Psoas issues causing chronic back pain

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Joined: Sat Sep 23, 2006 2:25 am
Location: Vancouver

Psoas issues causing chronic back pain

Post by Bernie »

I recently received the following question:

  • Hi Bernie,

    I am deeply appreciative of your teaching and regularly practice under your (online) guidance, including through Yoga International. I have recently realized the the cause of my chronic back pain is due to a hiked hip, which is due to a tight illiopsoas. This is a decades long problem for me. That muscle group is always "on" in my body - and I am just learning how to tell it to turn off.

    I am fit, an active yogi, flexible, and strong. I have done everything I know of to correct the problem except directly relax this chronically tightened muscle pair -which I have only recently realized is the culprit. I am currently reading the book, Tight Hip, Twisted Core. It is authored by a PT and hip specialist. She advocates against deep stretching of the illiopsoas. Since yin is passive and "stress" rather than "stretch" - I'm wondering if you think that yin aimed at elongating the psoas or illiacus is wise for someone like me with a chronically shortened muscle group in that area.

    I am trying to do whatever will heal me and not cause further problems or "anger" that muscle group. I am having to re-learn how to sit, sleep, and drive my car to not hold the muscle tense. Finally, just full disclosure on what I'm doing to relax and reprogram this area, I am also doing somatics and learning how to correct the "muscle amnesia" that happens when a muscle remains activated 24/7 for twenty years!

    All of this does seem to be helping, I just want to make sure that I am practicing yoga in a way that supports my healing - both in my yin and hatha daily practice. Any thoughts at all that you can provide would be so appreciated!! Your work uniquely informs and supports my practice.

    Warmly, J
Hi J…

I am sorry to hear about your chronic back pain. As you know, I am not a therapist and cannot diagnose you. But, I can throw out a few ideas for you.

Often in therapy, there arises the idea that we need to stretch what is tight and strengthen what is weak. Thus, if you really do have a tight iliopsoas, then the idea would be to stretch it out. But, three questions arise in my mind: 1) is it really tight? 2) even if it is tight, is it the cause of your pain, and 3) why does the author/PT advise against stretching it? (I have not read that book.)

I can say, from studying with Prof Stuart McGill, one of his initial steps is to determine the cause of the problem, and one way to do that is through provocation: what movements or positions cause your pain to worsen? Flexion? Twists? Supporting weight in your hands or on your shoulders? A therapist should take you through several movements to find out which ones cause or aggravate the problem: that will give some clues as to the cause. Once you know the cause, then some physical therapy can be prescribed to help with that particular cause. For example: does lying in a Supported Bridge make your pain worse? This position is one way to deeply stretch the iliopsoas, and if tightness there is the cause of your pain, going deeply into Supported Bridge is likely to make your pain worse. Unfortunately, if such tightness is the problem, the only way to loosen the iliopsoas is through this very kind of pose. Only you would have to start very shallow and for short times, and slowly work towards longer and deeper holds. (I also suspect that if your iliopsoas is as tight as you think, you wont be able to lift your hips very high in a Supported Bridge. But, if you can lift your hips 4 inches or more off the floor with no pain, then I would suggest you do not have a tight iliopsoas.)

Your pain may have nothing to do with your iliopsoas: it may not even be structural caused. We are learning a lot about how fascia can be the source of our back pain due to a thickening of the lumbar dorsal fascia and the presence of a lot of pain receptors in the fascia. The cause may also be due to other areas of the biopsychosocial model of pain. Indeed one study (at the Boeing factory) of thousands of people found that back pain was not correlated to the job, but to how much people disliked their job. At the end of the day, I would recommend you find a therapist who can work with you individually, and consider all aspects of your unique biology and biography. Your pain may be caused by structure malalignment, but it may have more to do with other issues too.

Stuart McGill has a very useful book for non-therapists called The Back Mechanic. This would be a great starting place for anyone suffering chronic or acute back pain. He offers several tests and exercises that have proven helpful for thousands.

Another book to add to your library is Yoga and Science in Pain Care written by several yoga teachers and pain researchers.

However, again, a book is not a therapist. Best is to find one.

Good luck!
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Re: Psoas issues causing chronic back pain

Post by toaster »

Bernie, thanks so much for sharing this interesting discussion! I have been told in the past (by a massage therapist), that my psoas muscles are "tight," but I can do the supported bridge. In fact, I actually love that pose because it feels so good in the psoas area! I will say that when I went through a period (about 10 years ago) where I had low back pain for several months, focusing on stretching the psoas did seem to help. I also wonder about the pesky quadratus lumborum muscle being a factor in back pain. I have a sort of nagging issue (occasionally discomfort, not really pain) in the area of my left QL, and now stretching this area feels so good.

Thanks also for the book links; I plan to check those out.
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