Manual Therapy for the Body and the Mind

Psoas: At The Core Of It All

Home » Uncategorized » Psoas: At The Core Of It All

psoas

It’s amazing what a motivator pain can be, and how hard it can be to pin down sometimes. For years, I have had low-grade pain in my right side. At different times, it has affected my shoulder, ribcage, outer hip, groin and knee; sometimes one area by itself, and other times in different combinations. There are any number of events in my life which could have been contributing causes. Between bicycle accidents, falls, the amount of heavy lifting I’ve done over the years and just day-to-day living, it would be hard to say any one thing was behind it. My focus lately has been on trying to determine what is happening in my body, and what I can do to improve it.

I’m convinced that there is a connection between the areas of pain; all are right sided, and seem to play off of each other. I went to a chiropractor, who told me I had a subluxation (when a rib slips out of alignment at the attachment to the spine). He adjusted me many times, and it felt great for a few hours but came right back. A physical therapist gave me a great set of exercises for my shoulder, which have helped, but haven’t resolved the tension I get there, and didn’t even come close to addressing any of the other issues.

My general doctor recently checked for hernia, appendicitis, kidney and liver issues, with no satisfaction (if you can call a positive result for any of those things satisfying). Yoga has been the most constant source of relief, although the relief seems to last just about as long as it takes me to overdo something and spark a new wave of symptoms.

Through all this, I’ve had it in mind that the hips must be playing an important role. An imbalance there can create issues throughout the body. I see it in my practice regularly, and have been working with clients there for some time. In particular, there is a muscle located directly in the path of much of my pain. It is known as psoas, one of the deepest muscles in the core of the body. In my schooling, I learned that it, along with its best buddy iliacus, is a hip flexor. They bring the knee toward the chest, or the chest toward the knee, depending on which body part needs to move at a given moment. Simple, right? Wellllll….maybe not.

As I began doing research for this post, I found many interesting articles about the psoas. One such article mentioned a book by a woman named Liz Koch, the title of which is “The Psoas Book”. Ms. Koch, a sufferer of scoliosis, has dedicated much of her life to understanding and teaching about the significance of this muscle in healthy movement, as a fundamental support muscle, and its impact on many levels when there is imbalance there. The book is a short read; actually it is a student manual that goes with workshops she offers on the subject, primarily for yoga and dance instructors. It is also a prime example of great things coming in small packages. She discusses many interesting points, quoting Ida Rolf, author and founder of The Rolfing Institute, Moshe Feldenkrais, innovator of the Feldenkrais Method of Somatic Education, Judith Aston of Aston Patterning and others. This book, along with articles by Tom Myers, Leon Chaitow, Gil Hedley and others, has opened my eyes to a whole new level of understanding.

Among the points I found most interesting are:

  • The location of psoas positions it to be central to interaction between the visceral body, the diaphragm, the blood, and the nervous system.
  • The Lumbar nerve plexus, a grouping of autonomic nerve ganglia responsible for innervating the viscera below the diaphragm, is actually embedded in this muscle. In a state of surprise/ threat, the instinctual response of psoas is to contract, bringing the knees toward the chest, protecting this vital and exposed area of the body. Continual tension in psoas can have a huge impact on the health and function of these vital organs
  • The solar plexus, sometimes referred to as the “abdominal brain”, is located directly in front of the thoraco-lumbar junction, where psoas attaches at its top-most point. The solar plexus is commonly associated with emotion and “gut feelings”.
  • The thoraco-lumbar junction, located at the lowest thoracic vertebra and the first lumbar vertebra, is a significant anchor for, and place of interactivity between the psoas, quadratus lumborum, diaphragm, and trapezius, supporting proprioceptive and nervous system information up and down the spinal column
    1. Psoas’ upper most attachment is at the sides (transverse processes) of T12 and each of the lumbar vertebrae, and is a significant player in controlling the lordotic curve of the lumbar spine
    2. Quadratus Lumborum attaches at the 12th rib and the transverse processes of all the lumbar vertebrae but the lowest, and the crest of the hipbone. It functions as a lateral stabilizer for the trunk
    3. Trapezius, a large muscle on the back of the body, is significant in maintaining the kyphotic curve of the thoracic spine, as well as controlling a large amount of shoulder and neck movement. It’s lowest attachment is at the backmost outcropping (spinous process) of the same T12 vertebra, and at each of the spinous processes of the thoracic and cervical vertebrae up to the back of the head
    4. The diaphragm attaches at the front of the lumbar vertebrae and the inner surfaces of the lower 6 ribs. Its tendinous crurae merge with the fascia of the psoas. In addition to being the primary muscle of breathing, this muscle creates a shelf of support for the heart and a “roof” over the liver, stomach and spleen, and is a contributor of support for the lordotic curve of the lumbar spine
  • Fascial connections between the psoas, diaphragm above and pelvic floor below, put it in an ideal position to control compression of the lumbar spine, aiding stability of the low back
  • Contraction and release of this muscle, along with the diaphragm and abdominals, actually massages the internal organs, helping support blood flow and the general healthy function of the organs
  • The positioning of psoas allows it to assist the pelvic floor, creating a shelf of support for the internal organs, and for the fetus during pregnancy
  • The fascial layers of the kidney are so closely integrated with those of psoas as to be one and the same; one can not surgically separate the two without negatively impacting the connective tissue of one or both
  • Psoas follows a significant parallel path with the descending aorta through the lumbar and hip region, having an impact on, and being impacted by, blood flow to the lower body
  • Psoas is an important muscle for maintaining the lordotic curvature and rotational balance of the lumbar spine. From its’ 6 attachments at the transverse processes of the lowest thoracic vertebra (T12), and each of the lumbar vertebrae, it extends downward and forward around the fronts of the hip joints. Each segment of this muscle can contract or lengthen more or less independent of the others, allowing it a great deal of control over the entire low back and by extension, the entire body
  • It also has an impact on pelvic tilt of the hips and stability of the pelvic floor, functioning in opposition to the deep lateral rotators on the outer hip
  • As a hip flexor, one of its most important roles is to support the free swinging movement and weight transfer into the legs during walking and running

