Chronic Low Back Pain – Psoas
Psoas is your primary hip flexor. It can cause a well defined and excruciating pain pattern. The two psoas muscles and ileacus together are called iliopsoas.
Dysfunction on either side will cause you pain on that side in a diffuse spot in the lower back. There are seven primary muscle groups that refer pain into the low back. However, this is one of two found on the front of the body.
The first step in untangling any case of lower back pain is to confirm or eliminate more serious spinal injury or degeneration as a cause. After consultation with trained medical professionals, you can focus on the soft tissue aspects of chronic lower back pain – psoas is just one them.
Activation of Psoas Trigger Points
The chronic low back pain psoas causes stem from trigger points in the muscle. Problems with other muscles often activate iliopsoas secondarily. For instance, a fall or sudden overload can activate them simultaneously with these other muscles.
Prolonged flexion can activate iliopsoas trigger points. For example, sitting with the hips flexed for a long time shortens these muscles and promotes myofascial dysfunction and trigger points in the psoas.
In fact, sustained immobility in any seated position will reduce circulation and aggravate iliopsoas trigger points.
What Makes This Type of Low Back Pain Worse?
Psoas has a helper. The rectus femoris muscle is the only one of the quads that crosses the hip. It assists in hip flexion. Tight bands in this muscle prevent full hip extension and can make trigger points in the iliopsoas worse. See the article on Knee Pain for rectus femoris self care.
Some types of skeletal variations can also make myofascial dysfunction of the psoas worse. A trained professional should evaluate these.
A soft mattress that sags in the middle aggravates tension in the low back muscles. There are many types of mattresses available; what you replace it with is a largely a matter of taste but we recommend a firm mattress.
The overload caused by the repetitive vigorous contractions of situps and improperly performed crunches can increase dysfunction of the iliopsoas. Consider the eccentric contraction of slow sit-backs as pictured or some of the many plank variations instead.
Forceful attempts to lengthen the hamstrings by reaching strenuously for the toes can cause sudden overload of iliopsoas. Instead, you can avoid the low back pain that this causes by performing more gentle, passive stretches of the hamstrings.
More importantly, ongoing issues with the iliopsoas can cause distorted posture that overloads back and neck muscles, perpetuating trigger points and dysfunction in them.
How Can I Help Myself With Low Back Pain?
When sitting for prolonged periods, try to modify your seating so that your the angle of your hips is more open. The tilting stool pictured is just one of a variety of ways you can achieve this. This type of seating is a better alternative than standing for many office workers. When driving, cruise control will provide you the opportunity to move a bit over extended distances.
If you sleep on your back a pillow under the knees will provide gentle flexion at the hip and reduce stress on the iliopsoas. When sleeping on the side it is important to avoid sleeping in the fetal position, with the hips sharply flexed.
There are many ways to stretch the iliopsoas. One easy and safe way that requires no equipment is the low lunge. As you can see, for this purpose, the movement of is forward (not “deeper”) to provide gentle extension of at the hip for the trailing leg. Some YouTube videos provide is a good illustration of a safe active psoas stretch with warmup and a deep low lunge.
Many people do better with a passive psoas stretch, often done by letting the leg hang off the end of a table, extending the hip. We prefer supporting the flexed leg on a stool or similar rather than pulling it to the chest. Put a pillow on the floor for your foot. Ideally the height of the table allows you to barely touch a pillow when you begin. It should sink in thoroughly as the psoas releases.
How Can a Therapist Help You With Low Back Pain?
In most cases of chronic low back pain – psoas trigger point dysfunction rarely occurs in isolation. Many people are challenged by the complex relationships of the psoas to other muscles that act on the hip and and low back.
Psoas does not like to be be stretched forcefully. Because most of the muscle lies deep in the abdomen, a skilled therapist can often access it more effectively.
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It was interesting, and helpful for my IT band and hip
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What a great experience. The provider was able to recommend things I can do to improve my pain. Address issues I didn’t even share with her that she was able to tell just by her exam and treating me for what i went for. Will be back. Feeling grateful
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Of course, everyone is different and many of us have additional challenges and complications. Naturally, we tailor our treatment plans to the individual, but there are common foundations to this work with everyone.
If you are having similar issues, you may find that a just few treatment sessions helps! We will identify and treat root causes of your individual case. We also offer professional treatment modalities and techniques in a professional setting.
All treatment is performed by licensed professionals with additional training and certifications in advanced techniques. This includes trigger point therapy, fascial stretching, neuromuscular and movement therapy, kinesio taping, myofascial release, cupping, acoustic compression, self-care classes and more. We often combine several of these techniques into a single session..
No one wants chronic pain! We can work together with you to help sort out the issues.
Click here or all us at 630-858-0000 today to make an appointment!
Extra – Anatomy of Iliopsoas
The iliopsoas is the primary hip flexor. It is assisted by the rectus femoris (one of four quads), the adductors and handful of other muscles. It is also an important postural muscle.
When standing or sitting it is important for maintaining upright posture. Portions of psoas major are continuous with the quadratus lumborum muscle. Together, these muscles are two of the most important “core” muscles in the low back.
Iliopsoas can also refer strongly to the thigh. However, we know it best as one of the primary causes of low back pain. The referral to the back forms a distinctive vertical pattern along the lumbar spine. The pattern can extend from the low back upward as high as the lower border of the shoulder blades.
Extra – Janda’s Lower Crossed Syndrome
Myofascial dysfunction in the iliopsoas often occurs as part of a pattern with other hip muscles acting on the hip. This has been called Lower Crossed Syndrome.
The “cross” is an imbalance between four different groups of muscles; the iliopsoas/spinal erectors, which are too tight, and the glutes/abdominals, which are too weak.
Correcting this requires treatment and stretching of the hip flexors and spinal erectors. However, this is only addresses half of the problem. It is also necessary to strengthen the glutes and certain abdominal muscles to restore balance to this key area.