Can This Psoas Be Saved?

ExRx: Clearing up the confusion about the psoas muscles, which are buried deep in the trunk.

It’s no wonder the psoas are so misunderstood. The very process of naming these muscles connecting the top half of the body to the lower half has been a series of errors spanning four centuries.

Long before Hippocrates began using the modern Latin term psoa—muscle of the loins—ancient Greek anatomists called these muscles the “womb of the kidneys,” owing to their physical relationship to those organs. In the 1600s, the French anatomist Riolanus committed a grammatical error that survives to this day, identifying the two psoa muscles as the psoas instead of using the proper Latin psoai (Diab 1999)—a goof that would, in the end, perhaps influence our tendency to think of these muscles as a co-functioning team rather than as individual muscles that can adapt to our asymmetrical habits.

Adding insult to injury, in the 1950s John Basmajian, MD, father of electromyograph (EMG) science, argued that the iliacus and psoas muscles could not be expected to have unique functions because they share a common lower attachment site. His opinion triggered widespread use of the term iliopsoas, stripping each muscle of its individual identity and setting the precedent of misattributing iliacus EMG measures to the deeper and more-difficult-to-read psoas muscle. All this historical context makes it much easier to understand why there is widespread confusion about the actual role of the psoas.

Anatomical Review

When speaking of the psoas, it’s noteworthy to mention that while this term represents two muscles—the psoas major and minor—the latter is present in only about half the population. This article will focus specifically on the psoas major.

While the psoas major may seem like one long muscle that passes over multiple joints, dissection reveals a slightly different story. The body of each psoas contains (on average) 11 branches of muscle fibers—fascicles with separate attachments to bony sites—with the most superior fascicle attaching to the lowest thoracic vertebra, while others continue on down to various sites on the lumbar spine and to a final attachment on the femur. In addition to attaching on the transverse processes of some vertebrae, the psoas attaches directly to each of the lumbar spine’s intervertebral disks. This adds up to a total of 22 attachments: one on each thigh and 20 points of attachment on the spine.

The psoas has two layers—superficial and deep. Embedded between these muscles is the lumbar plexus, a dense collection of nerves that innervate the transverse and oblique abdominals, the pelvic floor, the deep hip rotators and most thigh muscles (Kirchmair et al. 2008). Because the psoas attaches at multiple locations, passes over multiple joints and entraps a major neurological network, it is no wonder that so many injuries can be blamed on one misbehaving muscle.

Psoas Mechanics

In light of all those connection points, you might ask, Does the psoas flex the hip? Does it move the spine? Or does it do a little of both?

Biomechanists are always trying to figure out what a muscle is “supposed” to be doing, considering joint health, leverage and force production. All those connections to the spine seem to imply that the preferred role of the psoas would be to somehow move the spine. But tests of this hypothesis show that the angles of attachment don’t allow much force production during side bending (lateral flexion). Remember those grade school (old school!)–style sit-ups from the National Fitness Testing program (now known as the President’s Challenge Program)? During motions like sit-ups (which, oddly enough, are still part of the protocol), the psoas simultaneously extends the upper vertebrae while flexing the lower vertebrae, creating a shearing motion on the spine (one vertebra sliding forward on the other) and exerting substantial compressive loads (Bogduk, Pearcy & Hadfield 1992)—not the most preferred movement for long-term spinal health.

Studies show that the psoas has an active role in hip flexion, but compared with the iliacus, the psoas plays a larger role in vertebral stabilization (keeping the vertebrae from rotating in the frontal plane) than in generating leg motions (Hu et al. 2011). And finally, the many attachments make it extremely important that the psoas can lengthen enough to allow the spine, pelvis and hips to articulate and move naturally for a pain-free and injury-free body.

The “Sitting” Psoas

If you’ve ever watched a triathlete transition (decrepitly) from the cycling phase of a race to the running portion, you have a sense of how a long bout with a tightening psoas can affect our ability to walk upright. In a slightly less extreme way, hours (and hours and hours) in the sitting position affect the psoas’s ability to extend to its full length—a length that allows us to stand in alignment and, perhaps more crucially, lets the hip extend as we walk. If you quickly calculate how many of your clients move from 8 or more hours of sitting at their jobs to “fitness” activities that further perpetuate the skeletal arrangement of a shortened psoas (cycling, stair-stepping, sitting on weight machines), then it is no surprise that the exercising population has so many psoas-related issues of the low back, pelvis and hips.

What Does a Short Psoas “Look” Like?

It is not uncommon for professionals to spot an exaggerated curve in the “low back” and conclude that the client has an anterior pelvic tilt. This form of postural assessment is flawed, however, because there are no objective data points to determine actual skeletal position or where, specifically, the curve is occurring. The spinal curve from a tight psoas is not a hyperextension of the lumbar spine, nor does it result from an anterior pelvic tilt. It is, rather, a unique curve created by anterior displacement (shear) of superior vertebrae coupled with various degrees of extension and flexion in the upper and lower lumbar spine, respectively. It looks very similar to hyperlordosis, with the exception of one bony marker: the rib cage.

