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Wikipedia Entry on Somatics

The Psoas Muscles, Psoas Stretches, and Abdominal Exercises for Back Pain

© 2004 Lawrence Gold | revised Jan 2010
certified practitioner
Hanna Somatic Education®
The Dr. Ida P. Rolf method of Structural Integration

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SUMMARY - Before you start a program to relieve psoas pain, know:
  • what the symptoms are of tight psoas muscles vs. other conditions that produce similar pain

  • whether tight psoas muscles are the root of the problem or an effect of a different problem

  • the difference between approaches to freeing psoas muscles

  • whether an approach promises through, durable relief or partial, temporary relief
In this article, I cover those topics, give you an opportunity to experience changing your own muscle/movement memory, and provide access to what you need for complete psoas muscle relief.

BELOW:

Because pain that comes from other causes is so often mistaken as coming from tight psoas muscles, we are careful to distinguish pain from tight psoas muscles from pain of other causes. Sometimes, tight psoas muscles are are part of a larger contraction pattern and so are not the central problem (despite the diagnoses of well-meaning practitioners and therapists, who sometimes miss connections, as we all do).


The psoas muscles are very "popular", these days -- often cited as the cause of back pain. If you have both tight psoas muscles and back pain, you may have a twisted sacrum* (S-I joint dysfunction) -- a surprisingly common condition. In that case, tight psoas muscles are an effect of a twisted sacrum, not the cause of the pain, and they cannot be released without correcting sacrum position.

You may determine whether you have that condition by reading and following the instructions in this entry on S-I joint dysfunction. If you have the condition, click on the "regimen" link at the bottom of that entry; an email window will open; send the email (blank) and you will receive a "quick response" email message with access to the self-relief regimen.

* The sacrum is the central bone of the pelvis, running from the waistline in back to the tailbone.

Is It Psoas Pain? | Where Does Psoas Muscle Pain ("Iliopsoas Syndrome") Show up and What Does It Feel Like?

Iliopsoas syndrome is a collection of symptoms caused by tight iliopsoas muscles and experienced anywhere along their length.

Psoas muscle pain may show up as groin pain (psoas tendinitis or psoas bursitis), deep pelvic pain, and/or pain deep in the belly. Tight psoas muscles are also a major player in hip joint pain (front).

Lower back pain at waist-level (lumbopelvic pain), when accompanied by groin pain or deep pain in a hip joint suggests a twisted sacrum in which the psoas muscle of one side is stabilizing an unstable internal pelvic structure. In that case the psoas should be freed as part of correcting sacrum position; you should read this entry for "fit".

The iliopsoas muscles consist of the iliacus muscles, which span from each groin to the sides of the pelvic cavity; the psoas muscles span from the inner groin to the spine behind the breathing diaphragm; because they share the same tendon at the groin, they are called, "the iliopsoas muscles".

The iliopsoas muscles are large and long; pain may show up anywhere along their length. See the image, at right.

THE ILIOPSOAS MUSCLES and QUADRATUS LUMBORUM

Tight psoas muscles put undue pressure on the bursa* at the groin, causing iliopsoas bursitis and iliopsoas tendinitis.

Tight psoas muscles are in a constant state of fatigue and feel sore, giving rise to pelvic and abdominal pain.

* A bursa is a fluid-filled sac that acts like a pulley over which a tendon passes on its way to its attachment on a bone and against which it rubs during movement. Tight muscles make the tendon rub hard against a bursa.

Other Symptoms Of Psoas Muscle Malfunction That You May Have, but not Connect with a Tight Psoas Muscle

(1) impaired breathing, (2) poor digestion from compressed abdominal contents with impaired circulation, (3) chronic constipation (from sluggish lumbar plexus function), (4) poor postural alignment, (5) poor support; gravity then drags posture down; (6) heavy-feeling legs; (7) back tension to counteract what is, in effect, a movement toward collapse. This muscular effort (a) taxes the body's vital resources, (b) introduces strain in the involved musculature (e.g., the extensors of the back), and (c) sets the stage for back pain and back spasm.

