Important Muscles Involved in Lower Back Pain – Part 2 : Psoas

15 June, 2010 at 00:21 9 comments

The Psoas muscle is one of the most commonly involved yet under treated muscle in lower back pain conditions, save to say it is probably the number 1 missing link in a lot of cases where the muscle has never been directly addressed and appropriately rehabilitated in many cases of unresolved lower back pain.  Due to the relatively deep location of the main fibres of the psoas muscle, it is seldom treated directly unless the practitioner concerned has had training in the appropriate techniques.  The muscle itself covers a very large area of the lower back and pelvic areas, significantly it attaches to the front facing side of each of the lowest set of 5 vertebrae bones of the spine, continues on to lines in the inside of the pelvis (where it is sometimes becomes known as the “iliacus” muscle) and finally attaches to the top inner part of the femur (aka tigh bone).  Due to its attachment to the front of the lower spine, tension in the psoas muscle can pull the spine forward causing an excessive forward curvature in this region (known as an excessive “lordosis”) which in turn causes the opposing muscles attached to the back facing side of the spine to become over stretched and over tensioned (muscles including the quadratus lumborum and other spinal muscles which we discussed in part 1 of this article series).

As can be seen from the above diagram set depicting the trigger point pain referral patterns for the psoas, the first illustration shows the pain pattern for the back of the body which is essentially quite straightforward as it is just a localised pattern (relative to the absolutely position of the psoas muscle itself) running parallel along either side of the lower part of the spine.   The second illustration however might be a surprise as it shows pain referral which can get set-up and experienced on the front of side of the body which in this case is a region around the inner groin and inner thigh area, so anyone experiencing pain in these areas it’s possible to attribute this to trigger points in your psoas muscle.  Proper and thorough treatment of the trigger points in the psoas muscle requires that the practitioner goes in gradually and eases in deeply moving the intestines aside in order to make contact with the psoas (and iliacus), the direction of aim is toward the spine in order to work directly on the psoas (but not ultimately to make contact with the spine).  This procedure need not be excruciatingly painful for you the client so long as your practitioner maintains a “listening sense of touch” at all times, as well as working slowly and gradually in rather than forcing their way in with battling haste and impatience.

The following video gives a nice interactive over view of the anatomy for the psoas muscle and gives a few pointers on what issues may arise as a result of the psoas muscle being overly locked in tension or on the flip side in weakness (which is generally rare):

So, here is our first video showing you a classic de facto standard stretch for the psoas muscle, note that a varation of this stretch can also be done whilst lying totally flat on the floor i.e. the leg that would have been hanging off the edge of the bench in the video example would instead be stretched out straight flat against the floor instead:

Now, here are 2 alternatives…  The first variation is a stretch that can be performed standing (instead of lying down):

The second variation is a bit more complicated to grasp, but fine once you’ve understood what you’ve got to do!  This video was for me personally a very interesting stumble upon as it’s is based upon the paradigm of myofascial stretching.  I myself perform myofoscial release work for releasing individual muscles, but have never really looked into studying myofascial stretching before and has thus whetted my appetite, so any comments welcome about this from either total new comers or those experienced in myofascial stretching already.  I tried the exercise in the video below for the first time earlier on just before writing this article and it is certainly effective yet gentle and holistic (i.e. you can feel other parts of your body gradually and subtly freeing up as well during the stretch process) all at the same time:

Remember, if you have on-going lower back pain and have never had your psoas muscle properly treated for trigger points and properly (myofascially) released by a suitably qualified massage or physical therapist, chances are that this is exactly what the missing link is.

Take care for now and see you for the part 3!


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Important Muscles Involved in Lower Back Pain – Part 1 : Quadratus Lumborum Important Muscles Involved in Lower Back Pain – Part 3 : Rectus Abdominus

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  • […] as always, following on from the precedent set up in part 1 and part 2 of this series, we a video now for you giving a basic overview of the anatomy relating to this […]

  • […] to performing direct physical manipulation of bones. If you have not yet read our articles on the Psoas and Quadratus Lumborum muscles, please feel free to click the aforementioned links to convince […]

  • […] Important Muscles Involved in Lower Back Pain – Part 2 : Psoas June 2010 2 comments 5 […]

  • 4. Donna  |  7 October, 2011 at 03:36

    I gave birth via c-section and 5 months after, I had an emergency colostomy. Nine months after this surgery I had a colostomy reversal. During these period, I gained a lot of weight and my belly portruded severely.

