Hip Flexors and Low Back Pain
  • Dr. Elaine Screaton DC

Low Back Pain- Psoas I Was Saying...

Updated: Jun 25, 2019


When we think of low back pain, we often think of the muscles and joints on the posterior side of the body (back) and core as being the main culprits. We often forget of the psoas muscle and how it relates to back pain.


The above diagram shows our psoas muscle (pronounced 'so-as'). As you can see, it is a long muscle, situated on the front and side of the spine that attaches onto the femur (thigh bone). Based on its attachment sites, it plays a role in hip flexion, lateral lumbar flexion (bending to the side) and forward lumbar flexion.

Psoas is almost always a culprit with anyone experiencing low back pain or sacroiliac joint pain. In most individuals with low back pain, psoas will demonstrate atrophy (ie wasting away of muscle tissue, leading to muscle weakness). Muscle weakness in psoas (and other lumbar stabilizers) reduces stability of the lumbar spine (low back), and thus predisposes someone to injury.

Typically, with any muscle injury, the muscle gets short, tight and weak. Therefore, the best way to rehab these muscles is the lengthen them, and strengthen them.

Here are some targeted psoas stretches and strengthening exercises to help combat low back pain:

Couch Stretch:


This is the couch stretch. Best done kneeling with a cushion under the knee. You should feel this stretch at the front of the hip. Hold for 1 minute minimum to allow muscle to relax.

Lunge Stretch:


This the lunge stretch for the hip flexors. You should feel this stretch at the front of the hip. If more stretch is required, you can raise the arm above the head of the leg that is kneeling (in this case you would raise your left arm above your head). Hold for 1 minute to allow the muscle to relax, and as you work through the stretch feel your hip opening more.

Seated Psoas Lift:


This video demonstrates a seated psoas lift. As you lift one of your legs, apply downward pressure with your opposite hand. Hold for 4 seconds each side, repeating 10-12 times/side.

Lying Psoas March:


This video demonstrates a laying psoas march. This can be done with a band for resistance as this video demonstrates, or you can use your opposite hand to provide counter pressure (similar to the seated psoas lift). The key here is to ensure that the core and low back remain braced, with the spine flat against the floor (no spine arching) to ensure proper muscle activation.

Prior to starting any exercise program, please check with your health care provider to ensure these exercises are right for you. They will be able to advise you as to the proper exercise to perform to minimize pain and optimize performance.

Dr. Elaine Screaton (DC, BSc) is a Chiropractor in Calgary, AB currently practicing at Synergea Family Health Centre in Calgary, AB. For more information on Dr. Elaine, check out www.drscreaton.ca

References:

1. Kim, Seongho, Hyungguen Kim, and Jaeyeop Chung. "Effects of spinal stabilization exercise on the cross-sectional areas of the lumbar multifidus and psoas major muscles, pain intensity, and lumbar muscle strength of patients with degenerative disc disease." Journal of physical therapy science 26.4 (2014): 579-582.

2. Barker, Karen L., Delva R. Shamley, and David Jackson. "Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability." Spine 29.22 (2004): E515-E519.

3. Wikipedia contributors. (2018, September 23). Psoas major muscle. In Wikipedia, The Free Encyclopedia. Retrieved 22:28, November 19, 2018, from https://en.wikipedia.org/w/index.php?title=Psoas_major_muscle&oldid=860805289


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© 2019 Dr Elaine Screaton

Tel: 403-247-2947

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