Back pain sufferers know all too well the agony of simple movement. For many, spinal adjustments, massage or the more drastic measure -- back surgery -- are ineffective because the real issue could be psoas syndrome. Lower back pain has classic symptoms. There is the achy lower back for a few days. Then, the pain seems to spread to the rest of the low back, lower thoracic and even the buttocks (gluteal muscles) and hip. The initial pain happens when rising from a seated position. Even standing, walking or lying down is not comfortable. Extending the leg while driving can cause pain too.
This chronic lower back pain involving the hips, legs or thoracic areas of the body can many times be traced to a spasm of the iliopsoas which is not directly in the back. The iliopsoas is not one muscle, but two – the iliacus and the psoas and they are joined laterally by the tendon. They are found not in the back, per se, where the pain seems to centralized, but internally, the front or groin area of the body attached to the T12 and L5 vertebrae and the femur (thigh bone). These two muscles start at different points – the psoas starts at the spine and the iliacus originates from the hip bone – they end up at the upper portion of the thigh bone. It is at this point of joining that most injuries occur. This is psoas syndrome.
So, how is it that low back pain occurs from an issue with a muscle in the front of the pelvic area? As a combined muscle, this iliopsoas is a major flexor of the trunk and pelvis. When it is overworked or too weak to handle the stress that is put on it, spasm occurs. What happens then is that muscles around it compensate and pain occurs in those surrounding muscles. These muscles draw the spine out of alignment causing herniation of a disc and irritate the sciatic nerve.
Psoas syndrome is caused by a sudden contraction of the muscle which results in a rupture or tear of the muscle usually at the point of connection. The iliopsis, sometimes referred to as the tendon gets injured by the overuse of the hip area causing inflammation. Runners, jumpers, strength trainers bending and squatting repetitively, and sports participants that require a lot of kicking are those who are most risk of developing iliopsoas tendonitis. Pain with tendonitis develops slowly and builds up over a period of time whereas the psoas syndrome is evidenced by sudden and sharp pain.
The reason that back surgery is often unsuccessful is that it does not address the real issue. It may repair or remove a disc because of compression, but the problem may have been muscular. Back massage for low back pain does not treat psoas syndrome because the muscle traverses the body internally and there is only a very small area of accessibility on the surface of the body. This area is called the femoral triangle and it is hard to get to.
The most effective physical treatment of psoas syndrome involves rest, warmth and gentle stretching of the muscle to bring it out of spasm. Long term, the combined muscle area (iliopsoas) must be strengthened. Physical therapy and specific, targeted strengthening exercises are recommended to avoid further injury.