Dominic Stone
The psoas muscle is a core muscle that helps move the hips and upper legs and supports posture. It is located in the lower back and pelvis and is responsible for hip flexion, lumbar spine stabilization, and posture maintenance. When the psoas muscle becomes tight, it can lead to discomfort and mobility issues. There are several factors that can contribute to a tight psoas muscle, including prolonged sitting, certain athletic activities, stress, and poor posture. Prolonged sitting keeps the psoas muscle in a shortened state, while athletic activities that involve repetitive hip flexion, such as running or dancing, can cause overuse or trauma. Stress can also lead to muscle tension, and poor posture can further contribute to tightness.
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Prolonged sitting
Sitting for long periods can also cause tightness in the muscles around the hips and lower back. The psoas muscle is located deep within the core of the body, underneath other spinal and abdominal muscles, and so it is difficult to feel with your hands. When the psoas muscle is tight, it can cause dull aching pain in the lower back and groin due to increased pressure in these areas.
The psoas muscle flexes the hip, so when it contracts, it brings the knee towards the stomach. It also laterally rotates the hip, allowing the leg to be held outward from the body. If you spend a lot of time sitting, your psoas muscle is likely to be tight as a result of spending so much time in a shortened state.
To prevent the psoas muscle from tightening due to prolonged sitting, it is recommended to get up and move and stretch regularly. It is also suggested to sit with your hips in line or slightly higher than your knees. This will slightly improve the position of the psoas and help to prevent it from shortening and tightening.
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Overuse or trauma
Psoas syndrome is a condition characterised by pain and inflammation of the distal iliopsoas tendon, with less frequent involvement of the distal muscle. It is commonly caused by overuse or trauma, particularly in athletes who engage in repetitive hip flexion, such as runners, dancers, and high jumpers. Overuse can lead to muscle tightness, weakness, and injury, resulting in avulsion or tearing away from its bony attachment. This can occur anywhere along the psoas muscle, including the lesser trochanter, the bony projection from the lower or back part of the femur neck base.
Athletes who participate in sports that require repeated bending of an externally rotated hip are at risk of psoas avulsion injuries. This includes ballet dancers, who often experience a snapping or clicking sensation due to the psoas muscle's role in laterally rotating the hip. Other sports that can lead to psoas avulsion injuries include resistance training, gymnastics, soccer, rowing, track and field, and uphill running. Activities that involve speed and sudden stops, as well as sudden and forceful contractions of the pelvic muscle, can also contribute to psoas avulsion injuries.
In addition to athletes, individuals who spend a lot of time sitting can also develop a tight psoas muscle due to the muscle being in a shortened state for extended periods. Prolonged sitting can lead to muscle tightness and weakness, increasing the risk of avulsion injuries when engaging in physical activities.
Psoas syndrome caused by overuse or trauma typically responds well to conservative management, and full recovery is often achieved. Treatment options include rest, physical therapy, and anti-inflammatory medications. Early identification and prompt involvement of specialists improve the likelihood of a successful recovery.
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Malignant invasion
MPS is caused by malignant infiltration of the psoas muscle and adjacent nerves. It has been associated with metastatic carcinoma, melanoma, liposarcoma, and non-Hodgkin's lymphoma. In one case, a 68-year-old woman presented with a sarcoma in the left psoas muscle, resulting in symptoms of MPS. The patient underwent pre-surgical radiotherapy, which improved pain control without increasing analgesic medications.
Radiotherapy has been shown to be effective in managing the pain associated with MPS and should be considered as a therapeutic option. It is non-invasive, and any acute side effects can be easily managed with modern pharmaceuticals. Surgery is another treatment option, but it is difficult in this region due to the elusive nature of clear margins.
The true incidence and prevalence of MPS in the general population are unknown, likely due to frequent underdiagnosis, misdiagnosis, and spontaneous symptom resolution before clinical evaluation. However, it is important to rule out metastatic spread to the psoas muscle when assessing patients with psoas syndrome.
