The Iliopsoas and Low Back Pain

Our last blog dissussed what the iliopsoas muscle group consists of and its anatomical position in the body.  Today’s blog will discuss how this muscle group may cause low back pain.  Despite the fact that the iliopsoas is made up of more than one muscle, the psoas major is typically the muscle most involved with low back pain due to its origins at the L1 to L5 vertebrae of the low back. 

The psoas muscle itself can be irritated and cause pain along the front of the hip and deep in the abdomen, but the low back pain that it causes is typically due to the position into which it pulls the low back.  When the psoas muscle is shortened and tight, it has the ability to pull the vertebrae of the back forward.  This forward pull creates an increased curve at the low back.  It is natural to have some degree of a curve at the low back, but an excessive curve increases pressure where it does not belong and thus may cause pain. 

In addition to pulling the low back vertebrae out of their proper positions, a shortened psoas muscle can also affect the position of the pelvis.  The pelvis is comprised of several bones, but the important thing to note with this topic is that there are two halves to the pelvis.  If the psoas muscle is excessively tight or short, overtime it can cause one side of the pelvis to rotate out of its correct position.  This rotated position can create pain at the low back, pain in the pelvis or sacrum region, and even cause nerve compression resulting in irritation down the leg on the same side or opposite side of the tight psoas muscle.

Dysfunction at the psoas can result in a plethera of symptoms depending on how long irritation has been present and how much the mechanics of the body have adjusted to compensate for the symptoms.  Pain may be present with several activities including standing, walking, running, rising from sitting, walking up steps, or lunging forward. 

In order to treat back pain as a result of psoas dysfunction, the psoas itself as well as the resulting mechanical changes to the body must be addressed.  Manual techniques may be used by a physical therapist to correct any alignment issues.  These techniques include manually mobilizing the lumbar or pelvic region, and other manual treatments like massage, deep tissue release, and relaxation techniques can also be used to decrease tension and irritation at the psoas muscle.  Stretching is also an important component to rehabilitation following psoas dysfunction.  The psoas muscle must be gradually stretched which can be achieved in a lunge position with the painful hip in the back and gently leaning into the lunge until a stretch is felt at the front of the hip.  If the backside of the hip becomes tight as a result of any alignment issues, then stretching may also be needed for the back of the hip.  Strengthening of the abdominal and hip muscles, especially those along the outside and back of the hip, is also necessary in order to improve function and reduce the risk of symptom reoccurance.  There are a wide variety of exercises that can be performed to strengthen these muscles and a physical therapist can set up an appropriate exercise program for home use.

We hope this blog was informative.  If you have any questions on this topic or any others in which you are interested, feel free to leave any questions, comments, or suggestions. Thank you for reading and stay active.

 

Kateri Kane PT, DPT

Advanced Physical Therapy and Fitness, Mechanicsburg, PA          

 

Resources:

http://www.physiokinetics.gr/pdf/PDIS_introduction_0[1].pdf

http://jaoa.org/article.aspx?articleid=2094465

http://www.somatics.com/psoas.htm

What is Iliopsoas Tendonitis?

More frequently lately I have been seeing patients with injuries to their iliopsoas muscle group.  This muscle area is a good one to discuss because it is not as commonly known as areas like the quadriceps and hamstrings and can be confusing for people to understand because it involves both the hip and the back.  Let’s delve a little further into what makes up this muscle group.

The iliopsoas is made up of two separate muscles: the iliacus and the psoas major.  The iliacus starts at the inner surface of the hip bone known as the ilium and connects to an area on the upper inner surface of the thigh bone (femur) known as the lesser trochanter.  The psoas major starts at the bodies of the vertebrae that make up the low back and extends to connect to the less trochanter (same as the iliacus).  In approximately 40% of the population there is an additional muscle called the psoas minor that also belongs to this muscle group.  It connects to the body of the L1 vertebrae and extends down to a portion of the pubic bone known as the inferior ramus.  Together these muscles assist with lifting the leg into a bent position as when walk up steps, assist with rotating the hip outward, and help to bend the trunk at the waist when the legs are in a fixed stationary position as when sitting up from a lying down position.

Now you know what the iliopsoas is made up of, but what is iliopsoas tendonitis?  Tendonitis is a term that means inflammation of the tendon; therefore, iliopsoas tendonitis would mean inflammation of the tendons of the iliopsoas muscles.  Inflammation can result in pain and discomfort during various hip motions that involve activation of the iliopsoas including walking up steps, sitting up, walking, and running, to name a few.  Positions that put the muscle group on stretch like lying down with the legs straight instead of bent or lunging forward with the painful hip in the back can also be aggravating, especially when symptoms are particularly flared up.  The condition can often be associated with a snapping or clicking sound at the hip during movement, which is why it can also be referred to as “snapping hip.”

Treatment of iliopsoas tendonitis depends on the severity of the condition.  The milder the symptoms are, the less invasive the treatment is.  When the symptoms are mild, individuals often just need to modify their activities to limit overuse of the iliopsoas and take anti-inflammatory medication.  Cortisone injections may also be utilized.  If the symptoms persist, however, further intervention may be warranted.  Physical therapy can assist with guiding you through recovery and regaining previous function via an exercise program heavily geared toward stretching and gradual strengthening, as symptoms and strength allow.  A less common intervention which is used only when symptoms continue to persist despite conservative treatment is surgery.  A surgeon may choose to fully release the tendon, partially release the tendon, remove inflamed tissue, or attempt to lengthen the tendon via small incisions.  Once again, surgical intervention is not as common and typically conservative treatment with physical therapy and relative rest from aggravating activities is all that is needed.

