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Instep Dance Magazine Articles

Reprints of monthly column as first appearing in Instep Dance Magazine.

December 1998

The Psoas - Hidden Influence on Posture

By Rick Allen, DC

"Better health leads to better dancing."

Over the last three months we have reviewed how the feet influence overall posture and how you may benefit from special support of your feet. This month let's move up to the pelvis and low back. This is an area of the common complaint, "Oh, my back hurts." While you may feel the pain in your back, the problem often arises in the front of the spine, where the large psoas (pronounced "so-as" - the "p" is silent) muscle lies hidden underneath your abdomen. Let's first examine the anatomy and function of the psoas muscle. Then let's apply our knowledge to finding solutions for the problem of low back pain caused by malfunction of the psoas.

[ Diagram of Psoas ]

Anatomy

As shown in the adjacent figure, the psoas major is a long, thick muscle that lies along the edge of the lumbar region of the spine. Psoas is a Greek word meaning the muscle of the loin. Butchers refer to the psoas muscle in animals as the tenderloin. It runs from the L1 to L5 vertebrae and associated T12 to L5 intervertebral discs down across the pelvis. It is joined by fibers of the iliacus muscle that starts from the inside surface of the pelvis. They blend together, forming the iliopsoas muscle, and insert on the thigh at the lesser trochanter of the femur. Overall, the iliopsoas, or just "psoas" for short, connects the low back with the upper leg.

Function

The psoas has two primary functions:
  • When the leg is free to move, as when walking, it is a strong flexor of the thigh at the hip joint.
  • When the leg is planted firmly, as when standing or sitting still, it bends the lower spine forward. This action is used to maintain the balance of the trunk when sitting.

Malfunction

When you sit the psoas is in a shortened position. When you sit a great deal, as many of us do, it tends to stay short, even when you stand up! The shortened psoas then pulls the lower spine forward. The paraspinal muscles of the low back then counter this pull by tightening, much as support lines on a radio tower, tent pole or mast of a sailing ship. This tug of war pulls the spine down, compressing the facet joints and intervertebral discs of the lumbar spine. The facets become irritated, causing a nagging, aching low back. The discs degenerate over time, becoming thinner and less flexible. The degeneration makes them more susceptible to bulging or tearing, especially with twisting and bending. The disc may even herniate and press on the sciatic nerve, causing unbearable pain down one or both of the legs.

Presentation

[ Diagram of Thomas Test ]

Patients typically come into my office complaining of an aching low back. Occasionally, when the psoas is extra tight on one side, they will be twisted. They may have sciatic pain down one leg, but the predominant pain is in the low back, just above the pelvis. A straight leg raise (SLR) test will typically not create more pain as the hip is flexed to nearly a right angle, with stiffness of the hamstrings and the low back muscles being the limiting factor rather than pain. (The SLR test in a patient with a herniated disc is usually very painful with just six to ten inches of elevation, and is made worse with bending the foot up (Braggart's Test).) Thomas' test (see figure) is often positive for a short psoas. Overall, they will have reduced mobility of the low back.

Professional Treatment

Once the psoas has become chronically shortened to the point where your back aches, my experience is that you require professional chiropractic help. Unfortunately, many chiropractors concentrate only on the back and ignore treating the psoas on the front. The best treatment I have found is an active myofascial and muscle release that I learned in postgraduate massage therapy classes. It is performed from the front, pressing into the abdomen. Considerable skill and care is required to release the tight psoas and the associated fascial covering while not injuring the abdominal organs, so I recommend you seek the help of an experienced professional. Don't just ask a friend to push into your belly!

Most cases respond within four to eight treatments, although I have had some cases where we have had to work for about two months to achieve the desired increase in flexibility and relief of low back pain. In such cases there is often a hindrance to progress, such as counterproductive sitting in a poorly designed chair or standing with poor posture. Sometimes more serious conditions, such as disease of the intervertebral and sacroiliac joints, may cause protective spasm of the psoas.

Results - Two Case Studies

The best way to explain the difference release of the psoas muscle can make is to give you two case studies. Let two of my grateful patients explain in their own words.

Michelle Uttke referred her dance student, Chad Bartmess, to me for help with chronic low back pain that hindered his competitive dancing. I focussed treatment on the psoas, performing myofascial release and stretching. Summarizing his experience, Chad told me, "After years of pain and discomfort from low back and neck injuries, continuing therapy and repeated attempts to get me to undergo surgery, I gave up! No sign of relief in sight until I heard Dr. Rick talk on posture at Michelle Uttke's dance studio. Michelle recommended that I see Dr. Rick for help as she had done. After two months of treatments, I feel great. I can move, turn, bend and dance like I have not been able to do for years! Thanks, Dr. Rick."

Judy Rush is an office worker in Portland. Approximately three years ago she developed low back pain following a cross-country airline flight. She was examined and treated by several medical doctors, who ruled out serious pathology and sent her to physical therapy for exercises. She had several sets of x-rays and a magnetic resonance image (MRI) of the low back that did not reveal the problem. Nothing seemed to help. The pain in her low back persisted for three years until I performed myofascial release and stretching on her psoas muscles. To help her long-term, I had her employer's ergonomic specialist evaluate and correct her desk and chair to fit her properly.

Judy explains just what a difference treatment has made: "Since Dr. Rick has been treating my psoas muscles, I have started to enjoy life again. I have suffered the last three years from chronic low back pain. Through weekly massage and chiropractic adjustments, in additional to stretching at work and home to keep the psoas muscles stretched out, my chronic low back pain is almost non-existent. It's amazing how these muscles affected my quality of life for the worse. I feel better now than I have for the last three years!!!"

Of course, each case is unique, so I suggest you seek knowledgeable professional care locally. Take care of your psoas, improve you posture and improve your life and, especially, your dancing!

Next article: Let's review some stretches that will help keep your psoas muscle functioning properly.

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