Monday, February 27, 2012

Dealing with Back Pain: Psoas

Back pain can come from a variety of places.  Did you know that back pain can come from muscles in your abdomen?  One of these muscles is called the psoas (pronounced "SO-az").  It actually connects up with another muscle called the iliacus and together they are called the iliopsoas ("Ill-ee-oh-SO-az'").

The psoas can refer pain to the back, anywhere from the shoulder blades to the buttocks area.  Back pain from the psoas is usually on one side of the spine or the other, unless both the psoas muscles have trigger points, in which case, the pain will not feel like it is confined to one side or the other.  Here are some other places that the psoas can refer to:

  • groin 
  • upper thigh 
  • contributes to scoliosis 
  • abdomen 
  • genitals 
  • stiffness in hips or groin in morning when you get up 
  • rotates legs outward 
  • can't stand up straight
  • stooped posture
  • leaning to one side

(Information is from, The Trigger Point Therapy Workbook, by Clair Davies, pp. 151-155.)

The psoas attaches to the bones of the spine, starting at about the height of the last rib. It comes down and forward to attach to the top of the thigh bone.  The iliacus portion of the muscle starts at the front of the hip bones and joins the psoas to attach at the same place on the top of the thigh bone.
Primitive drawing, but it should give you an idea.  The psoas is shown in red, the iliacus in green.  

While the iliacus is a little more accessible, the psoas is buried deep in the abdomen.  But it is possible to work it.

You must use caution.  It is important to stay away from major veins and arteries, so if you feel a pulse when working your psoas, just move over a bit until you do not feel it anymore.

The psoas is actually located under your intestines.  To work it, you need to come in at an angle.  There are a couple of ways to work the psoas.

One is to lie down on your back with your knees bent.  Then let your knees drop to one side.  This will bring the hip opposite your knees up and move your intestines over a little. (Move your knees to the other side to work the other psoas.)

The main trigger points are a couple of inches away from the belly button on either side.  You can start there and look for trigger points about halfway between your belly button and your hip bone.  Bring your hands together with the fingers of each hand on the backs of the fingers of the opposite hand.  Using this tool, push down into your abdomen, searching for trigger points.
Tool for working abdominal trigger points, including the psoas.

You will probably find trigger points in other abdominal muscles, and you can just go ahead and work those while you are at it.  If you want to know for sure if you have located the psoas, you can move your leg up and down.  You should be able to feel the muscle under your fingers as you move it.  Do not work the muscle while moving, however.  Trigger points are much easier to work out when the muscle is relaxed.

A second way to work the psoas, and this is where I am saying use caution, is to use the theracane.  I personally like to do it this way, at least sometimes, because my arms seem to wear out pretty fast when I work my abdomen.  I would advise that you learn how to find the psoas first, using your hands and when you feel like you have a good handle on where it is located, then you can move up to using the theracane.

To work the right psoas, hold the theracane in front of you with the curve on the right, curve facing upward.  Grasp the top of the curve in your right hand and the outermost handle in your left hand.
Holding the theracane.

Let your knees fall to your left side.  Then push the remaining handle into the trigger point.  It is very important to proceed gently and carefully.
Using remaining handle, press into trigger point.  I am standing in this picture to provide a better view how to push in with the theracane, but you would be lying down.  

You can also work the iliacus with a lacrosse ball against the wall or a countertop.  Place the ball just below your hip bone in the front.  You can also work your quadratus lumborum, another contributor to back pain, by placing the ball just above the hip bone.  Working both of these areas will make it easier to work the psoas.

When you work the psoas muscles, be sure to work both of them every time.  And it is a good idea to work your glutes, quads and hamstrings, since they work with the psoas.  If all of the muscles are tight, and you loosen one of them, the others may reflexively tighten even more.  Picture a tug-of-war happening.  As long as both sides are pulling hard on the rope, it stays pretty much in the same place.  But, if one side lets go, the other side will end up falling down because they have still been exerting the same amount of force needed to keep that rope in the same place when the other side is pulling with all of their might.

So, if two muscles (for example) are plagued with trigger points, both muscles will be extremely tight, but that tightness will be tempered by the pull of the other muscle.  When one muscle suddenly has its trigger points released, there is no longer a pull on the other muscle and it is likely to tighten even more, resulting in more pain.  Because of this, it is a good idea to work any muscles that are antagonists (the muscles perform opposite functions) or synergists (the muscles perform a function together) at the same time that you work the original muscle.

Addendum added Oct. 23, 2012: 
I have found another way to work the psoas which I think is easier IF you are able to get down on the floor.  I have been able to get down on the floor lately, and it is easier to access the psoas using this method.

Part 1:
1) I lie face down on the floor with a lacrosse ball placed between me and the floor, about two inches out from my waist.  I take slow, deep, full (abdomen fills also) breaths and let myself fall further into the ball each time I exhale.  After two or three times, I go to step 2. 

2) I lift my head and rest on my elbows and forearms.  At the same time, I pull slightly forward.  I do the same breathing routine.  Then I go to step 3.

3) As I exhale my first deep breath, I lift my leg on the same side the ball is on and I let myself fall into the ball.  I hold my leg in that position until I have done about 3 repetitions.  The leg is lifted from the hip.

Then I repeat on the other side.

Part 2:
Then I turn over onto my back and work two or three trigger points at my bottom rib area and at the top of my pelvis (about waist level).  Using the breathing technique is helpful here also.  I do this on both sides.  Then I roll over gently and get up.

I found this excellent youtube video by tptherapy that shows how to do Part 1:  Trigger Point Weekly Workout #1   There is more on the video, but the part I am referring to is the first few minutes when he shows how to work the psoas with a therapy ball. 

For the second part of what I am describing, check here:  Remove Muscle Knots Yourself (Tennis Ball Release).  This youtube video by Paula Moore is excellent.  She also gives good advice about getting up from working your trigger points.  Don't just sit up.  She will show you how to roll over correctly when getting up.

One more thing:  This video, uploaded by posturedoc, describes a good sleeping position to help prevent back pain. I found it very helpful.  The Best Sleeping Position and How to Get Out of Bed

Hopefully, something here will help you. 


  1. The most effective psoas release that gave me relief was the Bowen therapy psoas move where they release it from a point in your crotch. I had a great massage therapist try it from the upper gut region but the Bowen technique was magical and gave instant relief.

  2. Thank you for your post, I will have to share this with my mother. She has been getting trigger point injections done in Draper, Ut and is always looking for stuff to do at home. I hope this helps relieve her pain.