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Psoas Syndrome - by Dr. Diderik Finne

Written by Sylvana Miller on 27 March 2013


The iliopsoas muscle is a major body mover but seldom considered as a source of pain. Chronic lower back pain involving the hips, legs, or thoracic regions can often be traced to an iliopsoas muscle spasm.

The iliopsoas is comprised of two muscles, the iliacus and the psoas, joined laterally by the psoas tendon. The iliopsoas originates anterior to the transverse processes of the T12 to L5 vertebrae and inserts into the lesser trochanter of the femur (thigh bone). Both muscles are innervated by the 1st through 3rd lumbar nerve roots. As a combined muscle, the iliopsoas is a major flexor of the trunk at the pelvis. In fact, it is considered the most powerful flexor of the thigh.

When the iliopsoas is overworked, or too weak to handle the stress imposed on it, it can go into spasm, causing many of the regional muscles to compensate and become hypertonic and painful as well. These muscles will draw the spine out of alignment, causing disc herniation, typically at L4-L5, and irritation of the sciatic nerve.

The reason back surgery is often unsuccessful is that it does not address the real problem. Back massage is also seldom effective at treating psoas syndrome, because the muscle traverses the body internally and is only accessible from a very small area on the surface, the "femoral triangle," where it inserts into the lesser trochanter of the femur.

The classic symptoms of an iliopsoas muscle spasm are diffuse, achy lower back pain of a few days onset. The pain seems to spread to the rest of the low back, lower thoracic and even into the gluteal and lateral hip regions. A keynote is initial pain upon rising from a seated position. Standing, walking and laying down are usually not affected except in severe cases. Relief of pain is often experienced by sitting down. Extending the leg, however, as in driving, can make the pain worse.

The pain is worse from continued standing and from twisting at the waist without moving the feet.

Physical treatment of psoas syndrome involves rest, warmth, and gentle stretching of the muscle in order to bring it out of spasm. Long term, the iliopsoas must be strengthened to avoid further injury.

Even more important, the question must be answered, 'What caused the iliopsoas to be overstressed in the first place?' Just as the iliopsoas is hidden deep in the body, the source of the stress brought to bear on it is also hidden in the unconscious. Most people who get psoas syndrome are not even aware of what is making them stressed.

In my experience, homeopathic treatment is the most effective for dealing with the underlying issues and should be used in conjunction with physical therapy.

The following series of exercises are designed first to stretch, then strengthen the iliopsoas.

Some of the poses are demonstrated in animation at the following website:

Begin the sequence with a gentle stretch, a modified Pavanamuktasana (Wind Removing Pose):
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. Repeat twice each side.

This stretch accomplishes the following:
1. Gently lengthens the Psoas to its required length without danger of overstretching.
2. Stabilizes the pelvis and helps to avoid low back pain.
3. Limbers up the Psoas in preparation for strengthening exercises. If the iliopsoas is in acute spasm, you should do nothing more than this exercise until the pain begins to dissipate. When you are ready to proceed, be conservative and do not push yourself, but try to relax into the postures.

1. Put your left foot on a stool, so you are in a modified forward stance. Interlace your fingers and raise your hands over your
head, trying to keep the arms as close as possible to your ears. Hold for a count of 10.
2. If you are able to do this position without difficulty, slowly bring your hands backwards to increase the stretch on your lower back.
Hold for an additional count of 10.
3. If you are able to hold this position, slowly move your hands laterally to the left, so you are bending both backwards and laterally at the waist. This stretch is specific for the iliopsoas. Hold for a count of 20, or as long as you can.
4. Repeat on the opposite side. To strengthen the iliopsoas, isometric contraction is used to isolate and awaken the dormant muscle. This technique requires an understanding of the action of the various muscles. For example, the psoas acts to flex the hip, i.e. either to bend the trunk forward or draw the knee up. These are the motions emphasized in the following postures.

1) Trikonasana (triangle pose)

1. Stand with your feet apart and your arms horizontal, as in the illustration below.
2. Turn the toe of the left foot towards the left and inhale.
3. Exhale, bend your left arm, bend your left knee and keeping your spine straight-bend your upper body laterally to the left until you
can rest your forearm on your left thigh (note: the illustration does not show the bent arm on the thigh).
4. Use your upper body to apply gentle downward pressure on the left leg. This action contracts the left iliopsoas. Hold the posture for a count of 10 or 20.
5. Repeat twice on both sides.

2) Virabhadrasana (warrior pose) II
1. This pose is similar to the triangle, but now you turn your upper body in the direction in which you are bending. Start from the triangle pose, turn the toe of your left foot toward the left and rotate your upper body to the left. Bend your left arm 90°, bend
forward to the left until you can rest your left forearm on your left thigh. Gently press downwards for a count of 10 or 20.
2. Repeat twice on both sides.
3. If you are just starting out, you can skip the next three poses and go directly to (6).

3) Dandayamana-Bibhaktapada-Janushirasana (standing separate leg head to knee pose)
1. This pose starts the same as the preceding one, but instead of putting your forearm on your thigh, reach down and touch the ground in front of or beside your foot. Then try to straighten your knee as much as possible.
2. Squeeze your torso against your thigh. Hold for a count of 10 or 20.
3. Repeat twice on both sides.

4) Parivritta Trikonasana (triangle pose, hand on floor)
1. Same as (1), except instead of leaning your elbow against your thigh you keep your arm straight and reach for the floor. Your other arm goes straight up, so your two arms are in a vertical line. Look up at the raised hand.
2. Repeat twice on both sides

5) Parvritta Parsvokonasana (revolved side angle pose)
1. Start from triangle pose and put your right hand down on the floor in front of your left foot. Raise your left arm up straight and look up at your left hand.
2. Repeat twice on both sides.

6) Dandayamana Bibhaktapada Paschimotthanasana (standing separate leg stretching pose)

1. Start from triangle pose, bend forward at the waist with your spine straight and grab the outside of your legs or feet with your hands. If you have difficulty grabbing your legs, bend your knees initially, then straighten them gradually.
2. Hold for a count of 20.
3. Repeat twice.

7) Counter-stretch
1. Kneel on the floor with your left knee on the floor. You may want to put a cushion or pad under the knee. Lift your left foot and grab the outside of your left ankle with your left hand. Pull your left leg toward you and lean your upper body forward.
2. Hold for a count of 10 and switch to the other side.
3. Repeat twice.
4. If you have some yoga experience, you can substitute the Standing Bow Pose (below right).

Counter stretch, initial position Standing Bow Pose

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