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. 

More Trigger Point Tools

Having the right tool can make all the difference. For example, it would not be very effective to use a screwdriver to hammer in a nail, and it would not make much sense to use a hammer on a screw. Sometimes, we can substitute another tool and it will be somewhat effective, like using a knife as a screwdriver, but it will be faster and more efficient to use the right tool. Sometimes, we have tools that are good enough, but a more specialized tool would make it so much easier.

I have introduced you to what I would consider the mainstays of a trigger point tool kit:  the lacrosse ball and the theracane (or backnobber). Today, I will introduce you to a few other tools that can be useful, especially for specific jobs.

Interestingly enough, bouncy balls are great tools for getting to some of the harder to reach muscles. They come in different sizes so you can usually find something that will fit your particular purpose. They are not as durable as lacrosse balls, but they are relatively inexpensive and they will last for quite a while.

Two sizes of bouncy balls and lacrosse ball.  

I have a favorite size that I have been using to massage the muscles in my arm while I am recovering from my elbow injury. There are many narrow muscles in several layers that I am working and this ball is perfect for this. The ball a size up is too big and the ball a size down is too small.  

Using bouncy ball on the outer elbow area.  

Using bouncy ball on inside area of elbow and down the arm.  

 Using the opposite hand, I press and roll the ball into my muscle. I use the heel of my palm to get particularly deep, but I also use the entire palm of my hand, and my four fingers held straight and close together to form one tool. Using this method, I roll the ball around my arm, and as I find trigger points, I work them for a few strokes before continuing on.

Getting in position to use the opposite hand on outer elbow.  The ball is placed between the palm and the opposite elbow. 

I have used a bigger size (the purple and orange ball in the photo above) for my triceps, and it is perfect for that. When I first got off the pain pills and I was starting to venture out into the world again, I went grocery shopping. I took that ball with me, and whenever my elbow started to really ache, I worked my triceps with the ball, and it relieved my pain.  

As part of my physical therapy, I have to wear a splint on my arm for 6 to 8 hours a day to help me stretch my muscles back to where they were before the accident. Often, my arm starts to ache when I wear this, but I can work some trigger points through the back side of it, which is open. I can also take the splint off temporarily, work some trigger points on the inside and put it back on. When I have worn it for several hours, my arm is usually pretty tender all over, and it hurts to move it. I use the ball to work all of the areas that are tender and stiff.  

The difference between the two arms.  I have gained quite a bit of range of motion, but I have some way to go still. My arm usually extends farther after I have had my arm in the hot whirlpool bath for 15 minutes at the physical therapist's office.   

My arm in the splint.  

Sometimes, I can just set the ball on the table, or another hard surface like a book, and roll the exposed part of my arm on the ball.  

Another tool that I have used recently is called the Palm Massager (made by a company called Pressure Positive, available online).  

Palm massager.

This handy tool is held in the palm of the hand. The fingers fit comfortably into grooves molded into the tops of the three "arms" of the tool. Each "arm" has a rounded end. Two of these ends are relatively small, while the remaining end is larger.  

The finger fits in the groove on top of the arm.

This design makes it easy to use quite a bit of pressure without totally trashing your fingers. I have used it for trigger points in the back of the neck, and, lately, I have used it to work my inner elbow. It is good for going deep.  

Using on the back of the neck.  It is even better if you can lean back into it, so that the muscles that you are working are relaxed.  

Late one night, I was using the palm massager on my inner elbow, and I was able to find some places that hurt that I had not been able to reach before. I worked them, and I could see that it was increasing my mobility. I was pretty excited. The next morning, I was dancing and singing: I've been dreaming of an arm that moves... to the tune of, "I've been dreaming of a true love's kiss," from the movie, Enchanted. It has become sort of a theme song for me.  

Another tool is the Knobble (also by Pressure Positive, available online).

The Knobble

This tool looks a lot like a round door knob. It has a rubber-like surface on its side, which helps in gripping the tool. I often like to hold the tool sideways and use the rubberized side for the trigger point therapy.

The Knobble, side view.

The Knobble is great for places that you want to get into deep with minimal effort. I have used it on my arms, my quads (but I decided later that I like the lacrosse ball against the wall better for the quads) and also on my pecs (using the side).

In position to use the Knobble on my arm.  My fingers are held up to show how the Knobble is placed.  They are wrapped around the Knobble when working the trigger points.  

Holding the Knobble sideways to work the pecs.  

I have even used it on the muscles of my head, staying on the gentler, rubber side.

Using the side of the Knobble on my temporalis muscle. 

Experimenting with different tools, you will probably find some that you prefer over others for particular tasks. The more comfortable you are using a tool, the more likely you will be to use it. You will also probably be more effective, giving the right amount of pressure, not too much, not too little.

Working Your Pecs

I got up early this morning and I was stiff, but I was so tired still and didn't really want to get up and work trigger points. I decided to work my chest muscles. I could work them without too much effort, without getting out of bed, and I was pleasantly surprised at how much it helped to release the tension in other muscles as well.  

Your "pecs," or pectoralis major are your large chest muscles. They are three large bands of muscles that fan from each side just below your shoulder to the middle of your chest (p. 136, if you have the Trigger Point Therapy Workbook).  Among other things, your pectorals work with your upper back muscles to keep your posture upright. If your pecs are tight, they are putting constant pressure on those upper back muscles. They tend to pull your shoulder toward the front.  

There is a domino effect to this, which can end up sending trigger points to the sternocleidomastoids and the scalenes, muscles in your neck which can be responsible for pain and stiffness in a lot of areas. There are other chest muscles as well, and it is not necessary to differentiate them at this point. Working any of them will do some good.  

The chest muscles are more tender than the back muscles (in my experience, anyway) and it does not take much to work them. Remember that you want to "hurt good." Don't try to rub them out; you will make things worse. Just work them. You can come back every couple of hours or so if you want to.  

I use one hand with four fingers held together as the precision tool, and place my other hand on the back of the "precision tool" and push. 

Place opposite hand on back of "precision tool." 

Lying in bed is actually a great place to work these because I can place the elbow of my working hand (the hand that is pushing) on the bed, so it takes very little effort to work these.  

Top hand is the "power."  Bottom hand is the "tool."

To be more specific, lying on my right side, I use my right arm (which I am lying on), bent at the elbow, to support my left arm, which is also bent at the elbow.  The left hand has fingers held together.  Using my right hand, I press the left finger tips into the trigger points.
Sw

itch sides to use the other hand.  

Search all around your chest area.  For women, you are searching in the muscles, so you are working around and under the breast.  (The breast itself is not muscle.)  

Working the pecs and other chest muscles.

If you have never done this before, you may be shocked, alarmed, or even frightened at how many places hurt.  These are trigger points.  They hurt a lot, but working them a little bit does a lot of good.  

If you are already up and about, another way to work at least some of your chest muscles is with a lacrosse ball against a wall that is close to a corner, so that you can lean in further without being blocked by the wall. 

This was written October 1, 2011.  Extra information added October 22, 2011.

Note:  Please be patient with me as I learn how to use these publishing tools.  I have tried several times, for example, to fix the word "switch" above, but it keeps publishing the split word.  Eventually, I will figure out why it is happening and come back and fix it.