A relação entre as alterações teciduais do músculo iliopsoas e a dor lombar

Abstract

Low back pain is one of the most common diseases in the western world and is considered the main cause of disability in Brazil due to population growth and aging. The main muscles affected in low back pain of mechanical origin are the abdominals, gluteus, piriformis, quadratus lumborum and iliopsoas. The iliopsoas is a deep muscle group that anatomically connects the spine to the lower limbs. Its stabilizing potential lies in the fact that it may be able to lead to segmental stiffness of the lumbar spine when generating compressive forces. Pain and excessive muscle contraction can lead to tissue adaptation that is often disabling. Patients with low back pain may experience a reduction in hip extension due to shortening of their flexor muscles leading to abnormal lumbar pelvic alignment, altering the length and mobility of the pelvic lumbar musculature. Therefore, theoretically, increasing hip extension can reduce low back pain. Normalizing the iliopsoas complex can decrease the inhibition of other trunk stabilizing muscles and give individuals the ability to produce greater stability during movement. Several muscles are mentioned in the literature in direct relation to the cause of low back pain, however, little is known about the relationship between low back pain and iliopsoas. The aim of this study is to investigate the relationship between tissue changes in the iliopsoas muscle and low back pain. A search for articles was carried out in the electronic databases Pubmed and Scielo in the period between March and April 2022, using the following descriptors: iliopsoas, low back pain, rehabilitation, mobility limitation. Studies that did not have a significant relationship between the descriptors, or even that correlated low back pain with other muscle groups other than the hip flexors, were excluded. The search resulted in 6 articles that related tissue changes in the iliopsoas with low back pain. Based on the analysis of the selected studies, the direct relationship between muscle shortening, cross-sectional area and muscle imbalance, understood as the variation in strength of the iliopsoas muscle, can be observed. These alterations can interfere with the joint alignment of the lumbar spine and pelvis and, thus, trigger pain and musculoskeletal dysfunction. It is essential that these alterations are recognized during the physiotherapeutic evaluation. Thus, rehabilitation will lead to a reorganization of the musculoskeletal system, recovering the ideal muscle length-tension, which will act directly on joint alignment and lumbopelvic stabilization.