The Psoas and Chiropractic
There is a problem that is affecting many of your patients and you may not be addressing it. Do these symptoms sound familiar: Their problem starts simple and benign. Usually without pain. Then it grows. A little pain across the lower back. An ache in the lower back if they sit too long. Pain in the hip. A limp. Clicking in the hip. Pain the first thing in the morning that subsides as they getup and going. Pain or discomfort just as the patient begins to stand up from a seated position. At its worst the patient can’t stand up straight and they are in agony. Sometimes the problem in kids will be labeled “growing pains”.
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Sound like someone you have seen recently? Someone you know? You are probably seeing a Psoas problem. The Psoas problem is common and often debilitating and in most cases has a relatively easy solution.
To understand the solution you need to know a little about the Psoas muscle. It is one of the largest and most important posture muscles in the human body. Yet, the Psoas is greatly overlooked because it is awkward to work on with most manual techniques. This muscle is deep inside the abdomen and attaches to the front of the spine and the spinal disks. The attachments are from the diaphragm (12th thoracic) through the bottom of the low back spine (5th lumbar). It travels through the abdomen and joins up with a muscle that attaches to the inside of the hip bone called the Illiacus. This is why the muscle is often called the Illiopsoas. We will call the whole thing the Psoas for ease of communication. The muscle attaches to the upper part of the upper leg bone after having gone underneath the Inguinal ligament. The Psoas is the most powerful hip flexor (bringing the thigh to the chest) and is the main muscle that bends the body forward at the waist.
Now with the anatomy lesson out of the way, let’s get practical. For your further understanding you need to revisit a principle of muscle: muscle that shortens and stays that way will tend to stay that way. Remember that. It is vital. To visualize this or to experience it put your arm in a sling with your elbow bent sharply. Leave it there all day then remove the sling and try to straighten the arm. It will be difficult and slow. Knowing that, let’s get back to the Psoas.
When a person sits for long periods of time whether at a desk, driving a vehicle or playing video games on the floor, the legs are bent toward the chest. This means the Psoas will be foreshortened. (This can also happen with improper sit-ups.) Remember what we said a minute ago, a muscle that shortens and stays that way will tend to stay that way? When a person stands up after having been sitting, the Psoas muscle has to lengthen. If it is tight, it will pull on the low back spine and disks and create stress. Often, this is felt as tightness across the lower back, stiff hips or even outright pain. If the Psoas is tight on one side more that the other it creates torsion and increased stress on the disks between the vertebra. Over time this situation will lead to more serious structural problems.
One last big example before we give you the solution. When a person sleeps at night, they often are on their side and usually have their leg, or legs curled up in the “fetal position.” This causes the Psoas to be shortened all night. In the morning the person often is slow to get out of bed, finds standing upright difficult, and has to push on the lower back to get moving. Usually, this person is okay once they are up and moving around or after a hot shower. That is “classic” indicator of a Psoas problem.
So what do you have to do? This is the great part. Teaching the patient/client about the problem and showing them a very precise stretch, done 3-5 times a day is usually enough to resolve the problem. In some harder cases a person may need to have the Psoas worked on by a professional trained in specific Psoas work. That is where you come in. Manually working on the muscle will accelerate the results and will help those patients/clients that just won’t do the stretch. In some people, they will not resolve without the manual work being done. Many times, with the stretch and manual work, patients will experience almost miraculous results.
How do you do the stretch? Begin on your knees. Bring one leg up so that the foot rests on the floor and has the leg at a little over 90 degree angle. Then, holding onto something to stabilize yourself, you will bring your hips forward and down while keeping your upper body completely upright. As your hips go forward, you will feel a pull and tightening of the front of the hip on the side that the knee is on the floor.
Once in this position, you will hold it for at least 15 seconds. A great way to count (as well as increase the results) is to breathe in and out very deeply 3 times. As you exhale you will find yourself able to stretch out a little more. Once you have finished on one side come back to the starting position, switch feet that are on the floor and stretch the other side.
While doing this stretch it is important not to rotate the body or to lean forward at the waist. Concentrate on keeping your body upright to increase the effectiveness of the stretch.
Does your patient/client sit at a computer all day? Have them stop at least once an hour and stretch the Psoas. They will feel taller, have less pain and stiffness and, thanks to the breathing exercises, their mind will be clearer.
Does your patient/client drive a lot? This work will be vital for them. Every stop they take should include a Psoas stretch. Flying for hours? Do the stretch. A student sitting in class? Do the stretch. Low back and disk problems? This manual work and the stretch could literally prevent surgery!
As a chiropractor, I have found that often the alignment of the spine is affected. Adjusting of the spine may need to occur before proper balance of the muscles can be restored.
Professionals interested in providing this valuable, easy to perform, manual work to patients can access information on the sight as well. Discounted online professional chiropractic continuing education is available through CESoup.com.
My encouragement to you is learn this and DO IT! Your patients/clients have everything to gain by this simple work.
About the Author
Dr. Kevin W. Ross is a chiropractor in Tempe, Arizona, USA.