I am super excited to be talking with you today because we’re going to be talking about one of my favorite subjects, the hip flexors. I love to geek out, talk about different muscle groups, and how they interact and influence different parts of your body. The hip flexors are one of the most, if not the most, important muscle group for you to understand when it comes to lower back pain. It’s important to spend some time looking and talking about the hip flexors. The more you can understand how they cause back and other issues throughout the body, the more you’re going to get effective at fixing your back pain for good. This is why we call it the hidden secret. This is a subject not very many people know a lot about.
The hip flexors in particular, and the hip in general, is a group of muscles. There’s one muscle in particular we’re going to be focusing on, the psoas. It’s spelled PSOAS, the P is silent.
The psoas, a part of your hip muscle group, is the hidden secret to fixing your lower back pain.
Over the years, I’ve found there are many people, clinicians, doctors, other therapists, chiropractors, and healthcare practitioners who don’t know how to fix lower back pain. I can’t tell you how many clients I’ve had over the years who have come in to see me after seeing other healthcare professionals and their back pain is not getting any better. When I sit down and I talk to them and go through the exam, I always go directly to their hip flexors. More specifically to that psoas muscle.
One client in particular stands out in my mind. As I’m looking at his psoas muscle and seeing how tender it is, he about jumped off the table. He had gone to another location and had about 11 or 12 sessions but his back pain wasn’t any better. I asked him, did anybody even look at your hip flexors? No one had ever looked at them, seen how tender or how sore they were. I knew right away that was his primary problem. He’s not the only one. There have been hundreds if not thousands of clients over the years where their hip flexors are the main problem with lower back pain. It has to be addressed.
It’s just one of those things, when somebody starts saying hey, my back hurts, they go directly to their back. The thing you have to remember is your back pain is probably not caused by your back. It’s caused by the imbalances of other muscle groups that are influencing your spine.
The psoas is so important to the lower back and your hips.
Not only can it affect your back, but it can affect your life. Your hips are one of the most important parts of the body. If your hips are not loose and healthy, then you’re going to have all kinds of problems. You can’t move properly if your hips are not healthy. Every movement is impacted by your hips. Sitting, standing, twisting, bending, walking, climbing, steps, the list it goes on and on. When you’re just out living your life, working, getting in and out of the car, grocery shopping, or dancing with your spouse your hips create that movement.
Your hips are made up of your pelvis and your pelvis is made up of three individual bones that are fused together. But as a unit, we refer to it as your pelvis and femur. Then there is a joint called the ball and socket joint, is your hip joint. The acetabulum foremoral acetabular joint. The pelvis is connected to the lumbar spine and together makes up the lumbopelvic area. The hips affect the angle of the person, meaning your pelvis can tip forward and backward. The orientation in the alinement of your hips will affect that. The pelvis will affect the spine.
There are over 15 different muscles in this hip area and we break them up into different groups. We think of this as your gluteal group, also known as your butt muscles. Then we have your muscles inside called your hip rotators. Your hip rotators are the ones that kind of turn your femur back and forth providing stability. Next, we have your ab in abductors that help pull the leg away from the body. The inside, basically your groin muscles, are called adductors and they pull it towards the body. The last group is the iliopsoas, which is in the front. That comes off the spine, through the abdominal area and attaches to your femur.
The Iliopsoas Hip Muscle Group
The most important portion of this is the psoas major. Theirs is a psoas major and a psoas minor. The psoas minor is pretty insignificant, there’s people who don’t even have it. Then you have the iliacus, the muscle that fills in the pelvis area that attaches to the femur. We’re not going to worry about the iliacus because it doesn’t influence the spine as much as the psoas does.
The psoas is the prime mover in flexing the hip. It comes off the spine, through the abdominal wall, and then merges with iliacus, and then attaches to the femur. Its job is to bring the leg up and helps flex the spine. If your legs are stationary and the muscle contracts, it can pull you forward. But it also stabilizes the spine, assists with the femur rotation, and the abduction bringing the leg to the inside. The psoas muscle does a lot of different things, but the primary function is bringing the leg up and bending the trunk forward. Okay.
It’s important to remember the psoas muscle is the only muscle connects the legs to the spine. It comes off of the spine, goes all the way through and connects to the femur. All of the other muscles in your back either connect the pelvis to the femur or the pelvis to the back. The psoas muscle is unique in the fact that this muscle connects the lower part of the body to the upper part of the body. That’s why it is so important.
The psoas muscle takes its attachment off of all the lumbar vertebrae. It goes up so high it can influence some of the actions of the diaphragm, such as your breathing patterns. As I mentioned before, it passes through the pelvis and abdominal area; blends with the iliacus, continues through the groin, attaches into this little PC (trochanter), and attaches to the femur. The psoas is critical for posture, movement, and your overall health.
It also helps create support to your organs in the abdominal area, the blood vessels of the abdominal region, and the nerves coming off the lumbar spine. As well as moving weight from the back to the legs and stabilizing your spine.
Think of your spine like a telephone pole.
What if that telephone pole was not buried in the ground? You’ve got electrical poles and telephone poles all over the place, but they buried those deep in the ground. Imagine it wasn’t buried in the ground. The telephone pole would fall over. Let’s say you couldn’t bury it in the ground. What could you do? You would attach guidewires from the ground up at different angles. That’s what the psoas does. You can see it comes up attaching along the side and to the femur where it gives stability, just like the guidewires.
If the wires don’t hold or they give away the telephone pole is going to fall over. If the wires on one side are lose and the other side they are super tight, the pole is going to lean one direction. Everything would have to be perfectly balanced and all that tension would have to be equal. That’s exactly what has to happen with your psoas muscle. Your psoas muscle can contract and relax independently of its attachments at the joints. Where it’s attached on your spine?
