The Mighty Psoas
Have you ever been to see your doctor, chiropractor, or massage therapist for lingering low back pain and left the session feeling the same discomfort? If you did, chances are that the medical professional simply ignored what could be one of the key contributors to low back pain and concentrated on only the area of pain itself. Though concentrated bodywork on the sore spot feels good at the time, in the long run, both of you end up spinning your wheels as you continue to search for successful treatments. A licensed massage therapist can treat the back until the cows come home; a chiropractor can make adjustment after adjustment; and some doctors god-forbid view surgery as the answer to the low back pain; but if the medical professional is not taking into account the Psoas muscle to treat low back pain, then an entire network of factors are being ignored.
What is the Psoas and what does it do? The Psoas is actually a combination of two muscles and is sometimes referred to as the Iliopsoas. It is one of the most important yet misunderstood muscles in the human body. The Psoas actually begins at the last thoracic vertebrae where the 12th and final rib of the ribcage is located and has tendonous attachments to four of the lumbar vertebrae (on the sides). It passes through the diaphragm over the sacroiliac joint of the pelvis and goes through the pelvic bowl where it attaches to the Iliacus (located on the inside of the pelvis) and attaches to the lesser trochanter at the top part of the femur bone on the inside of the thigh. It is important because it links our upper body with our lower body and along with the pirifomis muscle which attaches to the sacrum and the outside of the thigh at the greater trochanter of the femur creates a balanced tension on the sacrum at the sacroiliac joint. The Psoas is also one of the main movers if not the biggest mover of hip flexion which we use in our ever constant moving forward lives.
Additionally, the Psoas plays a key role in our core strength and balance. The Psoas muscle is located on both sides of the sacrum and has a great effect on our center of gravity. If the Psoas is weak, it can create lower back pain. If it is tight, it can also create low back pain. If the muscle contains trigger points or tight bands of muscle fibers within tight muscles then pain can be felt in the lower back and upper thigh.
Most people experience low back pain from stress, working or seating long hours in front of the computer, or from excessive weight gain. The Psoas is a key player in all of these factors contributing to the low back pain. From the dawn of time our initial response to stress has been to go into the fetal position which fires it to help move the body into flexion. Though we don’t always curl up into the fetal position when a boss or deadline is breathing down our necks, it is that ingrained response to stress contributing to back pain. When we sit for long hours at our desk, again our hips are flexing in relation to the rest of our body and this constant, though limited firing of the Psoas contributes to low back pain. Finally, extra weight in the abdomen translates to three times the weight on the lower back and if the Psoas and other core muscles are not strong and inflexible, then it does not take rocket science to understand the implications.
There are many ways to release the Psoas muscle. Performing the yoga posture “Sun Salutation” is a great way to self-release and stretch the Psoas. When anyone with deep low back pain is on my massage table, I like for them to lie on their back and passively I flex the hip while I work around and under the hip bone to release Psoas pain. This release can also be performed actively by having the patient flex and extend their hip as I apply upward tension in the direction of the muscle. One word of caution: the working area can be sensitive to the touch and can invoke an emotional response and one has to be mindful of nearby internal organs but when performed correctly and efficiently, it can be the difference between recurring low back pain and disappearing low back pain. Lastly, because so much depends on the strength and flexibility of the Psoas, a good stretch of the Psoas at the end of the session is important to keep the muscle loose and functioning maximally.
NY State Licensed Massage Therapist