Often when people suffer from on-going low back pain, the assumption is that the culprit is disc herniation, arthritis or sacroiliac pain.
“You may be experiencing pain from the sciatic nerve, but often the cause is not actually a disc issue,” says physical therapist Neal O’Neal, owner of Pursuit Physical Therapy in Renton and Redmond. “Most of the time it’s caused by a tight psoas muscle.”
The psoas muscle runs from the inside of the hip all the way up to the diaphragm, and works by flexing the hip joint and lifting the upper leg towards the body.
“When it comes to low back pain, the hip and back are intimately related,” O’Neal says. “The psoas is a major muscle commonly involved in back and hip flexor issues, because the back muscles will spasm to match the tension in a tight psoas. The psoas has a greater mechanical advantage than the muscles in the back, so it’s a reflexive spasm, and not the primary problem.”
Episodic or recurrent back pain caused by a tight psoas muscle is usually an injury from repetitive twisting. Everyday activities like digging, raking, sweeping or weed-eating are common causes.
“Pain and tightness is often not felt until two or three days after the activity,” O’Neal says. “When you are seated for a period of time this allows the psoas to shorten and tighten, locking fluid within the muscle. It also has an impact on the spinal nerves because they come through in the front before going over the hip and down the back of the leg – sciatica is actually a psoas problem.”
Tight psoas treatment
O’Neal says that, because the psoas muscle is in spasm, it does not respond well to stretching, and that tension is released through movement and pressure points.
“It’s best treated using the FABER technique, which stands for flexion, abduction and external rotation,” O’Neal says. “While standing or laying down, you lift your leg and rotate it outwards, while pressing on both sides of your belly button. You need to push on it quite hard because the psoas is located behind your intestines.”
O’Neal and the team at Pursuit Physical Therapy can demonstrate proper technique for treatment of a tight psoas muscle, with an understanding of the interaction between structure and function, to help you get back to doing what you love.
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