The Psoas Muscles, Psoas Stretches, and Abdominal Exercises for Back Pain

1. "Muscle/movement-memory" runs the show. Stretching creates only the memory of being stretched, not the memory of normal movement, which controls muscle tone and coordination.

2. In stretches, tight muscles remain passive, while other muscles force the stretch. That makes stretching an indirect approach. The direct approach is to retrain muscle/movement memory by movement training that actively uses your psoas muscles, which normalizes their tone and improves your coordination. You need to cultivate direct control of the psoas muscles to normalize their function.

3. The most common psoas muscle stretch (the psoas "lunge") is done standing or kneeling. When you are upright, balance reflexes based on your old muscle/movement memory come into play, which interferes with efforts to form new muscle/movement memory.

A Way Around the Limitations of Stretching

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Direct control develops when you position yourself to use your psoas muscles and then move with them. You exercise control of your psoas muscles "by feel" and improve with practice. Right now, you have partial (if any) control of your psoas muscles and they are "stuck" tight. "Control" means that you tense, relax, and move with your psoas muscles in a well-coordinated way.

Psoas muscle pain may show up as groin pain (psoas tendinitis or psoas bursitis), deep pelvic pain (lumbopelvic pain), pain deep in the belly, or lower back pain at waist-level. Tight psoas muscles are also a major player in hip joint pain.

The iliopsoas muscles are large and long; pain may show up anywhere along their length. See the image, at right.

Tight psoas muscles are in a constant state of fatigue and feel sore, giving rise to pelvic and abdominal pain.

Abdominal Strengthening Exercises and Psoas Stretches

Tight psoas muscles, whose tendons pass over the inside of the groin and attach at the inner thigh, push the pubic bone back; the upper pelvis tilts forward; the belly hangs forward and appears to bulge.

The way people commonly think about these two conditions -- bulging belly and tight psoas muscles -- gives rise to the way people treat psoas muscle pain.

• Bulging belly: abdominal strengthening exercises
• Tight psoas muscles: stretching exercises

Well, you can't correct either condition by strengthening and/or stretching. Here's why: Neither abdominal strengthening nor psoas stretching exercises efficiently changes muscle/movement memory, so you keep returning to that posture and shape. You need to change muscle-movement memory to get a lasting change.

When the psoas muscles function properly, they decrease the low-back curve and allow the spine and abdomen to fall back. The bulging belly settles back in, giving the appearance of strong abdominal muscles and the feel of a strong (i.e., effortlessly supportive) core. But it's not strength that's being felt, but the feeling of a different trunk shape.

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The psoas muscles lie behind the abdominal contents, from the level of your diaphragm to your inner thighs at the groin (lesser trochanters); the abdominal muscles lie in front of the abdominal contents, from the lower borders of the ribs (with the rectus muscles as high as the nipples) to the pubic bone.

Here's how they interact.

AS ANTAGONISTS
(opposition between muscles):

• When standing, contracted iliopsoas muscles (whose tendons ride over the pubic crests) push the pubic bone backward; the abdominal muscles pull the pubic bone forward. Co-contraction creates abdominal compression and disturbed function of the internal organs.
• The psoas minor muscles pull the lumbar spine forward; the abdominal muscles push the lumbar spine back (via pressure on abdominal contents and change of pelvic tilt).

  

  Deep Pelvic/Ilio-sacral (S-I) Joint Pain If you have deep pelvic pain, pain across the lower back, burning bladder or groin (and no infection), or numbness down your thigh, please also read this entry.

• In walking, the iliopsoas muscles of one side move the leg forward, and the abdominals bring the same-side hip and pubis forward. (discussed on more detail, below)
• The iliacus muscles, which feed into the quadratus lumborum muscles, which feed into the intercostal (rib) muscles. All these muscles move the trunk in the twisting/untwisting movements of walking.
• The psoas major muscles pull the fronts of attached vertebrae (at the level of the diaphragm), down and back; the abdominals push the same area back.
• One-sided contraction of the psoas muscles twists the torso and causes a sidebend toward the side of contraction (as if ducking to one side and looking over ones raised shoulder) -- it also retracts (pulls in) the leg toward the waist from within; abdominal muscles assist the shortening movement by pulling the hip (iliac crest) into the waist (part of being short-waisted).