The fear response is one that happens beyond our conscious control. When there is a loud noise or an event that catches us off guard, particularly one that threatens physical harm, the body goes into a protective mode. The head retracts in toward the shoulders, shoulders ride up toward the ears, the abdominal muscles and hip flexors contract, and the muscles of the back become rigid. In normal conditions, the threat subsides, and the contractions relax.

But as life becomes increasingly hectic, and stress is engrained as part of our daily routine even at a young age, the fear response also becomes part of that routine. Patterns of contraction become imbedded in our posture, creating numerous issues posturally, in the circulation and in the nervous system, all of which contribute to a negative impact on our sense of wellbeing. Specifically relating to psoas, we can see all of these elements. Too much tension compresses the lumbar spine, contributing to low back pain, disc problems, and compression of the vital organs within the core. Breathing becomes restricted as psoas pulls on the fascia and tendinous tissues of the diaphragm. Free movement of the hips and femurs, so important to healthy motility, become restricted, causing limitations of range, injurious wear patterns and pain in the hips, knees and feet. The descending aorta, which follows the path of psoas, can become constricted, limiting blood supply to the lower extremities, the sex organs and other viscera. With the lumbar plexus embedded within psoas, constant stress of the muscle sends signals out through the nerve endings, causing a negative feedback loop and dysfunction in the nervous system.

Whether as a response to anxiety, injury or just the way we have learned to carry ourselves from the time we were infants, imbalances in this muscle result in patterns of rotational pull on the spine, hips and by extension, the entire structure. In severe cases, scoliosis, a potentially debilitating condition results, causing the spine to curve dramatically to one side, forcing the ribcage to compress against the lungs and organs within.

There are several perspectives on the best way to address tension in the psoas. While many sports activities popular these days value muscle strength and endurance over maintenance of a limber body, there are those that do consider a balance between strength and suppleness to be of the utmost importance. Martial arts and yoga tend to be more focused in this way, although even in these activities, the understanding and approach of the teacher are fundamental to keeping this healthy balance.

Bodywork is primarily focused on maintaining healthy flexibility, although there are many approaches to and perspectives regarding maintaining that healthy balance between flexibility and stability. Manual therapists, and Rolfers/ Structural Integrationists in particular, believe that direct manipulation of psoas is the best approach. Due to its location, with so many sensitive organs, blood supply, nerve structures and easily damaged tissues nearby, proper training is a must when working manually. Others, like Feldenkrais practitioners, believe that body awareness is the key, while Judith Aston and others use a combination of the two.

Ms. Koch states in her book that direct manipulation of psoas is counterproductive due to its instinctual contraction response. She proposes a simple relaxation technique which she calls “Constructive Rest Position”, in which the person lies on their back, knees up and feet on the floor and just lets the body relax for 10 to 20 minutes. Following this is a series of slow movement exercises at the hip joint, focusing on movement of the legs independent of the pelvis. While I have done these exercises (in fact they are pretty much what my most recent physical therapist recommended) and find them to be very helpful, I also believe that direct manipulation of psoas, done slowly and carefully, is equally rewarding.

