The Psoas Muscle: Is This The Link To Chronic Lower Back Pain
The psoas is one of the most important yet neglected muscles in the body. It is a muscle that crosses two joints the sacroiliac and the illiofemoral. It also attaches to the anterior and lateral border of the intervertebral disc and on occasion can reach the posterior lateral border of the disc.
We have identified it as the major muscle weakness in the chronic back patient. When the psoas is in a hypertonic state it will cause difficulty in walking, prolonged standing, sitting to standing and rolling over in bed.
Several years ago I invested in a very expensive piece of equipment to benefit my patients with spinal stenosis and disc herniations. During my examination of a patient pool that had chronic back pain and had all seen several Doctors incorporating various therapies, the common pattern I witnessed with all of these patients was bilateral psoas weakness.
Why is this muscle that spreads from T12- L5 , then crosses the sacroiliac joint and attaches to the lesser trochanter of the femur ignored? We focus our attention on other muscles such as the piriformis or the gluteus medius and ignore what is in my opinion the most important muscle for chronic lower back pain, the psoas.
The psoas muscle allows you to bend your hips and legs towards your chest and bend forward to pick something up from the floor. It stabilizes the trunk and spine during movement and sitting.
EVALUATION OF THE PSOAS
The Thomas Test is the Orthopedic Test that evaluates hypertonicity of the Psoas muscle. It is performed while lying on the back, bring one knee up to the chest and let the other leg just rest flat on the table. If the leg lifts up at the knee when the opposite knee is flexed to the chest is a positive Thomas test.
Muscle testing to evaluate the strength of the Psoas is imperative in a comprehensive analysis of the Psoas. It is performed with the patient in the supine position, the leg abducted 30 degrees, foot externally rotated and the leg elevated at the hip approximately 90 degrees.
Palpation is also essential with proper evaluation of the psoas. It needs to be done along the illiacus muscle as well as the lesser trochanter. There will be tenderness noted as well as trigger points throughout the muscle.
TREATMENT OF THE PSOAS
Treatment consists of stretching and strengthening exercises. Although the psoas is a difficult muscle to stretch because it has so many actions on the spine and the hip it still must be performed on a daily basis.
We also incorporate a myofasical release technique utilizing cold laser, rapid release therapy and active stretching of the psoas muscle. This advanced neurological reset will improve motor strength immediately.
Tips To Maintain Psoas Health
Avoid sitting for prolonged periods: Sit with your hips level or slightly higher than your knees.
Consider lumbar support for your car
Stretch the psoas on a regular basis
Do Isometric exercises to maintain strength
Get Professional Massage or myofasical release
If you are experiencing chronic lower back or hip pain come to our office and get a thorough evaluation of the psoas muscle and determine if this has been the cause of that chronic issue.
Call us at 805 482-0723 for your evaluation
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