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

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!

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

This Quadratus Lumborum muscle is perhaps one of the most relevant yet not always adequately treated muscle by healthcare practitioners who work directly hands-on with the body’s physical structures in relation to attempting to resolve lower back pain conditions.  I will bring to your attention other relevant and important muscles involved in lower back pain and movement restriction issues in this series of forthcoming blog articles.  These articles will feature informative videos that I have come across on YouTube giving an introductory overview of the relevant anatomy background followed by useful self help stretching exercises to facilitate release of tension in the muscle being reviewed.

In the above image, drawing C illustrates the anatomical positioning of the Quadratus Lumborum muscle, note that this muscle is actually semi deep and beneath another group of muscles called the Erector Spinae group which sit directly on top.  Drawings A and B illustrate the pain referral pattern that can get set-up when there are trigger points in this muscle, as is usual with the phenomenon of trigger points the actual apparent location of the pain or soreness experienced as defined by the shaded areas in the above diagram is referred i.e. it’s possible that no pain maybe directly felt in the muscle itself even though micro tension knots in the muscles itself are causing pain to be referred and felt in the buttocks.

Here’s an interactive anatomy lesson and an example of some exercises you can do to help stretch and free up this muscle, although to do them requires additional equipment (a swiss ball) and would not be recommended to an absolute beginner:

The self help exercises which follow in each article must feel comfortable to do at all times, there is no useful benefit to be gained and the chance of injury to occur by pushing yourself into any discomfort or further pain.  Also, remember to breath in deeply and breath out just as you’re about to go into the stretch, many people commonly (and unconsciously) hold their breath as they are about to perform stretches find that they can go a lot further as well as with less resulting pain after changing over to breathing properly as suggested.

So to finish off with, here are some simple exercises which do not require additional equipment and can be done by most, if not all when adapted to within your tolerance level.

The exercises should ideally be performed daily as part of a rehabilitation program and in conjunction with regular visits to a suitably qualified massage or physical therapist who can perform the supporting release or soft tissue manipulation work on the muscles involved.

See you in part 2!  Take care now.

Stretching for every day muscle and joint health

Stretching is an important activity that helps to elongate the fibres of our muscles which in turn can prevent the fibres and other soft tissue structures surrounding them from dehydrating and stiffening up which would ultimately affect that muscles flexibility. Over the long term, stiffening up and over contracting of the fibres within a muscle can impede the flow of fresh blood and cause harmful metabolic waste chemicals to get trapped in the muscle tissues, this causes the stiffness and pain we feel as the end result.

Athletes and people who regularly do sporting, aerobic or body movement training activities all recognize the necessity and beneficial effects of stretching, thus they build in periods of stretching into their training schedules in order to accommodate this need.

Ballistic stretching is a generic name that I’m giving to any kind of stretching which involves repetitions in quick-fire succession and usually involves a lot of exertful force going past the comfortable range of movement. Ballistic therefore isn’t what the rest of this article is about. What the rest of this article is about and what has much higher therapeutic value in a rehabilitation or remedial context is the idea of focused stretching. Focused stretching is done with slowness and intent and (very importantly) involves breathing by receiving deep breaths in just before going into the stretch and breathing out slowly and fully whilst doing the stretch. If you’ve done any amount of work with a body awareness exercise system such tai-chi, qigong, palates or yoga (to name but a few) then you’ll be familiar with the idea of focused stretching.

Stretching is also a vital component of an effective remedial massage session as the fascia and filaments of muscle tissue which have already been passively worked on by the therapist will benefit from being re-aligned and stretched out properly by means of the client fully engaging the muscle that has just been worked on in active full range of movement. This is particularly important after trigger point worked has been carried out on a particular area, as there will be mis-aligned muscle fibres which will be facilitated back into a more healthy alignment by a good series of focused stretches to that muscle. The exact same thing can also be said after a session of indirect myofascial work.

From my own experience as a therapist, I would also say that there are good psychological reasons for the client to do a series of stretches after the necessary soft tissue manipulation work has been done on an area which has been an issue for the client, particularly where there has been a pain on movement or movement restriction challenge a stretch will prove to the client that things have improved! Have lost count of the number of times I’ve gently guided a client through a series of stretches and for them to be fully expecting the movement restriction or pain pattern to still be there, but instead for the situation to be improved to their surprise as they gingerly stretch out to the position where they are still expecting to fell pain or restriction. Once again, the importance of breathing into a focused stretched cannot be overemphasized enough, lots of anecdotal experiences available here once again, clients are always surprised how much further they can go when they breath out whilst going into the stretch instead of holding their breath whilst going into the stretch.

In the previous paragraph I was describing passive stretching i.e. whereby someone (a therapist in this case) assists and coordinates movement of the clients body in order to facilitate a stretch of the target muscle, this is done with client communication to indicate the comfort zone of the stretch as well the appropriate breathing taking place. It is possible for a client to come in for a session with me and for us to do nothing but passive stretching for the entire duration of an hour’s session. Active stretching on the other hand is the polar opposite category to passive stretching where the person doing the stretching does it to themselves with no actual physical assistance from anybody else around them, this is of course very useful to teach people so that they can do self stretching at home in-between session visits. A recommended series of stretching exercises is something I always give to my clients to do at home as this enhances the work we have already done during the session, helps maintain and prevent relapse and retrains the muscle physiology as well as the psyche of the individual into a new re-patterning of “this is now what’s possible” rather than unconsciously slipping back into the previous (less helpful) modus of operational possibility.

Another form of active stretching work that I like to use when appropriate in sessions with clients involves me applying an appropriate amount of pressure usually on or close to the attachment site of a muscle whilst the client very slowly and deliberately repeatedly performs an action with their body that will cause a focused gradual stretch of the whole of the muscle that we happen to be working on. This method of working is adapted from structural integration work (variously known also as postural re-alignment), which I’ve found to be very useful for clients who habitually just want to be in total control of their own bodies and find it very hard to relinquish any kind of passivity over to anything external or anyone that may be trying to assist them e.g. like going into a passive stretch.

There are many books on the subject of stretching, and no doubt if you’re already an active participant in sports, body exercise or movement therapy then you’ll probably already have all the books and other resources available at your finger tips already. If however you’re a complete beginner and need to start incorporating stretching in order to overcome the stiffness and bring back the suppleness into your daily life, something simple I highly recommend to anyone for the health benefits who isn’t already doing so, then this a great book for the lay person to dig into with good pictures, explanations and recommended stretching routines for before, during or after a particular every day activity such as using a computer, watching television, etc:

YouTube is another highly recommended resources for videos showing you how to stretch certain muscles and parts of your body, I’ve included an example selection on the YouTube video player widget which allows you to choose and play videos from a list of favorites over at my other website (ISCA Therapies) http://www.isca-therapies.co.uk