Psoas Syndrome is easily misdiagnosed due to it often presenting as lower back pain. Many patients may experience any number of the following symptoms:
- pain in the lumbosacral region when sitting or standing (lower back pain)
- lower back spasms
- delay or difficulty in achieving a fully erect posture
- pain in the contralateral gluteal region
- sciatica / radiating pain down your leg
- instability in your core
- decreased lower back flexibility
First, it is important to understand where the Psoas muscle is located and its surrounding structures – all of which work together to propel us forward in our daily activities. The Psoas & Iliacus muscles are what we’re going to focus on. Psoas is a deep core muscle connecting your lumbar vertebrae to your femur. It is the biggest and therefor strongest player in the “hip flexor” group. Iliacus is a smaller muscle originating on the medial aspect of your iliac fossa (inside your hip bones). As these muscles run together to share the same action, they now become known as iliopsoas.
Flexes the hip (brings your knees towards your chest), laterally rotates the hip (allowing you to stand like a ballet dancer with your toes pointed outwards), adducts the hip (brings your legs in towards the center of your body), lateral tilting the pelvis (hiking your hips one at a time), lateral flexion of the spine (banding your spine to one side).
It’s an interesting concept to think that the cause of the pain in your lower back can be related to a muscle originating on the anterior (front) of your lumbar vertebras (deep within your abdomen). With a good portion of today’s population having a desk or seated job, this muscle has to overwork as your hips are flexed for prolonged periods. Iliopsoas is forced to be in a shortened (contracted) state for on average 8 hours a day while you carry out your work tasks. Then on the weekend, when we’re wanting to get away from the office and hit the local ski hill or go on a hike/run to enjoy the outdoors, this muscle is now in a variable state because its job is to lengthen at great speeds to propel us forward to our fun weekend ahead. It is this sudden transition from sedentary to active that puts you at risk for symptoms of psoas syndrome.
Prolonged sitting, excessive running/training, lower back posture, restriction of your diaphragm (apical breathing), fascial restrictions due to the ureter lying directly in-front of this muscle in the case you are passing a kidney stone it will cause direct inflammation to the muscle, parietal peritoneum (covers the psoas muscle & appendix) so in turn an appendicitis can cause psoas irritation. Therefore, when treating the area, it is important to remember the dominant fascial component.
Massage Therapy techniques involving going through the abdomen and around your iliac crests (hips) are very effect ways of treating these muscles. Your RMT will have you in the side-lying position and/or lying face up to best treat this muscle group. A great technique is the “pin & stretch” or “isolytic release” which involves getting you as the patient to go through either passive or active ranges of motion to optimize lengthening and repair.
Physical exercise is also a major component in resolving psoas syndrome. The exercises will include active and passive spine, hip, and psoas muscle manipulation and stretching. Exercises include stretching and lower-impact dynamic exercises known as “closed chain” which are designed to stretch and strengthen the psoas muscle and allow the body to repair & recover. When doing homecare remember to take your time and breath through all movements.
Passive Stretch: Lie on the edge of a bed/table and pull your knee towards you. Let the other leg hang from the edge of the bed and keep it relaxed. You should feel a pulling at the front of your hip or thigh. This stretch is for the hanging leg. Hold for 30 seconds. See below for foam roller modification.
Forward Lunge Stretch: Keep your hips square and your chest open. Don’t let your knee bend past your toes. Hold for 30 seconds.
See below for a deeper modification. You can add more of a stretch by incorporating an anterior pelvic tilt – by tucking your buttocks underneath you and moving your pelvic bone towards you.
Straight Leg Raise: Lying on your back, lifting one leg up while keeping your knee straight, then slowly lower leg back down. Make sure you don’t arch your lower back during the exercise. Repeat 10x if possible on each side.
Standing Hip Flexion: Start by standing with your one leg planted and the other slightly behind you with a theraband or pulley around your ankle. Lift your leg up so that your hip and knee are bent to 90°, then slowly lower back down. Keep your hips level throughout the movement. Remembering to breath throughout all movements. Repeat 10x if possible.
Kelsey Garner, RMT