The musculature and connective tissue of the legs, which connect the legs with the pelvis and torso, largely determine the pelvic orientation (postural position), and thus the spinal curves. If the feet are not in the same vertical plane as the hip joints, but are somewhat behind the hip joints(swayback), or more ahead of them (the stooped posture of "old age"), the strain tilts the pelvis -- and excessive swayback (lordosis) or stoop (kyphosis) follows. This postural effect involves the postural reflexes of standing balance, reflexes that involve the abdominal musculature. If the psoas muscles are tighter on one side than the other (pain on one side), abdominal muscles are tighter on one side than the other, and hip height asymmetry results, contributing to the appearance of unequal leg length.

Where movement, abdominal organ function, and freedom from back pain are concerned, proper support from the legs is as important as the free, reciprocal interplay of the psoas and abdominal muscles.

Tight Psoas Muscles: 9 Central Questions Answered

PREVIEW LESSON INTRODUCTIONS and PURCHASE


CLICK HERE

About Therapeutic Options

Now, to get straight to the point, therapeutic options should take into account several conditions governing recovery from injury. Failure to do so accounts for the incomplete or temporary results of psoas stretches, for example.

  • "Muscle/movement-memory" | Muscle/movement-memory runs the show. Muscle/movement memory controls muscle tension (tone), coordination with other muscles (balance), and the ability to relax (comfort). Muscle/movement-memory keeps tight muscles tight and returns them to being tight, if forcibly made to relax.

  • Manual Manipulation and Muscle/movement-memory | Manual manipulation creates a strong memory of being manipulated or forced to relax (due to the intensity of sensations when being manipulated), but not an equally strong memory of normal movement under your own control. When treated with manual manipulation, people get a taste of free movement and then tend to return to their familiar state in hours or days after manipulation because of muscle/movement memory.

  • Stretching Exercises | In stretching exercises, tight muscles remain passive, while other muscles force the stretch. That makes stretching an indirect approach. The most common psoas muscle stretch (the psoas "lunge") is done standing or kneeling. When you are standing or kneeling, balance reflexes based on your old muscle/movement memory come into play, which interferes with efforts to form new muscle/movement memory.
PSOAS STRETCH ATTEMPT
PSOAS STRETCH ATTEMPT
  • Altering Muscle/movement-memory | Muscle/movement memory directly underlies the muscular tensions underlying psoas muscle pain. There exist more and less effective ways to change muscle/movement-memory, the least effective of which involves paying attention to and maintaining good posture. The most effective direct approach uses optimal learning techniques that rapidly cultivate new movement memory; it brings muscles into balance with each other and develops both strength and the ability to relax.

    New muscle/movement-memory undoes and replaces old, dysfunctional patterns of movement memory put in place by injury or habitual detrimental movements and positionings, such as sitting relatively immobile, at a high state of concentration, for long periods of time. You cultivate control directly through patterned movements that teach you to connect muscles and movements with each other and to regulate effort. Feelable improvements typically result from each practice session and endure through the activities of ordinary living.

TO PREVIEW THE LESSON INTRODUCTIONS, CLICK THE IMAGE:

Side-effects of Abdominal Strengthening Exercises

Abdominal exercises strengthen control of surface abdominal muscles; they don't improve control of the psoas muscles, which are deep.

Exercises to flatten the belly (e.g., crunches) cause the abdominal muscles to overpower psoas and spinal extensor muscles that are already too tight. Co-contraction results, in which abdominal organs are sandwiched between tight muscles, front and back, which impairs their functioning (e.g., digestive/eliminative problems).

High abdominal muscle tone from abdominal crunches drags the front of the ribs down and causes a head-forward position.

From the foregoing description, it's obvious that "inconvenient" consequences result from abdominal exercises -- as popular as those exercises are for the appearance of fitness. It's better to simply to balance the interaction of the psoas and abdominal muscles.

Direct control develops when you repeat a movement deliberately, develops faster when you repeat it slowly, develops still faster when you coordinate it with other movements, and develops still faster when you deliberately intend to remember the sensation of the movement. You exercise control "by feel" and improve with practice. That's how you gain control of your psoas muscles.

Right now, you have partial (if any) control of your psoas muscles and they are "stuck" tight. "Control" means that you are muscularly responsive (through movement) and able to tense, relax, and move with your psoas muscles helping and being helped in a well-coordinated way, with minimal effort and total comfort.

A Way Around the Limitations of Stretching


PREVIEW OF SELF-RELIEF INSTRUCTION

Abdominal Strengthening and The Bulging Belly

People with psoas muscle pain often have a bulging belly. People may think that a bulging belly indicates weak abdominal muscles, and that's understandable, but look deeper.

