psoas muscle pain

Psoas muscle pain may show up as groin pain (psoas tendinitis or psoas bursitis), pelvic pain, pain deep in the belly, or back pain. These locations of pain reveal the size and location of the psoas muscles, which span the distance from the inner groin to behind the respiratory (breathing) diaphragm (solar plexus region).

Because people so commonly treat psoas pain with abdominal strengthening exercises, stretching and simple muscular relaxation, and because a better way exists to end psoas muscle pain than strengthening exercises, stretching and simple muscular relaxation, I have written this article. In it, I clarify the relation of the abdominal muscles to the psoas muscles, how healthy (and unhealthy) psoas muscles function, health conditions often accompanying tight psoas muscles, and the attributes of a therapeutic approach that respects how the psoas muscles actually function.

A protruding belly commonly accompanies psoas muscle pain. People often assume that a protruding belly indicates weak abdominal muscles, and that's understandable. However, they also recognize that psoas pain indicates tight psoas muscles.

Tight psoas muscles, which lie behind the abdominal contents, pull the spine, and push the abdominal contents, forward, causing protrusion. Those same tight muscles put undue pressure on the bursa at the groin, causing iliopsoas bursitis and iliopsoas tendinitis. The psoas muscles, themselves, being always tight, are constantly fatigued and sore, giving rise to pelvic and abdominal pain.

These two conditions give rise to two assumptions that underlie the common way of treating psoas muscle pain.

* Protruding belly: abdominal strengthening
* Tight psoas muscles: stretching exercises

Here's the telling point: The brain controls the tension level of the psoas muscles as part of its control of movement and posture (postural reflexes). Neither abdominal strengthening nor psoas stretching exercises can change postural reflexes, which have to do with whole-body balance and coordination. You need to take another approach to correct psoas muscle problems: retrain the postural reflexes through movement training.

When the psoas muscles achieve their proper length and responsiveness, they stabilize the lumbar spine, giving the feeling of better support and strength, and allow the spine and abdomen to fall back, giving the appearance of strong abdominal muscles and the feel of a strong (i.e., effortlessly supportive) core.

The rest of this article more thoroughly discusses the relation of the psoas muscles, abdominal exercises, and back pain, so you understand what must be done to correct psoas muscle pain and attendant health conditions. If you find this article to be too much, don't despair, just click the following link:

Exercises that attempt to flatten the belly (e.g., crunches) generally produce a set pattern in which the abdominal muscles merely overpower psoas and spinal extensor muscles that are already held at too high a level of tension. A state of co-contraction results, which compresses abdominal organs and impairs their functioning (e.g., digestive/eliminative problems)

High abdominal muscle tone from abdominal crunches interferes with the ability to stand fully erect, as the contracted abdominal muscles drag the front of the ribs down. Numerous consequences follow: (1) breathing is impaired, (2) compression of abdominal contents results, impeding circulation, (3) deprived of the pumping effect of motion on fluid circulation, the lumbar plexus, which is embedded in the psoas, becomes less functional (slowed circulation slows tissue nutrition and removal of metabolic waste; nerve plexus metabolism slows; chronic constipation often results), (4) displacement of the centers of gravity of the body's segments from a vertical arrangement (standing or sitting) deprives them of support; gravity then drags them down and further in the direction of displacement; muscular involvement (at the back of the body) then becomes necessary to counteract what is, in effect, a movement toward collapse. This muscular effort (a) taxes the body's vital resources, (b) introduces strain in the involved musculature (e.g., the extensors of the back), and (c) sets the stage for back pain and back injury.

The psoas has often been portrayed as the villain in back pain, and exercise is often intended to "knock the psoas muscles out" (overpower them or substitute other muscles for them). However, it is obvious from the foregoing that "inconvenient" consequences result from that strategy. A more fitting approach is to balance the interaction of the psoas and abdominal muscles.

When the psoas and the abdominal muscles counterbalance each other, the psoas muscles contract and relax, shorten and lengthen appropriately in movement. The lumbar curve, rather than increasing, decreases; the back flattens and the abdominal contents move back into the abdominal cavity, where they are supported instead of hanging forward.

The musculature and connective tissue of the legs, which connect the legs with the pelvis and torso, largely determine the pelvic orientation (postural position), and thus the spinal curves. If the legs are not directly beneath the pelvis, but are somewhat behind the pelvis (swayback), or more ahead of the pelvis (the stooped posture of "old age"), pulls communicate from legs into pelvis through muscles and connective tissue that displace (tilt) the pelvis -- and excessive lordosis or kyphosis follows (depending on whether the person has a swayback or a stoop). This postural effect involves postural reflexes involved in standing balance, reflexes that involve the abdominal musculature. If the psoas muscles are tighter on one side than the other (pain on one side), abdominal muscles are tighter on one side than the other, and hip height asymmetry results, contributing to the appearance of unequal leg length.

Where movement, visceral (abdominal organ) function, and freedom from back pain are concerned, proper support from the legs is as important as the free, reciprocal interplay of the psoas and abdominal muscles.

"Spring in the step" isn't something you do; it's the natural outcome of good walking coordination. In fact, if it's something you "do", you're doing it wrong!

Dr. Ida P. Rolf described the role of the psoas in walking:

Let us be clear about this: the legs do not originate movement in the walk of a balanced body; the legs support and follow. Movement is initiated in the trunk and transmitted to the legs through the medium of the psoas.

(Rolf, 1977: Rolfing, the Integration of Human Structures, pg. 118: Dennis Landman Publishers).

As Dr. Rolf said, this is a description of walking in a balanced body; many people start walking by lifting one leg and swinging it forward, a movement that is ungainly and awkward -- but common, as psoas problems are common.

