I rarely pick a single muscle to focus on at Aging_with_Piazzazz, so you might wonder why the exception here. If you’ve ever spent any time at the gym, with a coach or yoga teacher, I suspect they have mentioned the psoas muscle. (It can be pronounced as “so as” or “so-ezz” just in case you want to discuss it with someone.) My reason for writing about it is the fact that the psoas is at the core of many hip, leg, back and general lower ‘core’ muscles, and their work.

What Does the Psoas Do?

The functions of this muscle are with us almost constantly. It helps us walk and flex the hip, bringing the thigh toward the chest. It allows us to curl up into a little ball, spring to action and even just stand upright. The Psoas supports our posture and stabilizes the vertebral column. Even when we are laying down, it helps us raise the trunk back up. And contracting one side or the other supports side bending of our lower spine.

Thus, the Psoas is essential for standing erect, walking, running, jumping, dancing, climbing stairs, even sitting and then rising again. It works jointly with muscles in the back and belly to allow us these movements.

While not always mentioned, it has a secondary benefit as well. It supports some internal organs, and as such, aids the circulation of blood and lymph. All in all, lots of important functions.

You use this muscle every day and you need the lower core to be strong to both perform to your best ability and to prevent injuries. The Psoas is the key stabilizing muscle of back/hip region.

Where is the Psoas Muscle?

The psoas is the main muscular connection between your lower body, hips and torso. Always described as a ‘deep’ muscle, it explains why we don’t normally think of massaging or building it up like we do other muscles.

The two psoas muscles are located on both sides of the body, going from your lower spine, through the hips and connecting to your thigh bone (femur). Each is fairly long, up to 16 inches. It’s this connection between the upper and lower body (joining the areas) that makes it a stabilizing force.

You may hear the term “iliopsoas muscle complex” which includes the psoas and iliacus muscle as well as the sometimes-present psoas minor muscle. Approximately 50% of people don’t have a psoas minor muscle, but evidently the other two take up the slack.

 

The Psoas Syndrome?

Just looking at the pictures above, you can visualize possible problems. Based on the attachments at either end of the muscle you can imagine how a spasm or tightening can pull or traction and create more back pain. It can happen on both sides, or just one, leading to changes in posture and resulting in pain in areas even outside the sphere of the muscle itself.

Further, posture misalignment stemming from tightening can lead to pelvic rotation, increased low back sway (lumbar lordosis), pelvic tilting, even rotated hips, legs or feet. Everything can be thrown out of alignment over time (even a short time).

The term “Psoas Syndrome” is generally reserved for a more moderate to severe situation of this alignment error. It refers to an actual irritation or injury and can affect one or both of the psoas muscles. Perhaps, it’s used as a diagnosis of mild conditions more frequently than it should compare to the rarer, actual syndrome. Still, it references the same area.

How Older Folks Suffer

The Psoas Syndrome (aka jumper’s hip, iliopsoas syndrome or dancer’s hip) is often assumed concentrated among athletes, as the ‘aka’ names would imply. Frequent suffers are runners, Field & Track participants (like high-jumpers) or dancers. But there is one group important to Aging_with_Pizzazz readers, and that is people who have undergone a total hip replacement.

One of the first noticeable signs is pain when you change positions. You may be sitting a while (especially if spending too much time at the computer or TV) and then feel pain and major stiffness when standing. You may find it problematic to stand fully upright or to hold yourself that way.

Indeed, pain is the most common symptom, even if your diagnosis of psoas ‘syndrome’ is exaggerated. Mild to moderate psoas spasm or tightness can cause discomfort in different parts of the lower body. Ordinary symptoms include:

• Lower back pain
• Stiffness or tightness in low back
• Pain in the butt, groin or hip
• Pelvis pain and stiffness
• Pain radiating down into your legs or to knees (perhaps imitating sciatica)
• Pain at the junction between your low spine and butt

Other symptoms are often described as “catching.” This can include a slipping or catching feeling in the groin when you bend your knee at an acute angle. You might hear snapping or cracking noises in your hip when you stand up (or straighten your legs). And you might notice a shuffling (or limping) gait as you walk.

Perhaps more importantly is what occurs if nothing is done for injury or weakness of the psoas muscles. Other areas of the body (muscles and tendons surrounding the area) will “compensate” for the problem. They work harder to make up for the weak or injured musculature, which leads to even more injuries.

