the sciatic nerve is irritated, the psoas muscle tenses. The source of the pain is from the spine, but you feel it in your hip and leg. And your so-ass is in sorry shape”.
To tell you the truth, I was happy to hear that my pain was just more of the same old from the sciatic nerve and a tweaked muscle, and not from a new source.
“OK”, I asked. “What do we do about it?"
Take it slow”, she said; “And come back Monday”.
Once home, I decided to do what I always do when faced with new information: Research it. First, I wanted to know what exactly this psoas muscle is. Then, I wanted to know why cannabis wasn’t helping. Last, I wanted to know what to do about the pain. The osteopath recommended osteopathy, but she would, wouldn’t she (sorry, 30 years in the civil service has made me cynical)? Here’s what I found.
I started at the website of the Cleveland Clinic, where I learned that the psoas muscle (also called psoas major) can be up to 16 inches long and that it is “located in the lower lumbar region of the spine and extends through the pelvis to the femur”. It “works by flexing the hip joint and lifting the upper leg towards the body” and that one movement created by the psoas is “walking”.
I also learned about “Psoas Syndrome”, which causes the following symptoms, among others:
- Lower back pain
- Pain on the border of the spine and the buttocks when sitting, getting up or changing positions
- Difficulty or pain when standing up straight
- Pain in the buttocks, groin pelvis and leg,
- Limping or shuffling stride
I also learned that the syndrome is most common in athletes, but that even old, out-of-shape people like me could get it.
After going through the list and mumbling “Yep, got that” to each item, and double-checking the information with The Journal of the American Osteopathic Association (not that the Cleveland Clinic needs double-checking, but that’s the way I am), and satisfying myself that the psoas was the culprit of my latest discomfort, I moved on to the next question.
Why Doesn't Cannabis Help?
My working hypothesis was that it had to do with the type of pain, and not with any inherent immunity the psoas has to THC. Here’s what I found:
- There are two types of pain, acute pain and chronic pain: “Acute pain is provoked by a specific disease or injury, serves a useful biologic purpose, is associated with skeletal muscle spasm and sympathetic nervous system activation, and is self-limited. Chronic pain, in contrast, may be considered a disease state. It is pain that outlasts the normal time of healing, if associated with a disease or injury. Chronic pain may arise from psychological states, serves no biologic purpose, and has no recognizable end-point”. Acute pain is also defined as pain that lasts up to three months. Chronic pain is present “most days” over at least six months.
- The pain from my shoulder and psoas is acute, not chronic. Cannabis is effective in controlling chronic pain, and there are hundreds of thousands of chronic pain sufferers who will to attest to that. But it isn’t as effective in reducing acute pain, as one recent study has stated: “cannabinoids appear to be most effective in controlling neuropathic pain, allodynia, medication-rebound headache, and chronic noncancer pain, but do not seem to offer any advantage over nonopioid analgesics for acute pain”. I’m not sure why this is (I’m not sure anyone has figured it out, yet), but that’s the way it is. Cannabis just doesn’t work for acute pain.
What Does Help?
Going back to my primary source, The Cleveland Clinic, it seems I made the right choice: “Psoas syndrome is best treated with physical exercises”. They recommend physical therapy, osteopathic manipulation, ultrasound treatment. Sometimes, injections may be necessary.
I haven’t tried ultrasound treatment, but I did find a suggestion for placement of TENS electrodes to treat pain-in-the-psoas and found that it worked for me. But it may not work for you- and you should ask a professional before trying it.
“Taking it easy” also helps. I’m not happy taking a week off (I probably need more, but like most people, I just can’t bring myself to do it) but not having to schlep to work and sit in the office takes a huge strain off my back, and gives me time to recuperate
Psoas syndrome is best alleviated with treatments like physiotherapy or osteopathy. In some cases, medication may be necessary.
If all of a sudden you find it hard to walk, feel pain in the lower back/spine/leg, have problems getting up, changing position or walking- take it seriously. Go to a doctor, get a full diagnosis (even if you need to spend money because your HMO is too slow) and get the right treatment fast.
For me, the osteopathic therapy is working. After four treatments the pain is more localized, in both the back and the shoulder, there is less numbness, range of motion is increasing and I’m walking better. It's still hard to sleep, sit for long periods or drive, and the cannabis still isn’t helping- but I don’t feel like I want to jump off the roof anymore, and I can see the light at the end of the tunnel.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
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© 2019 David A Cohen