Tight psoas muscles, whose tendons pass over the inside of the groin and attach at the inner thigh, push the pubic bone back; the upper pelvis tilts forward; the belly hangs forward and appears to bulge.

The way people commonly think about these two conditions -- bulging belly and tight psoas muscles -- gives rise to the way people treat psoas muscle pain.

  • Bulging belly: abdominal strengthening exercises
  • Tight psoas muscles: stretching exercises

Well, you can't correct either condition by strengthening and/or stretching. Here's why: Neither abdominal strengthening nor psoas stretching exercises efficiently changes muscle/movement memory, so you keep returning to that posture and shape. You need to change muscle-movement memory to get a lasting change.

How This Approach -- Somatic Education -- is Different

The approach to freeing tight psoas muscles explained here differs from, and is more direct than, common approaches to psoas muscle pain (usually, strengthening and stretching exercises, massage and/or attempts at muscular relaxation). Here, we address the root of the problem -- muscle/movement memory -- which explains why this approach to psoas muscle pain (and its related condition, iliopsoas bursitis) works so easily and so comfortably: it's easier to change movement memory than to force muscles controlled by movement memory to relax or move differently. The results that come from retraining muscle/movement memory are dramatic, generally beyond people's expectations, stable, and durable -- by way of comparison to the results of stretching or manual manipulations, with which you are presumably familiar.

It's the difference between "giving someone a fish" and "teaching someone to fish". One approach leaves a person dependent; the other gives them self-sufficiency.

With the approach shown here, results come so quickly and are so satisfying, the improvements so far-reaching, that it's easy to get motivated to do more.

This article provides a mental understanding. Health care professionals, especially, appreciate a technical understanding. So, I'm laying it all out for you. If you want a short-cut, you can get quick answers to nine central questions, immediately below.

However, direct experience makes mental understanding truly convincing.

Tight Psoas Muscles: 9 Central Questions Answered

PREVIEW LESSON INTRODUCTIONS and PURCHASE


CLICK HERE

Correcting the Bulging Belly by Changing Muscle/Movement-Memory

A bulging belly may (and often does) indicate tight psoas muscles, not weak abdominal muscles, particularly if you have a deep fold at your groin that doesn't disappear when you stand tall.

When the psoas muscles function properly, they decrease the low-back curve and allow the spine and abdomen to fall back. The bulging belly settles back in, giving the appearance of strong abdominal muscles and the feel of a strong (i.e., effortlessly supportive) core. But it's not strength that's being felt, but the feeling of a different trunk shape.

THE REST OF THIS ARTICLE IS MORE MORE TECHNICAL. IF YOU FIND IT TOO TECHNICAL, DON'T WORRY; CLICK THE FOLLOWING LINK:

Tight Psoas Muscles: 9 Central Questions Answered

To purchase, Free Your Psoas: all most people need, click the emblem at right.


CLICK HERE

TIGHT HAMSTRINGS

Tight psoas muscles pull the leg forward; hamstring muscles pull the leg back. Tight psoas muscles require hamstring muscles to overpower the forward pull of tight psoas muscles; it makes than have to overtighten. It works the other way, too: Tight hamstrings REQUIRE psoas muscles to tighten up to overpower them.

If your hamstrings are tight, please read this entry and see the hamstring somatic exercise video, there.

There's another reason why retraining postural reflexes/muscle-movement memory is more effective than strengthening and stretching. Stretching exercises, such as the "lunge" shown above, generally affect the more superficial muscles adjacent to the psoas muscles more than they do the psoas muscles, themselves. Those adjacent muscles (gluteus minimus) are easier to feel and to control than are the deeper psoas muscles, so those are the muscles stretching exercises generally reach, leaving the psoas muscles essentially unaffected. Anyway, control of tension and length in movement is the real issue, not degree of stretch, and if you can't control it, you can't change it.

The Relationship of Psoas, Abdominal Muscles and Back Pain

The psoas muscles and the abdominal muscles are opposing pairs (agonist and antagonist) as well as synergists (mutual helpers). Closely coordinated interaction between the two is healthy; poor coordination between the two creates problems.

The psoas muscles lie behind the abdominal contents, from the level of your diaphragm to your inner thighs at the groin (lesser trochanters); the abdominal muscles lie in front of the abdominal contents, from the lower borders of the ribs (with the rectus muscles as high as the nipples) to the pubic bone.