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Poor posture
When the psoas muscle becomes tight, it can lead to significant discomfort and mobility issues. For example, a tight psoas muscle can cause pain in the lower back, hips, and groin, as well as stiffness or tightness in the lower back. This pain can be triggered by positional changes, such as transitioning from a seated to a standing position, or difficulty maintaining an upright posture.
To prevent and treat a tight psoas muscle due to poor posture, it is important to focus on maintaining a neutral posture while sitting, exercising, or engaging in other physical activities. This includes keeping your head above your shoulders, holding your shoulders above your hips, and sitting with your knees bent at a 90-degree angle with your feet flat on the floor. Walking is also recommended, as it helps the body relax and return to a neutral posture, especially after prolonged sitting.
Incorporating regular movement breaks, ergonomic adjustments, strength training, and mind-body practices like yoga or Pilates can also help alleviate tension in the psoas muscle and improve overall posture.
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Stress
The psoas muscle is often referred to as the "muscle of the soul" as it is believed to store emotional tension. Due to its location deep within the core of the body, the psoas muscle instinctively tightens up when we feel stress or fear. Stress can lead to muscle tension, which may exacerbate existing issues within the psoas muscle.
When the psoas muscle becomes tight, it can lead to significant discomfort and several other issues. For instance, a tight psoas muscle can cause a thrusting forward of the rib cage, encouraging shallow breathing. This limited oxygen intake encourages the overuse of neck muscles. The psoas muscle creates a muscular shelf for the kidneys and adrenals. When you breathe in, the psoas gently massages these organs, making it easier for them to work. If your psoas muscles are imbalanced, your kidneys and adrenal glands may be as well, leading to physical and emotional exhaustion.
A tight psoas muscle can also contribute to a pelvic rotation, which in turn causes an internal rotation of one leg. To counterbalance this effect and maintain symmetry when walking, the opposite leg will rotate externally. This will make the internally rotated leg longer, so every time you take a step, it drives your leg up into your hip, which can lead to functional leg length discrepancy.
When the femur is locked into place by this tightened muscle, rotational movement will not occur. When a person's psoas is tight, they may experience pain in their lower back and hips due to compression of the discs. The tightness of the psoas muscle can also cause low back pain or pelvic pain. When the psoas muscles are too short or tight, they can pull the pelvis into an anterior tilt and cause hyperlordosis in the back. This misalignment is distinguished by tight hamstrings pulling down on the sitting bones, causing a flattened lumbar spine. The psoas muscles can pull the back forward and prevent a person from standing up straight, which can cause low-back pain and injuries at the intervertebral discs.
In addition to back pain, individuals may experience tightness or discomfort in the groin area. This sensation may be mistaken for a hip issue, but it is important to recognize that the source is often related to the psoas muscle. Some may also report pain that radiates down the legs, which can lead to confusion during diagnosis.
To address stress-related psoas syndrome, it is essential to consider both physical and emotional health. Conservative treatment options are often the first line of defense. One of the most effective methods is physical therapy, which focuses on stretching and strengthening exercises tailored to the individual's needs. A physical therapist may design a program that targets the psoas muscle specifically, helping to release tension and improve flexibility. Additionally, the use of heat and cold therapy can provide relief from pain and inflammation. Applying heat can help relax tight muscles, while cold packs can reduce swelling and numb sharp pain. Combining these therapies with rest can significantly enhance recovery.
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Frequently asked questions
Psoas Syndrome is a condition that affects the psoas muscle, a key muscle located in the lower back and pelvis. It is characterised by pain and inflammation of the distal iliopsoas tendon, with less frequent involvement of the distal muscle.
Psoas Syndrome is often caused by overuse or trauma, especially in athletes whose sports involve a lot of repetitive hip flexion, such as running, dancing, and high jumping. It can also be caused by prolonged sitting, poor posture, or spinal pathology in non-athletes.
Individuals with Psoas Syndrome may experience pain in the lower back, pelvis, hips, and groin. It can also cause constipation, shallow breathing, and physical and emotional exhaustion.
Conservative treatment options are often the first line of defence against Psoas Syndrome. Physical therapy, heat and cold therapy, rest, lifestyle modifications, and ergonomic adjustments are some of the recommended treatments.