I find myself in that common position of knowing just enough to know that I don’t know much. I’m sure that as I continue the search for answers to my own issues, more will be revealed, and then more again. And as I learn more about myself, I hope to be able to apply it to clients with similar concerns.

Please feel free to comment on personal experiences and insights.

References:

The Psoas Book 2nd Edition, Liz Koch; Guinea Pig Publications

Anatomy Trains 2nd Edition, Tom Myers; Elsevier Publications

The Trigger Point Therapy Workbook 2nd Edition, Claire Davies, Amber Davies, David Simons; New Harbinger Publications

The Opinionated Psoas, Tom Myers; Massage Therapy Magazine, 2001

Comments

  1. Sarah Warren on January 13, 2011 at 2:04 pm said:

    Great post, Greg! The psoas is an incredibly important muscle which most people know nothing about. If you haven’t read Somatics by Thomas Hanna, I highly recommend it. He explains the withdrawal reflex and trauma reflex which you discuss above, as well as other reflexes that affect our posture. He includes some really interesting case studies and it is a fun read!
    Another fun fact: Filet mignon is the psoas of the cow 🙂
    -Sarah

    • Thanks for your comments, Sarah. I have not read Somatics, but have heard it mentioned several times before. It’s on my list!

      And so, not only is psoas a diverse and multi-faceted muscle, it tastes good too!

  2. This is a very interesting post! Thanks for all of this information, which I find helpful in dealing with some of my residual pain from scoliosis. I’ve shared this on Twitter and FB.

  3. HELLO! Thank you for referencing my book. I will be teaching a Psoas Workshop in the Boston Area (Waltham) Sat & Sun August 13 & 14. This workshop is open to everyone and a great way to personally get to know your own psoas. More information at http://www.coreawareness.com
    I also encourage people to read Massage Therapy Magazine 2005 The Iliopsoas Muscle -Part 1 and Part 2 A Bio-Reverant Approach it details why non-invasive approaches are most effective for resolving “psoas issues” co-authored with International Trauma Recovery Expert Dr. David Berceli PhD. We delve into how the psoas is a responsive, intelligent tissue – a messenger of the central nervous system.

    • Wow! I was not expecting a response from my main source! Thank you for contributing. I will pass on word of your workshop, and will surely attend myself.

  4. Great synthesis of your explorations Greg. Thanks for taking the time to write it all down. Hope you plan to continue writing. 🙂 Lou

  5. Jennifer on July 2, 2011 at 6:38 am said:

    Hi! Thanks so much for your great writing on this subject. I have read Somatics by Thomas Hanna, as well as his other incredible book, Body Of Life. I HIGHLY recommend both of these books to anyone who finds this information ringing true. Hanna said that if you can sense it, you can change it. I love this, and he goes into this concept in great detail in the Body Of Life.

    I have been on a quest to stamp out pains (which have been numerous) and with overused and “tight” muscles I have found that they need a combination of (1) learning to relax their “stuck” contraction. This can be done by contracting the muscle(s) and slowly releasing (what Hanna talks about mainly in SOMATICS). You contract them WILLFULLY so that they are contracted PAST their stuck spot and then since you at least have control over this little window of opportunity, they relax the contraction you created, willfully, and then some. Little by little they will release. HOWEVER the psoas in particular is a tricky one to get to! Which leads me to (2) Understand and learn about your movement habits and create new movement coordination, through Feldenkrais is a great way to do this. You may find that you contract your hip flexors when you blink your left eye, to exaggerate a bit. Why? God knows. You’ve overused it for whatever reason and now it’s like a broken record, or a senile person who just keeps telling the same story over and over again. A long road indeed, but you will essentially create a new more efficient you, and you stand a chance of being in better shape and more fluid when you are 50 than when you were 20, or when you’re 70n than when you were 17 , or whatever. I know a woman who studies under Hanna who at 75 says he posture and body are more comfortable and aligned than when she was very young, or at all before she met Hanna (who studied under Feldenkrais). In other words, well worth the patience and effort. (3) TRY any and all other modalities for healing, my personal favorites are Rolfing, Nueromuscular Release Therapy, or if you can find any other magician who works with fascia. Seek out people like Greg, the author of this website, who also have movement awareness and background, and if you want to combine Somatics or Feldenkrais moves DURING your bodywork, even better! I also highly recommend Visualizing yourself as you’d like to be, and most of all, being patient with yourself. We are intelligent beings, and our abilities to sense and change ourselves are boundless. Hanna’s work is especially good to read if you agree with this, or would like to. He’s a great writer and reveals the somatic viewpoint as the only way to think about ourselves, as one organism of structure and function, rather than body and mind. The structure is all of the physical matter including the brain. The function is the how, including the how we use the brain.