Here's how they interact.

AS ANTAGONISTS
(opposition between muscles):
  • When standing, contracted iliopsoas muscles (whose tendons ride over the pubic crests) push the pubic bone backward; the abdominal muscles pull the pubic bone forward. Co-contraction creates abdominal compression and disturbed function of the internal organs.
  • The psoas minor muscles pull the lumbar spine forward; the abdominal muscles push the lumbar spine back (via pressure on abdominal contents and change of pelvic tilt).

    Deep Pelvic/Ilio-sacral
    (S-I) Joint Pain

    If you have deep pelvic pain, pain across the lower back, burning bladder or groin (and no infection), or numbness down your thigh, please also read this entry.

AS SYNERGISTS
(cooperation among muscles):
  • In walking, the iliopsoas muscles of one side move the leg forward, and the abdominals bring the same-side hip and pubis forward. (discussed on more detail, below)
  • The iliacus muscles, which feed into the quadratus lumborum muscles, which feed into the intercostal (rib) muscles. All these muscles move the trunk in the twisting/untwisting movements of walking.
  • The psoas major muscles pull the fronts of attached vertebrae (at the level of the diaphragm), down and back; the abdominals push the same area back.
  • One-sided contraction of the psoas muscles twists the torso and causes a sidebend toward the side of contraction (as if ducking to one side and looking over ones raised shoulder) -- it also retracts (pulls in) the leg toward the waist from within; abdominal muscles assist the shortening movement by pulling the hip (iliac crest) into the waist (part of being short-waisted).

Now, if this all sounds complicated, well, it is. Fortunately, we don't need to keep all this in mind when doing a self-relief program. In a self-relief program such as this one, you just follow step-by-step instructions done slowly and repeatedly enough that you actually remember it, by feel. If you're dubious about your ability to do the lessons correctly, as some people are, be assured: You can get coaching. You can even come to see me.

Tight Psoas Muscles: 9 Central Questions Answered

PREVIEW LESSON INTRODUCTIONS and PURCHASE


CLICK HERE

Signs of Psoas Health

When the psoas and the abdominal muscles counterbalance each other, the psoas muscles contract and relax, shorten and lengthen appropriately in movement. The lumbar curve, rather than increasing, decreases; the back flattens and the abdominal contents move back into the abdominal cavity, where they are supported instead of hanging forward.

Dr. Ida P. Rolf described the role of the psoas in walking:

Let us be clear about this: the legs do not originate movement in the walk of a balanced body; the legs support and follow. Movement is initiated in the trunk and transmitted to the legs through the medium of the psoas.
(Rolf, 1977: Rolfing, the Integration of Human Structures, pg. 118).

(A TECHNICAL DISCUSSION OF BALANCED WALKING)

    What this means is that movement forward starts in the trunk (as a slight swaying forward). That slight swaying forward starts as a shifting of weight onto one foot and a subtle lifting of the toes and/or front of that foot, which decreases support, so that you slightly sway forward. When you have swayed far enough forward, you spontaneously bring your other leg forward to catch your forward weight (knee movement forward initiated by the psoas). Your leg comes forward, your foot comes down and supports your weight as it comes forward; then your other leg comes forward. The movement is: foot, trunk, hip, knee, foot, in a cycle.

    A casual interpretation of this description might be that the psoas initiates hip flexion by bringing the thigh forward. It's not quite as simple as that.

    By its location, the psoas is also a rotator of the thigh. It passes down and forward from the lumbar spine, over the pubic crest, before its tendon passes posteriorly (back) to its insertion at the lesser trochanter of the thigh. Shortening of the psoas pulls upon that tendon, which pulls the medial aspect of the thigh forward, inducing rotation, knee outward.

    In healthy functioning, two actions regulate that tendency to knee-outward turning: (1) the same side of the pelvis rotates forward by action involving the iliacus muscle, the internal oblique (which is functionally continuous with the iliacus by its common insertion at the iliac crest) and the external oblique of the other side and (2) the gluteus minimus, which passes backward from below the iliac crest to the greater trochanter, assists the psoas in bringing the thigh forward, while aligning thigh rotation so the leg (optimally) swings directly in the line of travel (not commonly seen, but then idiosyncratic muscular tensions and inefficient movement are more common than well-organized movement -- so common that they are taken as "normal"). The glutei minimi (where your front pants pockets are) are internal rotators, as well as flexors, of the thigh at the hip joint. They function synergistically with the psoas.

