How To: Psoas Stretch for Back Pain

If you spend long periods of time with your legs flexed at the hip (such as when sitting or cycling) and are experiencing stiffness or aching in your back, there is a chance that a tightening of your Psoas muscle (right) could be a contributing factor.

The muscle attaches the leg to the back and is responsible for flexing the hip.

It will adaptively shorten when in a flexed state for extended periods and because it attaches to the lower back, as it shortens it can pull on the spine which can in turn cause stiffness and pain.

In this short clip below, Sally demonstrates how to effectively stretch the Psoas to ease any tightness.

Anatomy Of The Back

How is The Back Made Up?

Your spinal column provides support for your body. Without it, you wouldn’t be able to stand upright, bend or twist.

Vertebrae

 Your spine consists of 33 bones (your vertebrae) linking your skull and pelvis. Each vertebra has 3 main components;

1.      The vertebral body at the back of the vertebrae which supports your body weight

2.     The vertebral arch at the front of the vertebrae which protects the spinal cord.

3.     The transverse and spinous processes which serve as sites for ligament attachment.

Facet joints connect the vertebrae and allow the bones to glide smoothly against each other. The joints contain synovial fluid which acts as a lubricant and protects against wear and tear.

The Spine

The spinal column is made up of 4 different regions:

Cervical (neck)

Thoracic (chest)

Lumbar (low back)

Sacral (pelvic)

 The spine has a natural ‘S’ shaped curve when viewed from the side. The cervical and lumbar regions have a concave curve and the thoracic and sacral regions have a slight convex curve. These curves allow the spine to act like a spring, absorbing shock and maintaining balance.

 Running through the spinal column, protected by the bones, is the spinal cord. This is a cylinder of nerve tissue which connects your brain to the rest of your body, controlling your movement and keeping your organs functioning.

Intervertebral Discs

 The vertebrae are separated by soft, fluid filled cushions called intervertebral discs, which sit between the bones. It’s their job to act as shock absorbers, protecting the vertebrae and spinal cord from injury and/or trauma

Your intervertebral discs have a tough outer fibrous ring called the anulus fibrosus which contains and protects an inner gel-like centre called the nucleus pulposus. The nucleus pulposus is made up predominantly of water which can move in and out of the disc through small pores as the disc is loaded and unloaded.

Ligaments

 A network of ligaments and muscles join everything together to form the spinal column.

 Ligaments are tough bands or sheets of connective tissue and link bones together. The spinal ligaments help stabilise the joints by restricting excessive movements and preventing movement in certain directions.

Muscles

 The muscles of the spine work together to support the trunk, protect the spine and hold your body upright. They also allow you to bend, twist and move in multiple directions.

The erector spinae group (above) are a set of muscles which work together to straighten the back and keep you upright. Running almost the full length of the spine, they are made up of The Iliocostal, Longissimus and Spinalis muscles and play an important part in posture and support of the spine.

Another significant muscle used in the stabilisation of the lumbar spine is the Multifidus muscle (left). Together with the transverse abdominis and pelvic floor muscles, it stabilises the low back and pelvis before movement of the arms and/or legs takes place.

The transverse abdominis muscle (right) is the deepest of the abdominal muscles and wraps around the trunk from front to back. In Addition to supporting the organs located in the trunk, it acts as girdle, stabilising the back and pelvis prior to movement of the body.

Core Strength and Back Pain

Evidence shows that deconditioning because of pain and reduced activity in people who have chronic back pain can result in weakened muscles of the low back and spine.

It is possible for the body to be strong everywhere except the back. The back can only be strengthened when the lumbar spine is moving against resistance. and typically, if you have back pain, you will (unknowingly) change your body mechanics to protect your back, substituting pelvic motion for lumbar motion.

When we talk about the muscles of the back, we are referring to the lumbar extensor muscles at the back (right) which are attached to the spine and stabilise, rotate and extend the back.

When we talk about the core muscles, however, we are referring to the muscles of the trunk (Rectus Abdominis, Obliques and Transverse Abdominis - left - as well as the lumbar extensors) which surround the mid-section, front and back like a corset, stabilising the trunk as the limbs move, providing support for the back and helping us bend and rotate.

Symptoms

It’s not possible to tell whether the weakness causes the pain, or is as a result of the pain, but if you have any of the following symptoms, you may one of many who have weakened muscles of the low back and core:

Pain, aching or stiffness when on your feet for long periods

It is the primary job of your core and back muscles to keep you upright. When the muscles aren’t strong enough to support your body, they fatigue and ache as demand on them increases.

Pain when running or exercising

Same as above, your back and core will be working extra hard to maintain your posture and technique as you run/exercise or will force other muscles to work harder to compensate.

One study on a group of runners found that when the deep muscles of the core were in a weakened state, the body was forced to overcompensate using superficial abdominal muscles, meaning the runner was able to run in the same way, but with an increased load on the spine. https://www.painweek.org/media/news/avoiding-runners-chronic-back-pain-its-all-core

Aching and/or stiffness towards the end of the day

This could be a sign of muscle weakness. Again, your core and back have been working hard to maintain your position all day and may tire as the day progresses.

(note: any back pain which you notice at night when you lie down, and doesn’t go away when you adjust positions should be checked by a doctor as it could be a sign of something more serious)

Causes/Contributing Factors

Poor posture

Your core muscles are designed to carry your body in the best position for your comfort and health and to maintain correct alignment of your body, that is how your head, shoulders, spine, hips, knees and ankles line up with each other.

You should have a natural ‘s’ shape in your spine, so if you are not in alignment (for example, if your shoulders are rounded and your spine curves forwards excessively), your muscles become imbalanced. Some become shorter and tighter and others long and weak resulting in a reduction of use and weakening as a result.

Sitting down all day

When we stand and move, our deep core muscles are activated and working to keep us upright and to facilitate movement. As soon as we sit, the muscles switch off. This prolonged decrease in use can cause them to weaken over time.

Pregnancy

During pregnancy, the muscles at the front of the abdomen stretch and separate to accommodate the growing baby. This, combined with the tipping forward of the pelvis affects the ability to stabilise the core and weakens the muscles as they elongate.

The pelvic floor muscles also make up part of the ‘core’. They are essentially a hammock at the bottom of the pelvis, supporting the pelvic organs. As the baby passes through the pelvic floor muscles during birth, core stability is further compromised, and the pelvic floor can become weak.

During a caesarean delivery, the abdominal muscles are separated to allow the baby to be delivered. After they are stitched back together, scar tissue forms, which can affect the muscle’s ability to work properly as they contract.

Abdominal surgery

If the abdominal muscles have been cut during any abdominal surgery, just as with a C-section (above), the formation of scar tissue where the incision was made will affect the muscles’ ability to contract and may result in decreased strength.

Occupation

There may be an imbalance of the core muscles if they are forced to maintain an unnatural position for prolonged periods. This can be common in occupations such as mechanics, bricklayers and carpet fitters to give a few examples.

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