Now, if this all sounds complicated, well, it is. Fortunately, we don't need to keep all this in mind when we have free movement and good coordination; it just happens, the movement feels right and we feel well put-together. However, I understand how you might feel overwhelmed by all this information. Don't worry. I've provided a personal coaching option if you feel you need it to keep you progressing smoothly and I've organized the program in bite-size pieces.

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Exercises to flatten the belly (e.g., crunches) cause the abdominal muscles to overpower psoas and spinal extensor muscles that are already too tight. Co-contraction results, in which abdominal organs are sandwiched between tight muscles, front and back, which impairs their functioning (e.g., digestive/eliminative problems)

From the foregoing description, it's obvious that "inconvenient" consequences result from abdominal exercises -- as popular as those exercises are for the appearance of fitness. It's better to simply to balance the interaction of the psoas and abdominal muscles.

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 feet are not in the same vertical plane as the hip joints, but are somewhat behind the hip joints(swayback), or more ahead of them (the stooped posture of "old age"), the strain tilts the pelvis -- and excessive lordosis or kyphosis follows (depending on whether the person has a swayback or a stoop). This postural effect involves the postural reflexes of 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, 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.

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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.

(A TECHNICAL DISCUSSION OF BALANCED WALKING)

What this means is that movement forward starts in the trunk (as a slight swaying forward). That slight swaying forward starts as a shifting of weight onto one foot and a subtle lifting of the toes and/or front of that foot, which decreases support, so that you slightly sway forward. When you have swayed far enough forward, you spontaneously bring your other leg forward to catch your forward weight (knee movement forward initiated by the psoas). Your leg comes forward, your foot comes down and supports your weight as it comes forward; then your other leg comes forward. The movement is: foot, trunk, hip, knee, foot, in a cycle.

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

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 posteriorly (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 aligning thigh rotation so the leg (optimally) swings directly in the line of travel (not commonly seen, but then idiosyncratic muscular tensions and inefficient movement are more common than well-organized movement -- so common that they are taken as "normal"). 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.

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) lead to tripping over ones feet, when walking; to avoid tripping over ones own feet, the hip flexors must compensate by lifting the knee higher, leading to a similar problem. The answer to this problem, by the way, is not usually to strengthen the muscles of the shin (dorsiflexors), but to free the muscles of the calf, which are usually too tight.

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.

(TECHNICAL DISCUSSION ENDS)

The psoas, iliacus, abdominals, spinal extensors, hip joint flexors and extensors, and flexors of the ankles/feet all cooperate in walking movements. Poor coordination (generally through over-contraction or non-responsiveness of one or more of these "players") leads to dysfunction of the others and often to back pain. To strengthen the abdominal muscles is often misguided effort to correct problems that lie elsewhere - which explains why, even though abdominal strengthening exercises are so popular, back pain is still so common.

Because psoas problems are really movement and control problems (dysfunctions of "muscle memory/movement habit" problems), somatic education provides a better solution for the problem of psoas pain or back pain than abdominal strengthening exercises, which miss the other major players, and better than stretching or simple relaxation exercises, which cannot improve control and coordination.

When one side of the psoas is tight and short, the same side of the pelvis is restricted in its ability to move forward (and to permit its other side to move backward). Walking (gait) is more free on one side than the other, causing an altered walking pattern. Tight psoas muscles contribute to fatigue, sitting. Co-contracted glutei minimi frequently accompany and mask contracted psoas muscles. The co-contraction drags the front of the pelvis down. The lumbar spine curves forward, causing a back-arched, big-belly posture tending toward a forward-bending posture, which the extensors of the lumbar spine counter to keep the person upright. Tight spinal extensors suffer muscle fatigue and soreness. Thus, the correlation of tight psoas and back pain is explained.		Click for Tight Psoas? Sit too much? The basic principle and primary technique of clinical somatic education, click Definitive Pain Relief from Somatic Education. Preview the self-relief program, click  Free Your Psoas. Considering coming for one-on-one sessions? Read a description of a clinical somatic education session. Click here. See somatics in action. Click here. (CLICKING THESE LINKS OPENS NEW BROWSER WINDOWS, WHILE THIS ONE STAYS OPEN.)
As explained before, to tighten the abdominal muscles as a solution for this stressful situation is a misguided effort, as is stretching. What you need is to free and coordinate your psoas and glutei minimi muscles and the other, central movers and stabilizers of the body for a healthy core (not possible from mere "core strengthening" or "core workouts").

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