The biggest factor in back and hip pain is the psoas
muscle. The number of problems caused by the psoas is quite astonishing. These include: low back pain, sacroiliac pain, sciatica,
disc problems, spondylolysis, scoliosis, hip degeneration, knee pain, menstruation pain, infertility, and digestive problems.
The list can also include biomechanical problems like pelvic tilt, leg length discrepancies, kyphosis, and lumbar lordosis.
What is the psoas?
The psoas (pronounced “so - az”) primarily
flexes the hip and the spinal column. At about 16 inches long on the average, it is one of the largest and thickest muscles
of the body (in animals it's known as the tenderloin). This powerful muscle runs down the lower mid spine beginning at the
12th thoracic vertebrae connecting to all the vertebral bodies, discs and transverse processes of all the lumbar vertebrae
down across the pelvis to attach on the inside of the top of the leg at the lesser trochanter. The lower portion of the psoas
combines with fibers from the iliacus muscle, which sits inside the surface of the pelvis and sacrum, to become the Iliopsoas
muscle as it curves over the pubic bone and inserts on the lesser trochanter.
What
is the function of the psoas?
The psoas has a number of diverse functions making it a key factor in health. The
psoas as a hip and thigh flexor is the major walking muscle. If the legs are stationary the action of the psoas is a bend
the spine forward; if sitting it stabilizes and balances the trunk. The lower psoas brings the lumbar vertebrae forward and
downward to create pelvic tilt.
When we think of smooth, elegant and graceful movement in dancers and athletes
we are looking at the psoas functioning at it optimum. It requires that the psoas maintain the pelvis in a dynamically neutral
orientation that can move easily and retain structural integrity. This creates positions of the spine that require the least
muscular effort.
What are the common pain symptoms of the psoas?
When
the psoas muscle becomes contracted due to injuries, poor posture, prolonged sitting, or stress, it can alter the biomechanics
of the pelvis and the lumbar, thoracic and even cervical vertebrae. Typically a dysfunctional psoas is responsible for referred
pain down the front of the thigh and vertically along the lower to mid spinal column. Trigger points are found above the path
of the psoas on the abdomen. Frequently the quadratus lumborum muscles develop trigger point, as well as the piriformis, gluteals,
hamstrings, and erector spinae.
The psoas can torque your spine to the right or left, pull it forward and twist
the pelvis into various distortions. Frequently one psoas will shorten and pull the spine and/or pelvis to our dominant side.
The distortions of the spine and pelvis can also show up as a short or long leg. This all results in scoliosis, kyphosis,
lordosis, trigger points, and spasms in back muscles trying to resist the pulling of the psoas.
The psoas can pull
the spine downward, compressing the facet joints and the intervertebral discs of the lumbar spine. The pressure can cause
the discs to degenerate, becoming thinner and less flexible. This degeneration makes the discs more susceptible to bulging
or tearing, especially with twisting and bending movements.
What keeps the psoas
in contraction?
The psoas will stay contracted because of postural habits and trauma. The way we stand, walk and
sit can distort the psoas. If we walk or stand with our chin in an overly forward position the muscle will tighten. Sitting
through much of the day the psoas shortens to keep us bio mechanically balanced in our chairs. Over time we develop a “normal”
way of holding the psoas that is dysfunctional.
Unresolved trauma can keep the psoas short and reactive. The psoas
is a primary muscle in flight, fight, freeze or fear responses to danger. When survival is at stake, the psoas propels the
body to hit the ground running. When startled, it ignites preparation of the extensor muscles to reach out (grab hold) or
run. Until the psoas is released the muscle may stay contracted and go into further shortening and spasm very easily.
What kind of therapy can help me release the psoas?
I have seen many psoas injuries
as a Massage Therapist. As my practice evolved over 25 years I have tried a number of techniques to release the psoas. I've
had the most success by using Positional Release techniques.