    I developed severe pain in my lower back to the point of not being able to get up straight after a lying position. All kinds of tests were performed, MRIs, CT scans and nothing was found. Doctors cannot explain the reason for my pain.

    I was wondering if the cuts in my abdominal muscles could lead to this awful pain and also the weight gain. I have lost already 30 pounds and still need to lose another 60 to reach my ideal weight. However, in the past I have been overweight and never felt this excruciating pain. I never heard of the psoas muscle, but it seems that it might have something to do in my case. I wanted to know what is your opinion.

    Thank you very much!!!

    • 5. Henry Tang  |  7 October, 2011 at 17:25

      Hi Donna,

      Yes, I would say for anybody who has never had their psoas muscle physically worked on properly and released that it almost certainly need releasing. Because the psoas is such a deep but not entirely inaccessible muscle, it is often not treated by general massage or physical therapy work unless the practitioner has specific training to do this type of work. The psoas muscle because of position in the body is also physically interconnected to the respiratory diaphragm which is the sheet of muscle which sits underneath you lungs and is responsible for our breathing. The psoas muscle also run just in front of the kidneys and so can be affected and become tense if you are use to consistent adrenal stimulation such as high unremitting stress.

      I would generally recommend for you going to have sessions with a massage therapist or some kind of physical therapist who has training in fascia and myofascial release techniques, including perhaps also having training in cranio-sacral work and/or visceral manipulation. All these aforementioned modalities work with the interweaving all pervasive connective tissues of the body called fascia. In your case, I would have no doubt that due to the number of different operations you have to the abdominal area of your body that there will be severe restrictions to the fascia in that area of the body from scar tissue build up. Fascial or fascia related restrictions can be unobtrusively and relatively painlessly broken down harmlessly through physical work during fascia release sessions. Even though this type of work is physical in nature it can also be emotionally releasing and because any kind of operation is traumatic to the body the benefits of easing the physical restrictions in the soft tissues also releases the stored emotions, trauma and shock that is stuck in there too, the effects can be profound and result in a release from pain as well. Physically experienced pain can have both a physical and/or an emotional root cause to it. Find a practitioner who can work sympathetically and nurturingly with you.

      If there is any further help or advice that I can offer please feel free to contact me directly or feedback below.

      Thanks 🙂

      • 6. Donna  |  12 October, 2011 at 03:41

        Thank you for your thorough response. I am interested, however, do you have any suggestions for a practitioner with the specialty you recommend in the Miami, Florida area?

        I would greatly appreciate it!

        Thank you again and hopefully I can find someone that is able to help me.

        Warmest regards,


      • 7. Henry Tang  |  19 October, 2011 at 20:58

        Hi Donna – sorry for the delay in replying – yes if you are still looking for a suitable practitioner I can put word out to my network and see if there is someone in your area – I’m sure they’re will be?

      • 8. Donna  |  19 October, 2011 at 23:18

        Yes, I am still interested. Thank you so much!

      • 9. Henry Tang  |  24 October, 2011 at 19:57

        Hi Donna – I’ve not yet been able to locate someone in your area – however a friend, fellow massage therapist and wellness clinic owner has pointed me in the direction of this very useful website where you can search for practitioners nationally and internationally who are registered practitioners in particular therapies…

        There’s a lot of visceral manipulation trained therapists in the general Miami Florida area, so I’d imagine if you put your zip code into the search that should narrow things down somewhat. Let us know how you get on.

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Henry Tang – Therapeutic & Advanced Clinical Massage Practitioner (Crows Nest, Sydney, Australia)

Click image above to visit Spaces of Possibilities Wellness Centre, Crows Nest, Sydney, Australia.

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