Iliopsoas Muscle Problems Can Mimic Low Back Pain, Hip Pain, And Leg Pain
The psoas (pronounced so-as) syndrome is caused by a problem with the iliopsoas which is comprised of two muscles, the iliacus muscle and the psoas muscle which are joined by the psoas tendon.
Psoas syndrome is a problem with the psaos muscle relating to an imbalance of muscle function. Problems of the muscle occur from strain, spasms, contracture, which is a prolonged spasm and tendonitis, which is inflammation of the tendon that attaches the muscle to bone.
The psoas muscle is comprised of both the psoas major and minor, but as the psoas minor is often absent in individuals, this will focus mainly on the psoas major. A better understanding of the role of the psoas muscle and its impact on low back and pelvic stability and may improve suffering from lower back pain.
The iliopsoas is a major flexor of the trunk at the pelvis and is considered the most powerful flexor of the thigh.
There are times when back strain symptoms do not improve in a reasonably short time regardless of treatment and the condition gradually gets worse. The pain seems to spread to surrounding areas in the front of the hip, leg and even mid or upper back areas. It is possible that there is a problem with an iliopsoas muscle spasm or damage leading to a psoas syndrome. It can accompany other conditions affecting the low back and be the main cause of chronic or long standing low back pain.
Pain from the psoas muscle will often present as lower back pain and referral areas include the front of the thigh. The psoas muscle can be considered as a pain source in athletes, office workers or anyone who spends much of their day sitting. Psoas syndrome is thought to be prevalent in certain sports including soccer, dance, and hockey.
When the iliopsoas is overworked, or too weak to handle the stress imposed on it, it can go into spasm or tears in the muscle may leave scar tissue causing pain and weakness. This can cause many of the surrounding muscles to compensate and become tight and painful as well. These muscles can pull the spine out of alignment and may lead to disc herniation, usually at the L4-L5 level.
The iliopsoas is a muscle not understood by most people and many doctors and it is difficult for most to describe the pain location any more specifically than the low back. The classic symptoms of an iliopsoas muscle spasm or psoas syndrome are lower back pain and the pain may spread to the rest of the back, lower part of the upper back and even into the gluteal area, the groin and side hip regions. There may be initial pain upon rising from a seated position. Standing may be painful, but walking and laying down are usually not affected except in more severe or chronic cases. Side sleeping in the fetal position may cause shortening of the muscle and is not recommended. Relief of psoas syndrome pain is often experienced by sitting down, although, extending the leg as in driving can make the pain worse. The pain may be worse from long periods of standing and from twisting at the waist without moving the feet.
Strain or spasm of the psoas which leads to dysfunction is the most common reason for a psoas syndrome.
A position which shortens the muscle for long periods can cause spasm. This can happen if you sleep in the fetal position, sit for long periods or when working in a kneeling or crouching position. While a psoas strain (tear) can happen when the muscle is forcefully contracted. This can happen when you run uphill, do a straight leg sit-up or kicking like playing soccer or martial arts.
The pain from a psoas strain can start as a sharp groin pain. This pain may worsen when the hip is flexed or by resisting hip flexion (knee bent with pressure against bringing the leg toward the body). Someone with a psoas syndrome may have what is called an antalgic posture. The typical posture or stance is having pressure on the good side with flexion of the involved side, bent over and foot of the involved side pointed out.
Seeing a health care professional is recommended because there are causes of psoas syndrome not related to muscle strain or spasm, and some can be serious or even life threatening. These can be an aneurysm of the abdominal aorta, an abscess in the abdomen, inguinal hernia, cancer of the sigmoid colon or prostate, diverticulitis, appendicitis, Crohn’s disease, ureteral calculi, salpingitis, and prostatitis.
Treatment of psoas syndrome can be difficult, but usually involves rest, moist heat – shower or tub, and gentle stretching of the muscle to bring it out of spasm. If upright standing is very painful, a degree of mobility can be achieved temporarily by trying to move around on the hands and knees. If there is scar tissue involved, it needs to be addressed and direct access to this muscle is difficult due to the location. The best method of resolving chronic problems with the psoas is using active release technique to improve scar tissue function and strength, although this can be a somewhat painful process.
To stretch the right psoas muscle:
1. Lying on your back with a small pillow or cushion under your head, bring your left leg up and clasp it at the knee. Keep your neck relaxed and scapulas anchored.
2. Breathe in.
3. While breathing out, slowly stretch your right leg out along the floor. It is more important to keep the pelvis stable than to totally straighten the leg.
4. Breathe in.
5. While breathing out, bring your right leg back to the start position.
A technique to release the muscle can be done in a similar position. In the case of the right psoas syndrome, the left and right leg should be bent with feet on the ground and this relaxes the posas muscles. You can find tender areas in the muscle by pressing in with your fingers. When a tender area is found, press in (this will be painful) and hold while slowly letting the right leg out as in the second picture, keeping the left leg bent. This should be done slowly and continued until the leg is flat on the ground while maintaining pressure on the muscle. This can be repeated a few times and in different areas. It is suggested that a health care professional do this and I recommend contacting a certified active release practitioner in your area.
This stretch gently lengthens the Psoas Muscle to its required length without danger of overstretching, stabilizes the pelvis and helps to avoid low back pain and warms up the psoas in preparation for use.
If the iliopsoas is in acute spasm, you should do nothing more than this next exercise below until the pain begins to dissipate. Do not push yourself and try to relax into the posture. This shows stretching the left psoas muscle.
1. Put your left foot on a stool or a stable surface about the same height in a modified forward stance. Hold for a count of 10 to start and gradually increase to tolerance.
2. If you are able to do this position without difficulty, slowly bring your arms and hands up towards the ceiling to increase the stretch on your lower back. Hold for an additional count of 10 and gradually increase to tolerance.
Those who have psoas syndrome are likely to have difficulty getting up from a deep-seated chair and are unable to sit-ups. Truck drivers are particularly vulnerable to backache from a psoas syndrome because of the shortened position of the muscle while driving and should routinely perform stretches at every stop on the road. Set the back of the seat to recline some to prevent too much hip flexion. Back pain caused by the psoas muscle is also common during prgnancy. Doing sit-ups can cause problems with the psoas and it is recommended to do slow sit-backs instead.
After treatment, strengthening is important to help with prevention of psoas syndrome.
The Slow Sit-Back exercise to improve strength and coordination of the abdominal and iliopsoas muscles as the spine “rolls down”. This exercise requires a less demanding lengthening contraction, rather than the shortening contraction of a sit-up. Three cycles should be performed daily.
A. Pushing the body up with the arms from lying back to a seated position.
B. Beginning of the slow sit-back with the lower back flexed.
C. Rolling the back down so each spinal segment reaches the floor in succession.
D. Completion of slow sit-back exercise.
E. Period of full relaxation with abdominal breathing
For sleeping, you can place a pillow or body pillow under the knees when lying on the back. This produces some hip flexion and lessens tension on the iliopsoas muscles to help improve sleep. Again, avoid sleeping in the side in a tight fetal position that shortens the muscle. A sagging mattress can shorten the psoas muscle and cause back pain and morning stiffness. You can place your mattress on the floor or sleep on the floor for a night to see if this helps. If it does, you can get a new mattress or place a half inch plywood under the mattress to help.