A casual interpretation of her description of the beginning of walking might be that the psoas initiates hip flexion by bringing the thigh forward. It's not quite as simple as that.

The movement forward of walking starts in the trunk (as a slight falling forward). That slight falling forward starts as a shift of weight to one foot followed by a subtle lifting of the front of that foot (not the heel), which decreases support. Result: the person slightly falls forward. When the person has swayed far enough forward, the other leg spontaneously comes forward (knee movement forward initiated by the psoas, followed by the foot) to catch the forward weight. The leg follows and supports the movement of the torso, forward. The movement is: foot, hip, knee, foot, in a cycle.

By its location, the psoas is also a rotator of the thigh. It passes down and forward from the lumbar spine, over the pubic crest, before its tendon passes back to its insertion at the lesser trochanter of the thigh. Shortening of the psoas pulls upon that tendon, which pulls the medial aspect of the thigh forward, inducing rotation, knee outward.

In healthy functioning, two actions regulate that tendency to knee-outward turning: (1) the same side of the pelvis rotates forward by action involving the iliacus muscle, the internal oblique (which is functionally continuous with the iliacus by its common insertion at the iliac crest) and the external oblique of the other side and (2) the gluteus minimus, which passes backward from below the iliac crest to the greater trochanter, assists the psoas in bringing the thigh forward, while counter-balancing its tendency to rotate the thigh outward. The glutei minimi are internal rotators, as well as flexors, of the thigh at the hip joint. They function synergistically with the psoas.

This synergy causes forward movement of the thigh, aided by the forward movement of the same side of the pelvis. The movement functionally originates from the somatic center, through which the psoas passes on its way to the lumbar spine. Thus, Dr. Rolf's observation of the role of the psoas in initiating walking is explained.

Interestingly, the abdominals aid walking by assisting the pelvic rotational movement described, by means of their attachments along the anterior (front) border of the pelvis. Thus, the interplay of psoas and abdominals is explained.

When the psoas fails to lengthen properly, the same side of the pelvis is restricted in its ability to move backward (and to permit its other side to move forward). Co-contracted glutei minimi frequently accompany the contracted psoas of the same side, as does chronic constipation (for reasons described earlier). The co-contraction drags the front of the pelvis down. The lumbar spine is bent forward, tending toward a forward-bending posture, which the extensors of the lumbar spine counter to keep the person upright; as the spinal extensors contract, they suffer muscle fatigue and soreness. Thus, the correlation of tight psoas and back pain is explained.

As explained before, to tighten the abdominal muscles as a solution for this stressful situation is a misguided effort. What's needed is to improve the responsiveness of the psoas and glutei minimi to voluntary control, which means your ability to contract and relax them in movement.

A final interesting note brings the center (psoas) into relation with the periphery (feet). In healthy, well-integrated walking, the feet assist the psoas and glutei minimi in bringing the thigh forward. The phenomenon is known as "spring in the step."

Here's the description: When the thigh is farthest back, in walking, the ankle is most dorsi-flexed. That means that the calf muscles and hip flexors are at their fullest stretch and primed by stretch receptors, in those muscles, to contract. This is what happens in well-integrated walking: assisted by the stretch reflex, the plantar flexors of the feet put spring in the step, which assists the flexors of the hip joints in bringing the thigh forward.

Here's what makes it particularly interesting: when the plantar flexors fail to respond in a lively fashion, ones feet lack spring and the burden of bringing the thigh forward falls heavily upon the psoas and other hip joint flexors, which become conditioned to maintain a heightened state of tension and readiness to contract, and there we are: tight psoas and back pain. (Note that ineffective dorsi-flexors of the feet (lifters of the fronts of the feet) prevent adequate foot clearance of the ground, when walking; to avoid tripping on ones own feet, the hip flexors must compensate by lifting the knee higher, leading to a similar problem.)

Thus, it appears that the responsibility for problems with the psoas falls (in part, if not largely) upon the feet. No resolution of psoas problems can be expected without proper functioning of the lower legs and feet.

The common approach to tight psoas muscles is to do a kind of stretch that brings the thigh far back behind the midline.

Well, you can't do it that way.

Muscles are about movement. Muscle tone is controlled by the brain as part of learned movement patterns and postural reflexes. The only way to lastingly change muscle tone and muscle length is the retrain the brain's sense of movement. That can be done, but not by stretching: by movement training.

Let me show you something. It's a movement pattern that does retrain the brain's sense of movement and posture. I've chosen this maneuver to show you because it effectively improves foot function, as described, above. It is not a movement for freeing the psoas muscles, although that may happen to some degree because of how muscles are linked in coordination patterns, and in that sense it affects the hip flexors, the muscles of the trunk and the shoulders -- but only secondarily to the purpose of the maneuver, which is to free the lower legs and feet. It's called ...

The psoas, iliacus, abdominals, spinal extensors, hip joint flexors and extensors, and flexors of the ankles/feet are all inter-related in walking movements. Interference with their interplay (generally through over-contraction or non-responsiveness of one or more of these "players") leads to dysfunction and to back pain. The strategy of strengthening the abdominal muscles has been shown to be a misguided effort to correct problems that usually lie elsewhere - which explains why, even though abdominal strengthening exercises are so popular, back pain is still so common.

Because psoas problems are really coordination and control problems (dysfunctions of conditioned postural reflexes, i.e, "muscle memory/movement habit" problems), sensory-motor training (somatic education) provides more direct, and therefore, more immediately effective help for the problem of back pain than abdominal strengthening exercises, which miss the other major players, and than stretching or simple relaxation exercises, which cannot effectively retrain postural reflexes.