The psoas muscle (pronounced SO-as) may be the most important muscle in your body. Without this essential muscle group, you wouldn’t even be able to get out of bed in the morning! In fact, whether you run, bike, dance, practice yoga, or just hang out on your couch, your psoas muscles are involved. That’s because your psoas muscles are the primary connectors between your torso and your legs. They affect your posture and help to stabilize your spine.
The psoas muscles are made of both slow and fast twitching muscles. Because they are major flexors, weak psoas muscles can cause many of the surrounding muscles to compensate and become overused. That is why a tight or overstretched psoas muscle could be the cause of many of your aches and pains, including low back and pelvic pain.
The types of movement that can strain your psoas muscles include standing and twisting from your waist without moving your feet (think old-fashioned calisthenics) or any movement that causes your leg to externally rotate while extended, such as ballet-style leg lifts (or battement), and even doing too many sit-ups (your psoas muscles complete the last half of a sit-up).
But because many experts don’t understand the complexity of the psoas muscles, it’s not uncommon for people to be given the wrong diagnoses and treatments for their psoas-related pain.
My What Muscle? What You Need to Know about Your Psoas
Structurally, your psoas muscles are the deepest muscles in your core. They attach from your 12th thoracic vertebrae to your 5th lumbar vertebrae, through your pelvis, and then finally attach to your femurs. In fact, they are the only muscles that connect your spine to your legs.
Your psoas muscles allow you to bend your hips and legs toward your chest, for example, when you are going up stairs. They also help to move your leg forward when you walk or run. These same muscles flex your trunk forward when you bend over to pick up something from the floor. They also stabilize your trunk and spine during movement and sitting.
The psoas muscles support your internal organs and work like hydraulic pumps, allowing blood and lymph to be pushed in and out of your cells. They are vital not only to your structural well-being but also to your psychological well-being because of their connection to your breath.
Here’s why: there are two tendons for the diaphragm (called the crura) that extend down and connect to the spine alongside where the psoas muscles attach. One of the ligaments (the medial arcuate) wraps around the top of each psoas. Also, the diaphragm and the psoas muscles are connected through fascia that also connects the other hip muscles. These connections between the psoas muscle and the diaphragm literally connect your ability to walk and breathe and also how you respond to fear and excitement. When you are startled or under stress, your psoas contracts. In other words, your psoas has a direct influence on your fight-or-flight response!
During prolonged periods of stress, your psoas is constantly contracted. The same contraction occurs when you sit for long periods of time, engage in excessive running or walking, sleep in the fetal position, or do a lot of sit-ups. All of these activities compress the front of your hip and shorten your psoas muscle.
But that doesn’t necessarily mean you should automatically stretch your psoas if you have pain in the front of your hip joint. In fact, depending on your situation, stretching your psoas may actually do more harm than good! The key is to know whether your psoas is short and tight and thus in need of stretching or if it’s weak and overstretched and in need of strengthening.
7 Ways to Tell If You Have a Psoas Muscle Imbalance
When you have a tight (or short) psoas muscle, you may experience pain in your lower back or in your hips, especially when lifting your legs. This is caused by the muscle compressing the discs in the lumbar region of your back. Stretching your muscles and releasing the tension on the psoas is the best way to prevent this from happening. It takes time and daily attention to keep your psoas muscles relaxed, stretched, and strong.
While most people with psoas issues have tight psoas muscles, there are some people whose psoas muscles can be overstretched. In this case, if you stretch your psoas and it is already overstretched, you will cause more problems.
Here are 7 ways to tell if you have a psoas muscle imbalance:
- Leg length discrepancy. A tight psoas muscle can cause your pelvis to rotate forward. This, in turn, can cause an internal rotation of your leg on the affected side. The opposite leg will rotate externally in an effort to counterbalance. This will make the affected leg longer so that every time you take a step, it drives your leg up into your hip socket. This can lead to functional leg length discrepancy.
- Knee and low back pain. If you experience knee or low back pain with no apparent cause, it may be coming from your psoas muscles. When your femur is in essence locked into your hip socket due to a tight psoas muscle, rotation in the joint can’t occur. This can cause your knee and low back torque.
- Postural problems. When your psoas is too short or tight, it can pull your pelvis into an anterior tilt, compressing the spine and pulling your back into hyperlordosis or “duck butt.” If your psoas is overstretched or weak, it can flatten the natural curve of your lumbar spine, creating a “flat butt.” This misalignment is characterized by tight hamstrings pulling down on the sitting bones, which cause the sacrum to lose its natural curve and result in a flattened lumbar spine. This can lead to low-back injury, especially at the intervertebral discs. You may also feel pain at the front of your hip. Finally, it is possible for your psoas muscles to be both tight and overstretched. In this case, your pelvis is pulled forward in front of your center of gravity, causing your back to curve (swayback) and your head to poke forward.
