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For those of you who have been suffering from lower back pain, you’ll want to make sure that you have addressed your hip flexor flexibility. I speak from experience that it is paramount to be limber on both your front and backside. Below is some interesting reading and some pics of some stretches.
The Psoas Syndrome The iliopsoas is mainly a hip flexor and weak lateral rotator, and shortening will result in pulling the iliac bone anterior-inferior, increasing the lumbosacral angle and increasing lumbar lordosis. (Sway back)
Through the years many doctors within chiropractic and medicine have stressed the importance of the iliopsoas in relation to low back pain and viscera of the human body.1-8,10,11 Michele1 wrote a 550 page textbook, Iliopsoas, in which he relates psoas spasm to pelvic tilt, exaggerated lumbar lordosis, compensatory dorsal kyphosis, back pain, sacroiliac dysfunction, degenerative hip arthrosis, degenerative disc disease, spondylolysis, spondylolisthesis, scoliosis, malposture, and meralgia paraesthetica, among others. He stated, "Any and all defects of the spine and the hip joint structures should be evaluated in terms of disturbance of function of the iliopsoas."
Chronic psoas shortening and weakness may occur due to sleeping in the fetal position, exercise programs emphasizing repetitive hip flexion, and sedentary life styles. Most sports and daily activity emphasize a forward orientation and repetitive psoas contraction without offsetting stretching.2 Sypher3 feels that since the psoas is close to the axis of flexion and extension of the lumbar portion of the spine, it must compensate for imbalance between anterior abdominal muscles and posterior spinal muscles to stabilize the lumbar spine. Goodheart feels that psoas weakness is more common than hypertonicity.4 Nachemson feels that a chronically contracted psoas adds to the gravitational forces on the lumbar discs.5
Bachrach et al.2 states that the patient with a psoas syndrome may present with pain at the thoracolumbar, lower lumbar or sacroiliac area, sometimes referring pain to the knee. They state that the pain is never midline and is often relieved by sitting. According to Cailliet6 the anterior thigh pain associated with an acute scoliosis due to a disc herniation is often due to a compensating iliopsoas spasm splintering the spine away from the irritation. With a unilateral psoas spasm, the patient might be flexed forward with the lumbar spine drawn downward, forward, and rotated to the opposite side. The hip might be externally rotated with the foot everted.1
Functional examination may reveal, with the patient standing and the examiner contacting both PSISs, a higher PSIS on the contracted side and a more forward movement of the PSIS on the side of involvement during lumbar flexion. Durianova7 examined 30 patients with psoas spasm and found pain in the low back, in the shoulder region, sacroiliac joint, and radiation in the L5/S1 segments. He found pain on lumbar extension, trunk rotation, and hip flexion, with spinal segmental involvement at the thoracolumbar and craniocervical junction. With the patient prone, hip extension would be decreased and painful.
Treatment of a shortened iliopsoas is to stretch the muscle. A painless contract/relax method may also be used. Examination of the iliopsoas for trigger points may be valuable. Trigger points may be located just lateral to the rectus abdominis up to the xyphoid process, at the femoral triangle or at the iliac fossa where the iliacus originates. Back pain is usually felt vertically along the extensor muscles parallel to the spine
Patients who do sit-ups from a supine to a full-flexed position are really strengthening their iliopsoas rather than their abdominal muscles. They are creating an increased lordosis during the sit-up. The crunch method of sit-ups with the spine flat on the ground and the knees flexed over a chair is the recommended method. During the first 30 degrees of hip flexion there is little or no activity in the iliopsoas. After that range there is greatly increased activity.9
References
1. Michele AA: Iliopsoas. Springfield, Ill: Charles C. Thomas, 1962.
2. Bachrach RM, Micelotta J, Winuk C: The relationship of low back pain to psoas insufficiency. J Orth Med. 13:34-40, 1991.
3. Sypher F: Pain in the back: A general theory. J Intl Coll Surg., 333:718-728, 1960.
4. Goodheart GJ: Collected Published Articles and Reprints. Montpelier, Williams County Publishing, 1969.
5. Nachemson AL: Electromyographic studies on the vertebral portion of the psoas muscle. Acta Orthopaedica Scandinavica, 37:177-190, 1966.
6. Cailliet R: Low Back Pain Syndrome. Philadelphia: FA Davis, 84: 1962.
7. Durianova J: Psoas spasm in the clinical picture of low back pain. In: Lewit K, et al., eds. Rehabilitacia, Proceedings of the IVth Congress Prague: International Federation of Manual Medicine, 1975.
8. Travell JG, Daita B: Myofascial pain syndromes: The Travell trigger-point tapes, myofascial pain syndromes of the low back and hip. Baltimore, Maryland, Williams & Wikins, Electronic Media.
9. Basmajian JV, Deluca CJ: Muscles Alive: Their Function Revealed by Electromyography. ed 5. Baltimore: Williams & Wilkins, 311: 1985.