The muscle can still contract in the middle where it’s attached to your spine without moving these joints. It helps counterbalance the imbalances in the structure of the spine, it’s stabilizing the spine. If your spine is unbalanced, your psoas can help counteract that. In order to do that, your psoas has to be healthy.
Shortening of the Psoas
If the psoas starts to shorten or lose its flexibility, there are a lot of bad things that can happen. It will change how your body reacts to movement and stress. Then it causes other muscles to compensate for what it can’t do. If your psoas starts to become too tight or become shortened, it creates an uneven pull on the spine, like the telephone pole. It would be like your guidewires getting really tight on one side and a little loose on the other. Or your guidewires coming off at different angles with one angle pulling more than the other.
What’s going to happen is that’s going to change how that telephone pole sits. The same thing happens with your psoas. If it starts to tighten up, it will start to create a tipping of your pelvis in a forward direction. When your pelvis starts to tip, then the hip joints start to turn in a little bit, we call that internal rotation. They start to move to the inside. That creates a secondary effect where your quad muscles start to compensate for the femur changing position and they’ll overdevelop.
Every muscle group in the body has an opposing muscle group.
Those two groups have to be in balance with each other. Think of this like your biceps and triceps. Your biceps are on the front of the arm and the triceps are on the back. When they are relaxed, it means they are balanced, nothing is happening and your arms are straight. When you want to bend the elbow, the biceps have to contract to produce movement. If your triceps try to counteract it, no movement’s going to occur. Your brain sends a signal to the triceps that says shut down, basically turns it off so your bicep can bend the elbow. That’s what we call reciprocal inhibition. I don’t want to confuse you, but it’s a very important term to remember. Just remember that when movements occurring, the opposing muscle group of the muscle producing the movement has to relax.
The brain has to shut that off.
Your pelvis starts to tip forward. Femur starts turning in. Quad muscles get overdeveloped. The psoas muscle starts to shorten because it’s becoming overactive and becomes what we call hypertonic. Remember we said the psoas can contract independently of its joints? The psoas starts to adjust knot itself up, like a spasm or a knot in your neck. A knot is literally the muscle all contracted up. That’s happening in your psoas.
So, then the brain says, “Hey muscle, the psoas is trying to work. We’re going to shut the glutes off.” Guess what happens if your brain sends a signal to your butt muscle saying hey, you don’t need to contract anymore. You can relax, your psoas is taking over. Well, the psoas can’t do its work because now it’s gotten shortened, it’s hyperactive, and your gluteal muscle will weaken. That reciprocal inhibition becomes enough that those glutes will actually weaken.
You have one muscle back here, the quadratus lumborum, that runs off the back side of the spine and then attaches to the top of the pelvis up here to the ribs. That will start to knot up and that’s where people will get painful trigger points and creates a lot of compression in the spine. Then they’ll get back spasms. All of that is caused because the psoas gets unhealthy and becomes overactive. It creates this cascade of events in the body and that all impacts the spine itself. If somebody goes to see someone for their back and all they do is core strengthening because they claim your back is weak, you’re not addressing the problem.
If you’re not addressing the psoas and there’s things you have to do in order to get it to shut off, your back pain is not going to get better. This is extremely complicated. The hips and the back are very involved and it’s all centered around that psoas.
One of the main causes is exactly what I’m doing right now. It’s plain and simple, sitting. As we become more advanced in technology we are sitting more and more. There’s no doubt about it. We’re driving more, sit down to eat, watch TV, spend all of our time on our computers or other devices. We’re just doing a lot more sitting than we ever have in the history of mankind. It’s very interesting because third world countries don’t have back pain like we do. One of the thoughts is it’s because they’re not as sedentary.
A lot of times your more active in a third world country because you have to go out and get your own water. They have to do more physical work and they’re up and moving. They don’t sit down to relax because that’s not a part of their culture. These developed countries, like Europe and the United States, back pain is more prevalent. That is because of the sitting.
When you sit it shortens that psoas.
If I put Bob in a seated position, remember that muscles coming right down here, I’m going to shorten it because it’s going to create some slack. If you do that enough, eventually it’ll stay shortened and when you try to straighten it out, it goes into that spasm. You might say I don’t sit that much, Mike, why am I getting it? I’m an athlete. I work out a lot. I run and stretch but I still get these problems my back. Not only is sitting a cause, but the psoas can be impacted by repetitive movements and activities.
If you’re doing the same thing, running or biking the same way, you’re doing the same movements. It could be at work. You could be climbing stairs and you always lead with one leg versus the other. You are using that psoas too much in this same manner and not having things that are a little bit more varied in your activity levels. That’s why even athletes who are really active can suffer a psoas imbalance.
The psoas is just not key to posture, hip power, and spine support as well. It does all those things, but it is also directly linked to our nervous system. It has a very large impact on our central nervous system. I’m going to go into that more next time because that’s really important to understand. It’d be way too much for me to go into today. We’ll talk about that next time.
The Five Best Kept Secrets to Fast Back Pain Relief
If you haven’t gotten a copy of my new eBook, The Five Best Kept Secrets to Fast Back Pain Relief, you can get your copy Mike@flex-pt.com or shooting me a message on Facebook messenger. Just request “the back-pain report” and we’ll get that sent right out. Like always, I want to leave you guys with a really good thought-provoking quote. One of my favorite authors is Francis Chan. He said, “giving that is not motivated by love is worth nothing”. I would like to let you guys think about that one for a while.
Until next time. Power Your Life and keep moving forward.