In first addressing this topic we noted that the iliopsoas can be confusing because it may involve both the hip and the back.  Our next blog will discuss the effects of the iliopsoas muscle group on the low back.  We hope this blog was informative.  If you have any questions on this topic or any others in which you are interested, feel free to leave any questions, comments, or suggestions. Thank you for reading and stay active.

Resources:

http://www.sportsinjuryclinic.net/anatomy/human-muscles/iliopsoas

http://breakingmuscle.com/mobility-recovery/everything-you-need-to-know-about-the-iliopsoas

http://emedicine.medscape.com/article/90993-treatment

http://health.ucsd.edu/specialties/surgery/ortho/areas-expertise/sports-medicine/conditions/hip/Pages/iliopsoas-tendonitis.aspx

http://www.hindawi.com/journals/crior/2013/361087/

Obesity and Health Risks

Now that the New Year is here, many people have made resolutions to lose that excess weight that was gained over the holidays or as an accumulation over the years.  When weight loss is necessary, this is a wonderful goal.  One key factor to understand, though, is that having healthy weight is more important than just your outward appearance.  Sure, you may want to look good and feel good in your own skin; but there are also MANY health problems that you can escape by losing weight and avoiding obesity.

The following list may seem long, but ALL of these are conditions that can result from obesity.

  • Coronary Artery Disease (CAD) – plaque builds up in the arteries which is why this condition is also referred to as blocked arteries; heart attack or heart failure can result from the condition
  • High Blood Pressure – damage can occur to the body in many ways when the force of the blood pushing against the walls of the arteries increases as the heart pumps
  • Stroke – plaque built up in the arteries can cause a break off resulting in a clot; if the clot is close to the brain then it can block oxygen and result in a stroke
  • Type 2 Diabetes – an increase in intra-abdominal fat is correlated with a decrease in the effective use of insulin which is required to convert glucose (sugar) in the body to energy; obesity has also increased the risk of type 2 diabetes in children
  • Abnormal Blood Fats – obesity can result in high levels of triglycerides and LDL (“bad”) cholesterol and low levels of HDL (“good”) cholesterol which increases the risk of developing CAD
  • Metabolic Syndrome – this group of risk factors increases your chances of having heart disease, diabetes, or a stroke; risk factors include: a large waistline, higher than normal triglyceride level, lower than normal HDL level, higher than normal blood pressure, higher than normal fasting blood sugar level, or if you are on medications for any of these conditions
  • Cancer – obesity increases the risk for colon, breast, endometrial, and gallbladder cancers
  • Osteoarthritis – excess weight increases pressure through the joints, thus increasing the risk of developing arthritis especially in the knees, hips, and low back
  • Sleep Apnea – greater fat around the neck can narrow the airway and make pauses in breathing or shallow breathing while sleeping more likely
  • Reproductive problems – menstrual issues and infertility can occur with obesity
  • Gallstones – obesity can increase the risk of developing gallstones which are mostly made of cholesterol and can cause back pain; obesity can also increases the risk of an enlarged gallbladder which does not function

In order to know your risk for these conditions, it is improtant to know how to check if you are overweight or obese.  The best measures come from devices that can calculate body composition.  Certain devices can measure air or water displacement while in a testing apparatus in order to assess the amount of muscle versus fat in your body.  Due to the fact that these measurement devices are not always readily available to most people, measuring your waistline, the ratio of your waistline to your hips, and your body mass index (BMI) may be a quicker and more feasible option.  These measurements are not as accurate; however, they do have statistical correlations with health risks. 

To measure your waistline, find the smallest point around your abdomen and measure the circumference in centimeters.  Most women are at a higher risk for heart disease when their waistline is greater than 80-88 cm, whereas most men are at a higher risk when their waistline is greater than approximately 94-102 cm.  Asian men and women are at a higher risk with even smaller waistlines. 

To calculate your waist to hip ratio, measure the smallest point of your waistline and the widest point of your hips, then divide the waist measurement by the hip measurement.  Your hips should always be wider than your waistline.  Women with a ratio of 0.80 or below have a low health risk, those with a ratio of 0.81-0.85 have a moderate health risk, and those with a ratio greater than 0.85 are at a high health risk.  For men, the low range is 0.95 or below, medium is 0.96-1.0, and high is greater than 1.0. 

BMI is a measure of your weight compared to your height.  It is calculated by dividing your weight in kilograms by the square of your height in meters.  For a more information on BMI and an easier means of calculating this measure, check out our past blog BMI and Cholesterol.  A BMI of greater than 25 is considered overweight for most people and a BMI of 30 is considered obese.  Women are at a greater risk for heart problems when their BMI is over 21 and the risk for heart disease in both men and women is greatly increased once their BMI reaches 30 or above.

If, after testing yourself, you have discovered that you are overweight or obese; then refer to our past blogs Exercise for Health or Exercise for Weight Loss?, What Form of Exercise is Best for Your Goals?, and How to Lose Weight…Even Around the Holidays for good tips on healthy exercise and weight loss.  We hope this blog was informative.  If you have any questions on this topic or any others in which you are interested, feel free to leave any questions, comments, or suggestions. Thank you for reading and stay active.                                                                                                       

 

Resources:

http://www.nhlbi.nih.gov/health/health-topics/topics/obe/risks

http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/obesity/

http://www.sparkpeople.com/resource/fitness_articles.asp?id=776

http://www.nifs.org/fitness-center/fitness-assessments/bodpod

 

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