    This synergy causes forward movement of the thigh, aided by the forward movement of the same side of the pelvis. The movement functionally originates from the somatic center, through which the psoas passes on its way to the lumbar spine. Thus, Dr. Rolf's observation of the role of the psoas in initiating walking is explained.

    Interestingly, the abdominals aid walking by assisting the pelvic rotational movement described, by means of their attachments along the anterior (front) border of the pelvis. Thus, the interplay of psoas and abdominals is explained.

    A final interesting note brings the center (psoas) into relation with the periphery (feet). In healthy, well-integrated walking, the feet assist the psoas and hip joint flexors in bringing the thigh forward, causing "spring in the step."


    Here's the description: When the thigh is farthest back, in walking, the ankle is most dorsi-flexed. That means that the calf muscles and hip flexors are at their fullest stretch and primed by stretch receptors, in those muscles, to contract. This is what happens in well-integrated walking: assisted by the stretch reflex, the plantar flexors of the feet put spring in the step, which assists the flexors of the hip joints in bringing the thigh forward.

    Here's what makes it particularly interesting: when the plantar flexors fail to respond in a lively fashion, ones feet lack spring and the burden of bringing the thigh forward falls heavily upon the psoas and other hip joint flexors, which become conditioned to maintain a heightened state of tension and readiness to contract, and there we are: tight psoas and back pain. Note that ineffective dorsi-flexors of the feet (lifters of the fronts of the feet) lead to tripping over ones feet, when walking; to avoid tripping over ones own feet, the hip flexors must compensate by lifting the knee higher, leading to a similar problem. The answer to this problem, by the way, is not usually to strengthen the muscles of the shin (dorsiflexors), but to free the muscles of the calf, which are usually too tight.

    Thus, it appears that the responsibility for problems with the psoas falls (in part, if not largely) upon the feet. No resolution of psoas problems can be expected without proper functioning of the lower legs and feet.

(TECHNICAL DISCUSSION ENDS)


The psoas, iliacus, abdominals, spinal extensors, hip joint flexors and extensors, and flexors of the ankles/feet all cooperate in walking movements. Poor coordination (generally through over-contraction or non-responsiveness of one or more of these "players") leads to dysfunction of the others and often to back pain. To strengthen the abdominal muscles is often misguided effort to correct problems that lie elsewhere - which explains why, even though abdominal strengthening exercises are so popular, back pain is still so common.

Because psoas problems are really movement and control problems (dysfunctions of "muscle memory/movement habit" problems), somatic education provides a better solution for the problem of psoas pain or back pain than abdominal strengthening exercises, which miss the other major players, and better than stretching or simple relaxation exercises, which cannot improve control and coordination.

SUMMARY

When one side of the psoas is tight and short, the same side of the pelvis is restricted in its ability to move forward (and to permit its other side to move backward). Walking (gait) is more free on one side than the other, causing an altered walking pattern.

Tight psoas muscles contribute to fatigue, sitting.

Co-contracted glutei minimi frequently accompany and mask contracted psoas muscles. The co-contraction drags the front of the pelvis down. The lumbar spine curves forward, causing a back-arched, big-belly posture tending toward a forward-bending posture, which the extensors of the lumbar spine counter to keep the person upright.

Tight spinal extensors suffer muscle fatigue and soreness, felt in the spine region above (not at) the waistline.

  • Click for Tight Psoas? Sit too much?
  • The basic principle and primary technique of clinical somatic education, click It's for Your Comfort.
  • Preview  Free Your Psoas.
  • Considering coming for one-on-one sessions? Click At-Location Service.
    Read a description of a clinical somatic education session. Click here.
  • See somatics in action. Click here.

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  • As explained before, to tighten the abdominal muscles as a solution for this stressful situation is a misguided effort, as is stretching. What you need is to free and coordinate your psoas and hip joint flexors (front of hip joint) and the other, central movers and stabilizers of the body for a healthy core (not possible from mere "core strengthening" or "core workouts", which actually affect only surface muscles).

    Take Action -- What to Do Next

  • Click Free Your Psoas for a video overview of the self-relief program.
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