The Iliopsoas group and its role in back pain

By DR. ROB DESTEFANO

pain_in_the_back

Back pain is one of the most prevalent ailments of our society. Some argue that we’re not really fully evolved to walk and sit upright without complications, but as long as we’re trying, how can we make it less painful?

One of the major contributors to back pain is the Iliopsoas group. Comprised of three muscles, this group is the major hip flexor, and a major postural stabilizer of the body (it acts somewhat as a moderator between the abdominals and their antagonist the spinal erectors). Its location and actions, however, can be a little hard to get a handle on. The psoas major and minor travel from the front of the lumbar vertebrae, diagonally down through the abdomen—beneath the intestines–to attach on the front of the femur (thighbone) just to the inside of the hip joint. The iliacus lines the inside of the ilium, or pelvic bone, then feeds into the common tendon with the major and minor psoas. If your feet are fixed to the ground, the iliopsoas pulls the spine forward toward the legs; when the feet are free, the iliopsoas flexes and externally rotates the hip.

It is a tricky set of muscles to reach and treat manually, and treatment requires a practitioner with good hands…and some compassion. Because the muscles are deep to the intestines, the practitioner has to get under the organs in order to apply pressure to the muscle tissue. And because this muscle group is a primary “flight or fight” muscle, it is affected by stress, and can hold a lot of emotionally charged tension. Once MRI and X-Ray have ruled out structural damage, growths, or disease process, however, the Iliopsoas is one of the first places to look for some of these causes of back pain, despite the potential for discomfort.
 
Possible Symptoms:

Some common symptoms arising from Iliopsoas dysfunction are:

  • Low back aches and pain, that may gradually spread throughout the back and hips
  • Pain upon rising from a seated position, or standing upright too quickly
  • Pain during the second half of a sit-up
  • Discomfort or pain while driving with extended or flexed legs
  • Pain upon twisting the spine, or leaning to one side
  • Aches and pain with extended periods of time sitting or standing (especially with poor posture)

Some Possible accompanying symptoms:

  • Hip Pain
  • Pelvic Discomfort
  • Bowel disruption
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How Does It Happen?

Being over-tired, stressed and spent, interferes with proper healing, and contributes to the over-all stress of the muscles, so keeping balance in your life and diminishing stress is a great first step to a healthy iliopsoas. That being said, there are several mechanical reasons for iliopsoas dysfunction.

Prolonged sitting, especially when combined with a forward head posture–such as we often find in our computer-centric society–shortens the iliopsoas muscles. Even sleeping or driving, if the posture places the iliopsoas in a shortened state for too long, can compromise its resting length.

Excessive standing, with the back “collapsed,” knees hyper-extended and the hips pushed forward, encourages a shortened iliopsoas, and stresses a multitude of joints, instead of engaging the core and spinal stabilizers.

Even significant repetition of hip flexion can cause shortness and/or hyper tonicity (tightness) of the iliopsoas group. This can come in the form of frequent or distance cycling, stair climbing, or even certain weightlifting, or other exercise moves. Also, if the abdomen and iliopsoas are not coordinated, and the gait cycle is off, the resulting imbalances can cause further biomechanical compensations.

Why Does This Cause Pain?

A shortened iliopsoas group pulls the spine into hyperlordosis and an anteriorly tilted pelvis (an over-arched low back). This posture can put stress on all the spinal muscles, including the erector spinae–the muscles which hold the spine upright, and all the vertebral joints of the lower spine (causing pain).

Low back pain can also develop as a tight iliopsoas generates tension in its tendinous attachment to the lumbar spine. While this tension occurs in the muscle, the pain is felt along the low back. This tension can also affect nerve roots of the spine, resulting in nerve pain, which is felt in the low back, or radiating away from the area.

A short or tight iliopsoas can pull and twist the vertebrae, causing excess compression of the discs and other vertebral joints. These forces cause pain as they occur, but also lead to degeneration of the structures over time, which can result in structural damage, like disc herniation, and degenerative disease processes, a whole new cause of pain.

Iliopsoas dysfunction comes with many distracting companions, which contribute to the overall set of back pain symptoms: a dysfunctional psoas can put the burden of hip flexion on the other, weaker hip flexors, which can become overused, irritated and painful. Or a tightened, short psoas can inhibit gluteal function, further disrupting the balance of optimal muscle function, and putting undue pressure on inappropriate muscle groups.
 
What You Can Do?

  • Assessment, diagnosis and treatment by a medical professional
  • Self-Treat: psoas, low back, quadratus lumborum, spinal erectors  (see musclemedicinebook.com)
  • Stretch: iliopsoas, hamstrings, low back, hip flexors (see musclemedicinebook.com)
  • Strengthen: abs, glutes, spinal erectors/stabilizers, psoas if it’s weak. Then do functional full body exercises that emphasize posture and balance. Part of this might be retraining the body’s movement patterns to coordinate imbalanced muscles, like the synergists iliopsoas and abdominals, or antagonists iliopsoas and gluteals, during walking. (see musclemedicinebook.com)
  • “Abs” alone is not enough!! Commit to strengthening your core and floor (the muscles of the entire core and muscles of the pelvic floor)!
  • Muscle memory, neuromuscular facilitation, postural reflexes, all can be trained to bring peace back to the iliopsoas. Look into Alexander Technique, Feldenkrais, physical therapy, or a functional movement based exercise program.
  • Constructive Rest can bring much needed relief to a hypertonic iliopsoas (see coreawareness.com)
  • Instead of a chair, you may want to try to sit on a physioball! It forces you to engage you core and joint stabilizing muscles, it allows for movement, so the body is not so static, and it allows the hips to relax in a more neutral position as the legs slope off the side of the ball, rather than being held rigidly in flexion by a chair seat.
  • Combat stillness by moving, give the muscles a break from their shortened position by getting up and stretching them out every 20-30 minutes.
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For more information visit musclemedicinebook.com, chiroweb.com, coreawareness.com or somatics.com.

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