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. 

Working with the Theracane, Part 2

In this post, I will share more ways to use the theracane.

The theracane is great to use on your upper back, neck and shoulder muscles. Experiment with the larger knob and with the smaller knob (described in the last post) and see what you like best.

Whenever you can, let the theracane do the work for you. If you can, use the hand that is opposite the area to be worked to exert the pressure. It is easier to work trigger points if the muscle containing the trigger point is relaxed.

Theracane is working muscles on opposite side of back.

Front position of theracane to work other side of back.

To work your shoulder muscles, hold the cane with the curved part up and extending to the back. Place one hand on the curved part of the theracane and the other on the lower end of the cane. Place the large knob at the end of the curve on your shoulder. Push down with the top hand, and out with the bottom hand. Experiment with the leverage until you get the desired pressure.  

Using the opposite hand to exert the pressure.

Using the large knob is quite effective for the muscles in back of the neck and is especially useful when trying to get to some of the deeper muscles in your upper back and neck area. When working the muscles in the back of your neck, it is a good idea to lean back into the cane, relaxing the muscles that you are working.

Working the side of the neck.  

Your upper back and shoulders have several muscles that are layered on top of each other. Sometimes, it is necessary to push quite hard to get to a trigger point in the deeper muscles. Remember to let the leverage of the theracane do the work for you.   

There is a deep trigger point here.

Whenever you can, brace the theracane on something else in order to give you more leverage with less effort. If you are sitting, you can brace the bottom of the cane on your lap. You may also be able to brace the cane against your chair or couch. I have found a lot of places to brace my theracane when sitting in the front passenger seat of a car.  

Theracane is braced on lap, so that only one hand is working.

Using arm or wrist to give a break to the hand.

The large knob of the theracane is also good to use on the trigger points at and just below the rib cage in the back and side. Use caution here. These trigger points are very, very tender, and it does not take much to work them. I work mine perhaps two or three strokes and then come back to them later.  Also, stay on the muscles.  Don't start digging deep into the area below the ribs.  You have kidneys in there.  

To work this area, place the theracane curve around your waist, with the knob in back and the stick in front. Place your hands outside of each of the handles. Push forward with the hand that is closest to the straight end.

Working the back and sides near the bottom of the rib cage.

You can also use the large knob to work your chest muscles. Again, use caution because some of the chest muscles are also very tender. Go easy at first, and you will get an idea of how much pressure is just right.  (See my post on working pecs for more information on working your chest muscles.)  

 The theracane is a pretty handy tool.

Here is another theracane tip:  Take it in the car with you when you are driving. When you are stopped at a light, instead of getting upset at how long it is taking, work a couple of trigger points. (But don't relax so much that you are not ready to go the second the light turns green...) 

Working with the Theracane

The theracane is an incredible tool. It allows you to deep-massage places that you would not be able to do by yourself.

In this post, I will demonstrate some ways to use the theracane on four areas: the scalenes, the muscles in the back of the neck and head, the muscles under the arm, and the spinal muscles.

Before we get started, a word of caution... It is easy to get really carried away with the theracane. You might start really digging in, and later end up very sore. You might even end up with bruises. (Ask me how I know.) So, it is a good idea to go easy in the beginning. You will learn how much pressure to use on each area as you continue to practice.

Also, it is a good idea to have a layer of clothing of some kind between you and the theracane, especially when you are working more sensitive areas.

Scalenes

In a previous post, I demonstrated how to work your scalenes (muscles deep in the side of the neck) with supported fingers as the tool. It is also possible to work many of the scalenes with the theracane. It is a good idea to have worked them with your fingers first, so that you have an idea of where they are located, how the trigger points feel, and how much pressure to apply.

Start out with the theracane upside down. Place one hand on the ball at the end of the curved area. This will be your "anchor hand." Place the other hand up on the straight area, somewhere between the two handles. This will be your "guiding hand."

One hand on end of cane.

Alternatively, you can place the guiding hand on the lower handle. You may find that this gives you even better leverage.  

Guiding hand on lower handle.

Experiment with positioning your guiding hand until you can easily push the small knob into your scalenes. The idea is to use as little effort as possible and to let the leverage of the theracane do the work.  

Working scalene with theracane.

Change position for the fourth scalene.

In position to work fourth scalene.

Bring one hand up and place the other on the ball at the end of the theracane (not shown in picture). Press up on the bottom of the theracane to put pressure on the working knob. You may want to put your upper hand on top of the closest handle for more leverage.

Working fourth scalene.

Muscles in back of neck and head

As usual, do not press directly onto the bones of the spine. You are fine to gently press on your skull, however.

There are several layers of muscles in the back of the neck and head, some of them very small. Using one of the small knobs of the theracane can be an effective way to work these trigger points.

To work these muscles, bring the theracane to the back of the neck with the curve of the theracane extending forward. Bring the higher small knob to the back of the neck, holding the theracane in the middle of the curve on one side and just in front of the ball at the end of the stick on the other.

You can work the points by pressing the theracane forward, or you can hold the theracane stationary and lean your head back into the theracane.

Working the back of the neck.

You can use even less effort by bracing the theracane handles into the back of a chair, and leaning into the knob. I sometimes do this lying down in bed also, but you must be extremely slow and gentle when you lean back. I have had times when I had a headache, that I put the straight part of the cane (between the knobs, or right in the curve) right where the back of the head starts to curve (in the suboccipital area) and leaned back into it. It made it possible for me to get to sleep when nothing else worked.  

Brace the theracane "handles" against the back of the chair.

Muscles under the arm 

The muscles under the arm can be hard to get to and they are very important. Many of them are also quite tender, so go very, very easy.  

First, place the theracane in front of you with the curve extending back. Place the knob at the end of the curve, under your arm.  

In position for working under the arm.

Holding the end of the theracane with one hand, grab the top handle with the other hand.  

Ready to work the trigger points under the arm.

Use the leverage of the theracane to work the trigger points under your arm.  

Working trigger points under the arm with the theracane.
Side view.

Spinal muscles 

The theracane is particularly useful for getting the muscles right next to your spine.  

Get in position by bringing the theracane behind you with the curve extending forward.  

Getting in position to work the spinal muscles.

Place your arm behind the theracane on the straight end, in a place that is comfortable for your size body. In my case, it is between the lower handle and the end knob.  

Place your hand behind the theracane.

Place the top small knob of the theracane onto either side of the spine. (Never use the theracane directly on the spine.)  Slide the theracane up and down searching for trigger points. Then work them as you find them. Most of these will be quite small, so your stroke will be shorter and more focused.   

These are just some of the ways that you can use the theracane.