Assessing the Psoas

Because the psoas can shear the vertebral column forward, it is very common to see a “rib thrust” in those with a shortened psoas. Assessing this from a standing position can be difficult to do, though, as many people compensate for their tight psoas by slightly flexing their hips and knees to put a bit of “slack in the (psoas) line.” To keep your assessment objective, try this supine technique:

Begin with your client sitting on the floor with legs extended. The quadriceps should be fully relaxed and the hamstrings resting on the ground. Have the client begin to recline, stopping when the hamstrings lift away from the ground. At this angle, bolster your client under the head and scapulae, leaving space for the ribs to lower to the floor. The height of the bolstering will depend on psoas tension.

Ideally, we should be able to lie “in skeletal neutral” while on the floor. A shortened psoas will lift the thigh bones and/or the lower ribs away from the floor. This assessment is also the corrective. When you have identified that the psoas is indeed elevating the rib cage, instruct the client to relax until the lower ribs meet the ground. As your client releases, progressive shifting in the height or position of the bolster may be necessary.

Psoas or Iliacus?

Supine leg raises are a fairly common exercise in therapeutic and training situations. Ideally, raises should strengthen the legs, but most people actually do this exercise with their psoas instead of with the muscles needed for knee stability. How can you tell? Many exercisers will lift the leg while simultaneously tilting the pelvis posteriorly. While this is still technically a “leg raise,” the movement’s hinge is the lumbar spine—not the hip—which increases the load on the lumbar disks, fails to improve stabilization of the knee and further shortens the psoas. Teach leg raises a better way:

Have the client begin supine, with one knee bent and the other fully extended on the ground. Before beginning the exercise, the pelvis should be placed in neutral (with anterior superior iliac spine, aka ASIS, and pubic symphysis in the same horizontal plane). Cue your client to lift the straight leg to the height of the opposite knee without moving the pelvis.

Balancing the Psoas: What to Increase and What to Decrease

Perhaps never before have people been more informed via their healthcare team that their low back, hip, groin and pelvic issues are stemming from the mysterious psoas. This is why it is essential that movement professionals understand the anatomical features and biomechanical action of the psoas and know how to modify exercise programming to lessen the risk of an issue developing in the future.

It is no surprise why exercisers—from fitness and sport enthusiasts to elite professionals—have so many issues with their psoas. Performing a quick kinematic assessment of the most preferred exercise modes, you will find the majority of them are driven by hip flexion. And if you calculate and track a client’s habitual joint angles throughout the day, the results will likely show large periods (think hours!) sitting—at work, in the car, on the couch. Coupling work-time sitting with exercise-time sitting, the psoas doesn’t stand a chance with all that hip flexion!

While it may seem logical to balance a heavy hip-flexing habit with equal amounts of extension, this is not the best exercise prescription, as it does little to reduce the inappropriate amount of tension in the psoas—it just overrides it temporarily. Instead of adding extension exercises, look to replace common hip flexion activities like treadmill and bicycle workouts with in-line skating or cross-country skiing, actions driven more by hip extension. Talk to clients about reducing sitting time by using a standing workstation, and try to eliminate sitting (bikes, weight machines and so forth) during workouts. Consider adding a few psoas stretches and lengthening exercises like yoga’s warrior or lunge poses, paying special attention to the rib thrust. Rib thrusting during these exercises reduces their effectiveness in lengthening the psoas. Cue clients to lower the bottom ribs until they line up over the pelvis, to keep their muscular attachments in check.

For the latest research, statistics, sample classes, and more, "Like" IDEA on Facebook here.

15 more

Katy Bowman, MS

IDEA Author/Presenter
References
Alton, F., et al. 1998. A kinematic comparison of overground and treadmill walking. Clinical Biomechanics, 13 (6), 434–40.

Bogduk, N., Pearcy, M., & Hadfield, G. 1992. Anatomy and biomechanics of psoas major. Clinical Biomechanics, 7 (2), 109–19.

Diab, M. 1999. Lexicon of Orthopaedic Etymology. London: Informa House.

Hu, H., et al. 2011. Is the psoas a hip flexor in the active straight leg raise? European Spine Journal, 20, 759–65.

Kirchmair, L., et al. 2008. Lumbar plexus and psoas major muscle: Not always as expected. Regional Anesthesia and Pain Medicine, 33 (2), 109–14.
October 2012

© 2012 by IDEA Health & Fitness Inc. All rights reserved. Reproduction without permission is strictly prohibited.

Get the award-winning IDEA Fitness Journal delivered to your door every month!

