Of the 20-page muscle packet we were required to memorize word for word as Doctorate of Physical Therapy students, the very first of these was the “psoas”. It wasn’t until I started practicing that I realized its position as #1 was no accident. No other muscle is as infamous as the psoas. I am always amazed at how many patients tell me they’ve been diagnosed with a chronically “tight psoas” that needs to be “released.” However, when I test out this theory, more often than not, the psoas is not tight but lengthened and weak. In some instances, myofascial release of the psoas can actually exacerbate pain. Why is the psoas so misunderstood and how can you get it functioning correctly again?
The psoas is truly a special muscle. It is located in the deep abdominal cavity, attaching from the discs and vertebrae of the lumbar spine to the lesser trochanter of the femur right below the hip joint. Whereas other muscles attach from spine to the pelvis or the pelvis to the leg, the psoas is the only muscle that directly links the spine to the leg. With such a central location, it’s not hard to see why it is often implicated in back, hip, or pelvic pain. In practice, it is not uncommon to see psoas dysfunction show up as low back, groin, SIJ, or even piriformis pain.
Although traditionally the job of the psoas was thought to be hip flexion and sidebending of the lumbar spine, its description as a stabilizer is more appropriate. The psoas is crucial in centrating the hip joint and preventing slippage of the femoral head forward or up where it can cause damage to the hip joint or labrum. Its fibers blend with those of the deep myofascial system which includes the diaphragm, transversus abdominis, internal obliques, pelvic floor, and the multifidi. Thus it plays a key role in stabilizing the spine and balancing out the action of the superficial muscles of the back and abdomen to avoid degenerative disc and joint disease of the spine.
How can you get your psoas to work better? Because it is not simply a joint mover like the biceps or triceps, the psoas is a difficult muscle to unravel and strengthen. It is part of a system of deep stabilizing muscles; therefore, the best way to improve psoas function is to work in closed-chain myofascial patterns that train the deep stabilizing system. Due to its role as a link between the thoracic and pelvic diaphragms, it is equally important to retrain dysfunctional breathing patterns.
Once in a while a truly “tight” psoas does make an appearance, and in this instance, it is important to release the muscle with whatever method is most comfortable to the client. However, please note that this does not necessitate your therapist getting knuckles deep into your intestines to be effective.