October 14, 2020 3 min read

An office worker presented to the clinic complaining of low back pain, and health practitioners conducted a series of evaluations of the structures on the lower back area, which all turned out to be negative. Interestingly, after further investigation was performed, the cause was found to be remote from the lower back and involved mainly the hip flexor muscle, particularly the psoas. It seemed very unlikely as it's far from the complained area, but it's possible.

The psoas is considered deep core muscles and, together with the iliacus, are the main flexors of the hip, the muscles that are activated when lifting your thigh towards your trunk or when moving your trunk forward towards your hip. Unlike the quadriceps, hamstrings, and glutes which are commonly known, the psoas muscle is less commonly heard of but does serve important functions. Although this muscle plays a vital role in different lower limb movements, it acts mainly to stabilize the lower back region in various activities, such as during walking or bending forward. With this function in core stability, it is prone to cause low back pain.

THE TIGHT PSOAS AS THE CAUSE OF LOW BACK PAIN.The hip flexors become tight in people who engage in activities that require sitting for extended periods, like those who live a more sedentary lifestyle and spend a lot of time sitting or those who work at an office job for hours. When the psoas muscle becomes tight, it pulls the small of the back forward, causing excessive hollowing or curving of the lower back region — termed as lordosis. This postural orientation stresses the lower back structures, causing hip and low back pain, as well as limitations in hip and trunk movements.

THE PSOAS STRETCH. Several psoas stretches have been recommended to release tightness in the psoas muscle and relieve tension in the lower back. The exercises mainly consist of bringing the affected hip into extension, such as in lunging. The lunge stretch involved the patient stepping forward with the foot of the unaffected side while keeping the opposite foot (of the affected hip) flat on the ground. Keeping the body straight and erect, the patient is instructed to move the body forward by advancing the knee forward but not going beyond the toes until feeling a stretch in the low back. The position is held for 30 seconds before returning to the starting position. The procedure is repeated several times for 3 to 5 sets.

THE PSOAS RELEASE WITH RECOVAPRO

Using the Recovapro massage gun before flexibility exercises help to loosen the tight psoas so that stretching of the muscle can be more easily performed.

  • With the bullet head attachment, the gun is placed against the origin of the psoas, few inches (or about four fingerbreadths) to the sides of the navel.
  • With a pre-selected intensity, the gun is then moved up and down the spot while progressively applying a deeper pressure for trigger pointing session.
  • Simultaneously perform straight leg raising and feel that the right muscle is appropriately targeted so that release of tension is effectively achieved.
  • Move the gun in a circular and up-down pattern and try to look for tender spots before applying an active‑release technique.
  • While maintaining gun contact to the area, perform the active release by moving the hip into alternate flexion and extension with the knee bent. After a few repetitions, perform alternate hip internal and external rotation with the leg straight, followed by abduction and adduction with the knee bent and foot flat on the floor. Abduction and adduction are accomplished by moving the knee up pointing to the ceiling and down to the side.
  • Alternately perform the movements in active release until tension release is felt.
  • End the session with gentle stretching of the psoas muscle, as described above.