- Difficulty moving your bowels. A tight psoas muscle can contribute to or even cause constipation. A large network of lumbar nerves and blood vessels passes through and around the psoas muscles. Tightness in the psoas muscles can impede blood flow and nerve impulses to the pelvic organs and legs. In addition, when the psoas is tight, your torso shortens, decreasing the space for your internal organs. This affects food absorption and elimination. As such it can contribute to constipation, as well as sexual dysfunction.
- Menstrual cramps. An imbalance in your psoas muscles can be partially responsible for menstrual cramps, as it puts added pressure on your reproductive organs.
- Chest breathing. A tight psoas muscle can create a thrusting forward of the ribcage. This causes shallow, chest breathing, which limits the amount of oxygen taken in and encourages overuse of your neck muscles.
- Feeling exhausted. Your psoas muscles create a muscular shelf that your kidneys and adrenals rest on. As you breathe properly, your diaphragm moves and your psoas muscles gently massage these organs, stimulating blood circulation. But when the psoas muscles become imbalanced, so do your kidneys and adrenal glands, causing physical and emotional exhaustion.
In fact, according to Liz Koch, author of The Psoas Book, “The psoas is so intimately involved in such basic physical and emotional reactions, that a chronically tightened psoas continually signals your body that you’re in danger, eventually exhausting the adrenal glands and depleting the immune system.”
9 Tips for Keeping Your Psoas Muscles Happy and Healthy
Exercise, sitting in your favorite chair, wearing shoes, and even unhealed physical and emotional injuries can cause an imbalance in your psoas muscles. Getting things back in balance will give you a greater range of motion and relief from pain. Plus, you will feel more grounded and relaxed!
Here are some tips for getting things back in balance:
- Avoid sitting for extended periods. If you must sit for work or other reasons, sit with good posture and be sure your hips are level or slightly higher than your knees. It’s a good idea to put a towel folded lengthwise under your hips when sitting. This tilts the pelvis in a way that lengthens the hamstrings and relaxes the psoas muscles. Avoid bucket seats and chairs without support for your low back. Try to get up and move around every hour.
- Add support to your car seat. Use a rolled-up towel underneath your sit bones and/or behind your lumbar spine to keep the psoas and hip sockets released. If you are traveling long distances, stop every 3 hours to stretch and walk around for 10 minutes.
- Lay off extreme exercise routines. I don’t mean completely or forever. But if you are a power walker, distance runner, or sprinter, or even if you do a lot of sit-ups, you may want to alternate your workouts.
- Try resistance flexibility exercises. Resistance flexibility exercises can do wonders for your fascia. To strengthen your psoas, lay on your back with your hips abutting the wall next to a door frame. Raise one leg straight so that it is against the wall. (Your other leg will extend through the doorway.) Bend your extended leg and, using your hands to slow down the movement and create resistance, bring your bent knee toward your chest. Do this while also pressing your raised leg into the wall. Then reverse the motion of your bent leg. As you straighten it, continue to create resistance using your hands to push your leg out as your leg resists.
- Get a professional massage. Getting a massage from a seasoned practitioner can help relieve a tight psoas muscle. Understand that this work is not the most comfortable but can be of great benefit. In fact, getting myofascial release on a regular basis helps to keep your psoas, and all of your muscles, fluid. Assisted stretching (as with a resistance flexibility trainer) and yoga are also excellent ways to restore balance to your psoas.
- Take constructive rest. The constructive rest position (CRP) can relieve low back, pelvic, and hip tension while it allows your entire body to come into neutral. Lay on your back with your knees bent and your feet on the floor hip-width apart and parallel to each other. Place your heels a comfortable distance from your buttocks or about 16 inches away. Do not push your low back into the floor or tuck your pelvis. Rest your arms over your belly. Let gravity do the work. Doing this for 10 to 20 minutes every day will release tension in your psoas muscles and help to reestablish the neurobiological rhythms that calm and refresh.
- Pay attention to your pelvis! The length of the psoas determines whether or not your pelvis is free to move. To tell whether your psoas muscles are tight or overstretched, stand sideways by a mirror (or even better, have a friend take a photo of you from the side). Note the position of your pelvis. If you were to draw a line along your pelvis from back to front, that line should be pretty straight. If the line tilts downward, your pelvis is anteriorly rotated or moving toward the front of your body. This means that your psoas muscles may be short and tight. If the line runs upward, your pelvis is posteriorly tilted toward the back of your body. This means that your psoas muscles may be overstretched and weak.