10. Fox EA: Let us consider the importance of psoas muscle contraction. J Natl Chiro Assoc., 26(7):69-74, 1956.
11. Randeria JP: The role of the psoas muscles in low back pathology. Manuelle Medizin, 4:85-87, 1974.
12. Cyriax J: Textbook of Orthopaedic Medicine: Diagnosis of Soft Tissue Lesions. ed. 8. London: Bailliere Tindall, 1:389, 1982. Warren Hammer, M.S., D.C., D.A.B.C.O.Norwalk, Connecticut
The Psoas Syndrome The iliopsoas is mainly a hip flexor and weak lateral rotator, and shortening will result in pulling the iliac bone anterior-inferior, increasing the lumbosacral angle and increasing lumbar lordosis. (Sway back)
Through the years many doctors within chiropractic and medicine have stressed the importance of the iliopsoas in relation to low back pain and viscera of the human body.1-8,10,11 Michele1 wrote a 550 page textbook, Iliopsoas, in which he relates psoas spasm to pelvic tilt, exaggerated lumbar lordosis, compensatory dorsal kyphosis, back pain, sacroiliac dysfunction, degenerative hip arthrosis, degenerative disc disease, spondylolysis, spondylolisthesis, scoliosis, malposture, and meralgia paraesthetica, among others. He stated, "Any and all defects of the spine and the hip joint structures should be evaluated in terms of disturbance of function of the iliopsoas."
Chronic psoas shortening and weakness may occur due to sleeping in the fetal position, exercise programs emphasizing repetitive hip flexion, and sedentary life styles. Most sports and daily activity emphasize a forward orientation and repetitive psoas contraction without offsetting stretching.2 Sypher3 feels that since the psoas is close to the axis of flexion and extension of the lumbar portion of the spine, it must compensate for imbalance between anterior abdominal muscles and posterior spinal muscles to stabilize the lumbar spine. Goodheart feels that psoas weakness is more common than hypertonicity.4 Nachemson feels that a chronically contracted psoas adds to the gravitational forces on the lumbar discs.5
Bachrach et al.2 states that the patient with a psoas syndrome may present with pain at the thoracolumbar, lower lumbar or sacroiliac area, sometimes referring pain to the knee. They state that the pain is never midline and is often relieved by sitting. According to Cailliet6 the anterior thigh pain associated with an acute scoliosis due to a disc herniation is often due to a compensating iliopsoas spasm splintering the spine away from the irritation. With a unilateral psoas spasm, the patient might be flexed forward with the lumbar spine drawn downward, forward, and rotated to the opposite side. The hip might be externally rotated with the foot everted.1
Functional examination may reveal, with the patient standing and the examiner contacting both PSISs, a higher PSIS on the contracted side and a more forward movement of the PSIS on the side of involvement during lumbar flexion. Durianova7 examined 30 patients with psoas spasm and found pain in the low back, in the shoulder region, sacroiliac joint, and radiation in the L5/S1 segments. He found pain on lumbar extension, trunk rotation, and hip flexion, with spinal segmental involvement at the thoracolumbar and craniocervical junction. With the patient prone, hip extension would be decreased and painful.
Treatment of a shortened iliopsoas is to stretch the muscle. A painless contract/relax method may also be used. Examination of the iliopsoas for trigger points may be valuable. Trigger points may be located just lateral to the rectus abdominis up to the xyphoid process, at the femoral triangle or at the iliac fossa where the iliacus originates. Back pain is usually felt vertically along the extensor muscles parallel to the spine
Patients who do sit-ups from a supine to a full-flexed position are really strengthening their iliopsoas rather than their abdominal muscles. They are creating an increased lordosis during the sit-up. The crunch method of sit-ups with the spine flat on the ground and the knees flexed over a chair is the recommended method. During the first 30 degrees of hip flexion there is little or no activity in the iliopsoas. After that range there is greatly increased activity.9
References
1. Michele AA: Iliopsoas. Springfield, Ill: Charles C. Thomas, 1962.
2. Bachrach RM, Micelotta J, Winuk C: The relationship of low back pain to psoas insufficiency. J Orth Med. 13:34-40, 1991.
3. Sypher F: Pain in the back: A general theory. J Intl Coll Surg., 333:718-728, 1960.
4. Goodheart GJ: Collected Published Articles and Reprints. Montpelier, Williams County Publishing, 1969.
5. Nachemson AL: Electromyographic studies on the vertebral portion of the psoas muscle. Acta Orthopaedica Scandinavica, 37:177-190, 1966.
6. Cailliet R: Low Back Pain Syndrome. Philadelphia: FA Davis, 84: 1962.
7. Durianova J: Psoas spasm in the clinical picture of low back pain. In: Lewit K, et al., eds. Rehabilitacia, Proceedings of the IVth Congress Prague: International Federation of Manual Medicine, 1975.
8. Travell JG, Daita B: Myofascial pain syndromes: The Travell trigger-point tapes, myofascial pain syndromes of the low back and hip. Baltimore, Maryland, Williams & Wikins, Electronic Media.
9. Basmajian JV, Deluca CJ: Muscles Alive: Their Function Revealed by Electromyography. ed 5. Baltimore: Williams & Wilkins, 311: 1985.
10. Fox EA: Let us consider the importance of psoas muscle contraction. J Natl Chiro Assoc., 26(7):69-74, 1956.
11. Randeria JP: The role of the psoas muscles in low back pathology. Manuelle Medizin, 4:85-87, 1974.
12. Cyriax J: Textbook of Orthopaedic Medicine: Diagnosis of Soft Tissue Lesions. ed. 8. London: Bailliere Tindall, 1:389, 1982. Warren Hammer, M.S., D.C., D.A.B.C.O.Norwalk, Connecticut
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