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