- Release stress and past traumas. We store stress in our bodies. Tension in the hips is common, and it’s usually not just caused by lifestyle, age, and physical events such as injuries or accidents. It is also due to mental stress and unhealed traumas. Releasing stress daily can help keep your psoas healthy. Take a leisurely walk. Soak in a bath with Epsom salts. Acknowledge your emotions, express them, and release them. Divine Love is a great way to heal from past traumas. Finally, get out and do something pleasurable every day!
Use Pandiculation to Heal Your Psoas and All Your Muscles
Pandiculation, or active stretching, is a somatic movement that is typically associated with yawning, especially when you first wake up in the morning, but it is so much more than that. Pandiculation is actually your nervous system’s wake-up call. In fact, it has been called “nature’s reset button” because it prepares your sensory-motor system for movement. And pandiculation is critical to the proper functioning of your entire musculoskeletal system.
If you have ever seen a cat or dog move when they first wake up, you have probably noticed how they arch their backs up then drop their bellies while they lengthen their legs. We sometimes call this a “cat-cow” stretch in yoga. But your dog or cat is pandiculating. Humans pandiculate automatically when waking or after we have been sedentary for a while. Even fetuses have been seen pandiculating in the womb—it’s that deeply ingrained in our nervous systems.
Gentle somatic movement patterns that incorporate pandiculation can retrain your brain and muscles so that your muscles move more easily. Pandiculation works by sending biofeedback to your brain informing it of the level of contraction in your muscles. When done regularly, pandiculation can help prevent chronic muscle tension, restore proper muscle function, and even lengthen short, overly tight muscles.
Preventing muscle tension is critical to maintaining healthy posture and movement. The best part is you can learn how to do somatic movements at home to help ease the pain of tight muscles, including your psoas muscles.
There are 3 steps to a pandiculation:
- Flex. Gently contract the tense muscles. So, let’s say you have tight trapezius muscles and a sore neck and shoulders. You could contract your trapezius muscles and lift your shoulders to your ears.
- Extend. Slowly lengthen the muscles you have contracted. In the case of your shoulders, start to slowly pull them down and away from your ears. Do this in a controlled manner.
- Relax. Completely relax the muscles. When you relax the muscles you just contracted and lengthened, your brain integrates the new feedback. This helps your brain remember that those muscles don’t have to stay stuck.
Start with contracting and releasing one muscle at a time, then progress to a small group of muscles, and eventually move to larger movements involving many muscles and even your whole body.
Everyone can practice pandiculation. Some exercise forms, such as yoga and resistance flexibility, actually incorporate pandiculation. You can find specific pandiculation movement patterns online or look for a somatic movement class or workshop. It’s easy to perform pandiculation in as little as 5 minutes at home. Or you can do it 40 to 50 times per day—just like your dog or cat does!
Do You Suffer from Psoas Syndrome?
While most people with psoas imbalances will be able to heal through the exercises I mention above, there are some people who suffer from psoas syndrome, a painful condition often misdiagnosed because the symptoms are difficult to distinguish from other causes of back and hip pain. It’s not uncommon for people with psoas syndrome to see many doctors and have many tests, the results of which can be inconclusive. While psoas syndrome is more common in athletes, people who sit a lot can also be at risk.
Since the pain referral pattern of psoas syndrome is similar to other potentially serious conditions, doctors will want to rule out other causes of pain. One condition that psoas syndrome may mimic is a herniated nucleus pulposus. This is a condition in which part of the soft, gelatinous central portion of the disk is forced through a weakened part of the disk. Other conditions that psoas syndrome may mimic include hip arthritis, femoral bursitis, hip tendonitis, diverticulitis, salpingitis (inflammation of the Fallopian tubes), urethral stones, and even colon cancer.
When to Suspect You Have Psoas Syndrome
People who suffer from psoas syndrome have certain symptoms in common. The primary symptom is pain in the lumbosacral region when sitting or standing and pain that worsens when doing anything that bends the hip, such as walking, climbing stairs, squatting, and sitting. You may also have difficulty standing erect. Pain in the glutes is another common symptom, especially contralateral pain that radiates down the opposite leg. This pain usually stops at the knee. Pain in the lower abdomen, groin, iliac crest, and thigh/leg are also common.
If you suffer from these symptoms, be sure to see your health care provider to rule out other conditions and injuries. You may need a physical exam of your back and hip and diagnostic tests. If you are diagnosed with psoas syndrome, seek a practitioner who is experienced in applied kinesiology and biomechanics and who can address any potential pelvic distortion, joint restrictions, foot pronation, and hip and knee imbalances. Some chiropractors and massage therapists also have experience in treating psoas syndrome and use specific techniques, such as joint clearing, soft tissue release, cross-fiber massage, muscle energy, and proprioceptive neuromuscular facilitation (PNF) stretching to help relieve symptoms.