More on what to do will be found in following paragraphs.

Causes of Psoas Syndrome

Before we look at what to do in the way of help or prevention, we need to understand some of the causes of the syndrome (or faux, syndrome-lite) condition.

Generally, as indicated above, the syndrome is the result of injury or overuse. As we age, other disorders may play a concomitant role. Conditions like degenerative arthritis (osteoarthritis), bursitis and inflammatory RA (rheumatoid arthritis) in the hip can create secondary injury around the psoas.

Other noted causes can include these below. However, they are more a warning to adopt good habits rather than strictly adhering to avoidance.

• Exercises that involve repeated hip flexion (like full squats, lunges, kettlebell swings or — a warning to my husband– mountain climbing)
• Excessive long periods of sitting on a regular basis (causing your psoas muscles to shorten or tighten). This, followed immediately by physical activity (which may sound like a good idea), can create more pain. Simply a brief rest or quiet standing position before more physical activity should solve this.
• Stretch-shortening cycle training. Jumping in place, box drills or kettlebell swings are examples of these bodyweight resistance moves (aka Plyometric exercise) that are considered explosive.
• Surgery complications, especially total hip replacements.
  

The psoas affects the body, mind and spirit and is
perfectly referenced as the ‘Muscle of the Soul.’

(Term is taken from the Teachings of the Universal Healing Tao system
Mantak Chia’s book Energy Balance Through the Tao)

Treatment vs. Prevention 

It’s no surprise to readers of this blog that I prefer prevention to treatment whenever possible. I’ll proceed to prevention shortly but figured I would at least give a brief summary of typical Psoas Syndrome treatments.

As both stretching and strengthening of the psoas are important in both treatment and prevention, I’ll start there. If a diagnosis of psoas syndrome is not mild and self-care is questionable, then one of the first treatment options is physical therapy. Again, the goal is to stretch and strengthen the muscle, along with spine and hip joints. (For the home-doer, there are psoas muscle release tools that you can purchase to perform stretches over – it’s just an aid, as the muscle can be difficult to get to otherwise.)

Manipulation is another form of professional physical therapy, but more passive. You may try chiropractic adjustments, osteopathic manipulation, or myofascial release techniques. They aim to align and balance the body by gentle work with joints, bones, tendons and muscles of the lower core area.

Medication alone is rarely useful. However, OTC pain relievers like ibuprofen or acetaminophen are often suggested simply to manage pain. Ibuprofen is a non-steroidal anti-inflammatory; acetaminophen is for pain only.

Corticosteroid Interjections are sometimes used for more severe cases. This is more common when the cause of the condition is from hip-replacement.

A more severe, invasive treatment is surgery. In serious cases where all other methods and self-care have failed, surgery may be used. The surgeon may address the psoas itself by releasing the psoas tendon or lengthening the muscle.

Prevention

The goals of a preventative program are to maintain a healthy psoas, namely to stretch and strengthen your psoas muscles in everyday life. In my own workout app, PizzazzZZ-25, the psoas is utilized in several steps. This is particularly helpful to maintain an already well-functioning muscle and before any diagnosis of psoas issues.

Some of the general prevention steps for psoas health are familiar, not unexpected and all-around best practices for anyone.

1. Improve your flexibility to reduce injury or to bounce back from injury quicker.
2. Warming-up is NOT out of style. If you plan any vigorous physical activity (for instance, something like pickleball), warm up before you get going to avoid injury. Warming up not only brings up your heart rate in preparation, but it also gently stretches your muscles and tendons.
3. Another idea for warming-up is simply to start your activity very slowly and gradually.
4. Move more. Incorporate a few extra movements into your life. You can walk up and down stairs (we bought our house with this purposefully in mind), jog in place, use a rebounder or do some easy lunges or modified/gentle squats.
5. Stay active for fun. However, if you start any new exercise routine, ease into it gently and slowly. Make sure you allow yourself to recover a day or two after starting a new activity or sport.
6. Aim to deliberately stretch your legs and back for a few minutes at least 3-5 times a week
7. Avoid repetitive activities (with repeated jumping or twisting hips) until you have done strengthening of your psoas muscle. Also avoid walking, climbing or running up-hill if you have psoas problems that haven’t yet resolved.
8. Sit less when possible.