Get IDEA Fitness Journal

Article Comments

Anonymous
On Oct 15, 2012
Katy, I find your psoas article very interesting and informative. I am the author of the 2012 book the Vital Psoas Muscle and would love your feedback on it. Please let me know if you have seen it, if not I can get you a copy.
Thanks, Jo Ann Staugaard-Jones
Heidi Harrison
On Oct 18, 2012
excellent article. Thank you very much.
Heidi H
Jody Twer
On Oct 18, 2012
great info - thanks!
Anonymous
On Oct 18, 2012
good information and well written,thanks.
Kathy Moore
On Oct 19, 2012
Wow ! You just cleared up a lot of misconceptions about this important muscle group !
Maria Peterson
On Oct 19, 2012
Great article. Amazing how many attachment sites there are, all the way from the lowest thoracic vertebrae to the femur. So not only are the hip flexors tight, but there's a pull down on the chest cavity as well. So a healthy, lengthened psoas also makes for better breathing.
Nancy Matican Bock
On Oct 20, 2012
Much needed information! Thank you!
Lisa Blomquist
On Oct 20, 2012
helpful info, thanks. Would have been REALLY helpful with some pictures/graphics...
Kathi Hawraney
On Oct 20, 2012
Thanks!! Great explanation! I pictured several clients as I was reading the article.
Andrew Potts
On Oct 21, 2012
As a matter of interest would using. Old fashioned Granny bicycle not help. The spine in line upright cycling posture, as in standing must help considering the tempo is slow and the down force is mainly the muscles involved in hip extension. Think the bicycle that is used daily in places like Amsterdam. Or am I cycling up a one way street?
Lisa Roper
On Oct 21, 2012
Eliptical machines with heel-lowering inclines are excellent for avoiding further Psoas problems, also, stretching this muscle lightly before and for a few minutes after really helps to neutralize the spine, which really does contribute to better breathing. And consider wearing Kalso Earth Shoes to train and maintain this important alignment/strength/flexibility issue.
Heather Reade
On Oct 29, 2012
I found this article very useful, informative and well-written! I especially enjoyed the history behind the naming of the psoa/psoas.
While yoga is super for stretching the psoas, Qigong and Tai Chi also afford some very beneficial stretches. Would be happy to share some of those Qigong and Tai Chi stretches, if you're interested. :D
Anonymous
On Nov 02, 2012
Fascinating reading. Thank you. :)
Anonymous
On Nov 22, 2012
Hi Kathy,
What are your thoughts about massaging the psoas major muscle using ischemic compressions? Do you think it is safe?
Linda Hoppe
Claudia Micco
On Dec 22, 2012
Aloha, I really enjoyed this article. It is a fascinating area of the body. I am curious of your thoughts about weakness in this area in addition to the tightness, what the research shows on compensation from right to left, if any of this shows in degeneration of the hip joint. Mahalo Claudia Micco
Ian Rubin
On Jan 03, 2013
Nice article. It would be great to have photos of the assessment test. Thanks.
Anonymous
On Jan 03, 2013
I am so incredibly happy that someone is explaining the biomechanics, and misconceptions about this muscle which is so often overlooked. Thank you for your wonderful information about this.

Cecile Bankston,
IDEA fitness expert
Rhonda Johnson
On Jan 04, 2013
walking backwards on the treadmill from o degree elevation to 10-15 degree incline is an excellent way to re=position the pelvis and psoas optimally. the speed will need to be reduced to 1mph to possibly 2.5-3mph. never hold on, let your arms gently swing naturally.
Anonymous
On Jan 04, 2013
I am a FELDENKRAIS Method practitioner and instructor since 1987, a former dancer, and have been teaching anatomy since the 1980's. I appreciate the wonderful information about the psoas, the distinctions made and the clarity of comments relating to fitness. As a dancer in the late 1970's, we constantly heard talk of the psoas, but it was very narrowly understood. Thank you for the richness yo present!

The FELDENKRAIS Method is a marvelous means of re-patterning moving habits and balancing muscle recruitment with necessary inhibition in antagonists, all in the context of functional movement. If is interested in exploring Feldenbkrais Awareness Through Movement series, there is a wonderful web site called OpenATM.org, where you can download the classes of many different teachers - for FREE!

Olena Nitefor, M.Ed.
Anonymous
On Jan 07, 2013
Thank you! Excellent read of detailed information that I can and will apply to myself, my clients and to gym members who participate in the group exercise classes that I teach! Blessings in health!
John Bawden
On Jan 17, 2013
an easy to read and understand article. Pictures to accompany the assessment explanations would have been of great benefit. thanks
Andrea Baker
On Oct 10, 2013
I had a hip scope and a large bone spur was removed from my anterior hip. Ever since, my psoas has been very weak. I was unable to SLR for 6 months. It's still difficult for me 15 months post surgery. I recently started using the Hip Flexion Assist Device, that was designed for ms patients and my hip pain has greatly reduced, even when not in the device. I have mild hip dysplasia and I think when the surgery was done and the joint was distracted, it in some way affected my psoas, as well as the spur being removed. The surgery was the result of a skiing accident. I had no prior pain with the hop prior to the accident. The hip pain, and weakness has been a mystery to me, as well as the urinary incontinence I have when I'm more sore. I'm an orthopedic PT and would love any input you may have.

Add Comment

1 + 1 =
Cancel
View all questions