Self-Care Therapeutic Approach for Psoas

While tips and programs mentioned above are excellent for prevention, even a program like PizzazzEE won’t correct already painful psoas problems. You need a bit of therapeutic exercise. If it’s severe you may need one of the professional treatment solutions noted earlier, but that situation is less common.

Most people can make great strides by working to strengthen and stretch the psoas, even if you have mild pain or symptoms. And the good news is that even if you don’t have pain, these exercises that focus on hip rotation and target psoas function won’t hurt you. Well, maybe just in the way of a few minutes less for TV or goofing-off.

There are many exercises to help the psoas, most with a variety of descriptions. Some can seem extreme. I have picked 4 that I think can be done safely and produce great results. Two are for strengthening only; the other two for stretching and strengthening. (Read the Psoas Lunge carefully.)

I suggest incorporating each of these into your weekly routine (or 2-3 times/weekly) if you suspect you have a weak or tight psoas. However, start with those that do both stretching and strengthening. The next day you should instinctually have a better understanding whether you should continue just with those two or add the others as well.

 

Psoas Stretch and Strengthen
Bridge	Psoas Lunge for Seniors
Lie on the floor face up. Place feet firmly on floor, heels close to the butt, knees bent. Put arms alongside body with palms flat on floor. Slowly push your hips up, feeling stretch along thighs & hip flexors. (Hold a second.) Slowly lower your hips and butt back to the floor. Start out doing a set of 20 repetitions. When you feel stronger you could work up to (but not exceed) 5 sets of 20 repetitions. Tip: Best exercise to start with if you feel pain or weakness in low back, leg, groin area around Psoas	Step forward with one foot and place knee of other leg on ground behind you. Don’t let either knee flare out. Anchor front foot; don’t let your front knee go past your toes at any time. Keep back and head straight, not leaning forward. (This is an important point.) Rotate pelvic and hip area slightly backward to feel psoas stretch (also felt in front of thigh). Slightly rotate to open up your hips (without turning knees). Hold a few seconds. Start out doing 3-5 repetitions with each leg forward. You can work up to 2 sets of 10 repetitions. For an easier routine, instead of changing legs, do one leg at a time. Relax hip and pelvis and then push back and turn again for a second repetition and rotation. Tip: As in PizzazzEE step # 8, I prefer to place one hand on upper leg, gently holding it from moving while opening & rotating other hip.

Psoas Strengthen
Bent Leg Lift	Pelvic Tilt
Stand with feet less-than shoulder-width apart. Bend one leg at the knee with those toes pointed down. Anchor other foot to the floor, lift bent knee and hold for a few seconds. Lower your leg. Switch to other side. Start with lifting 2-3 times to make certain your balance is steady. Work up to repeating lift and hold 10 times. Tip: See Flamingo Challenge test for another advantage of this exercise.	Lie on floor, face up. Plant feet firmly on the floor with your knees bent. (Similar to Bridge pose.) Tighten belly muscles so lower back is flattened and pressed into floor (this will slightly tilt lower pelvis toward ceiling). Hold 10 seconds and relax. Start with 1-2 tilts. You can work up to five times total. Tip: When doing all 4 exercises, you may want to pair this with the bridge to save time.

Final Thought 

The Psoas muscle is a key to both stability and easing pain from multiple body areas. Its motions play a part in so much of what we do including walking, climbing stairs, sitting and standing. Taking care of it (either with preventative steps and activity or therapeutic exercises if you already suspect instability or weakness), will pay off in a myriad of ways for years to come. Psoas health is fantastic for our independence in aging.

All you have to do is stretch and strengthen the muscle. It’s no secret how we do this. Just follow the simple steps.

And one more thing, just in case you were wondering. While I can’t be sure, the title picture cat is not actually performing a good stretch of the psoas. Still, it looks mighty fine and inviting. Right?

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Resource Links:

Psoas Muscle: What It Is, Where It Is & Anatomy https://my.clevelandclinic.org/health/body/psoas-muscle

https://posturegeek.com/blog/psoas-muscle/

https://www.kenhub.com/en/library/anatomy/psoas-major-muscle

www.everipedia.com-Psoas major muscle

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Title picture: Cat stretch: Photo by Timo Volz on Unsplash

Psoas muscle pictures is by Unknown Author licensed under CC BY

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