  6. Dennis Corum on July 27, 2011 at 6:06 pm said:

    Thanks for making these comments available. It has sharpened my interest in successful approaches to treatment and understanding the references and reflexive nuance of issues interacting around the state of the psoas.

  7. Hi Greg.
    Great Post. I was looking at the effect of psoas on the blood supply, also. Thanks.
    But there is a missing piece to the psoas story. It is the transversospinalis muscle group. As you know, all muscles work in opposite pairs. The biceps flexes the forearm and triceps extends it. Everyone I’ve read, from Mabel Todd (who started it all with The Thinking Body), Liz Koch (the Psoas Book) , Eric Franklin (the Franklin Method), to Bonnie Bainbridge Cohen (Mind-Body Centering) speak as if the psoas does not have a partner.

    It does; the transversospinalis. Mabel Todd calls the psoas the most important muscle in body for erect posture. I agree. But it has a partner. Acting alone, the psoas would keep the lumbar curve pulled into an always con-caved shape. But as Blandine Calais-Germain says in Anatomy of Movement “The psoas, in combination with the posterior transversospinalis muscles, forms a system of four muscular bundles arranged around the lumbar spine. By contracting together these four bundles can act to erect (straighten the lumbar spine), rather than increasing lordosis.

    So the psoas and transversospinalis paired the same way as the biceps and triceps. At 72 my dance program didn’t start to feel youthful until I hunted down the psoas – transversospinalis pairing. The psoas is super important, but it does not work alone.

    • Thanks for posting, Bob.

      Agreed, the relationship between psoas and transversospinalis is an important one, but not the only one. Quadratus lumborum, deep rotators, abdominals, even trapezius and diaphragm are all impacted by this dynamic muscle.

  8. One of my favorite topics! Nice discussion and a good overview article. The tenderloin of the pig is also the psoas. Lets not omit the quad group as a functional partner in flexion. Resistance stretching is an effective strategy for improving psoas functionality, reminding us of the reciprocal importance of both strength and flexibility in skeletal muscle.

  9. Aways good to see someone putting more info on psoas out there…I truly believe it’s that important. Two thoughts: first, I second Liz Koch in her desire to promote Berceli’s trauma release work. He suggests you can’t really get full psoas release from bodywork alone, and while I disagree, it’s a worthwhile pursuit to use his Trauma Release Process. Second, I’m quite interested in Porges’ polyvagal theory, which shows us that the vagus nerve, the only cranial nerve that leaves the head for the body, is all about fight-or-flight as it runs in/near psoas; but also about freeze…an older system that allows us to check out of our bodies. Personaly, I’m coming to believe many of us with tight psoas muscles have checked out and are living in a frozen state. Releasing/resolving psoas tension contributes to well-being overall. My favorite quote from Porges: “…the pivotal point is, can we get people to feel safe?” I believe safety is grounded in psoas.

  10. The article is an interesting summary of some of the information that’s out there. I have a few comments:

    “Ms. Koch states in her book that direct manipulation of psoas is counterproductive due to its instinctual contraction response.”

    While stretching & movement therapy is very helpful, for some people, the stresses, tensions & trauma in psoas are too chronically held to release throughout those means alone. I often use manual pressure to release psoas quite effectively, without triggering such negative reactions.

    Back when I traveled around the country visiting clinics of therapists who were taking my training programs, they frequently talked about how painful it was to work on psoas muscle. I still hear this today when working with therapists. Yet I never have that problem, even when working on clients these therapists had worked with. The reason, I believe, is that most therapists try to go too fast, too deep, too soon into psoas.

    When I work, I use a NO Pain, MORE Gain approach. I do NOT go deeper into the tissues if the client is experiencing ANY negative sensations. This is NOT about what they can tolerate. It is what they either LIKE, or are completely neutral about. If they have to “breath through” the sensation, then it’s too deep.

    This way, they can relax more fully, and faster, than if they are tolerating anything.

    Some people believe this must take a long time. In fact, in the long run, it does not. It is actually faster, again, in the long run. Especially when working with the deep abdominals, which are, of course, protected by the surface abdominals.

    I make sure the abdominal wall is sufficiently relaxed before pressing deeper into the psoas. There are a lot of people who have a LOT of sensitivity in the abdominal wall itself, and a few, sometimes many, minutes releasing that is important. As a result, I have literally had my elbow in some people’s psoas muscles for many minutes at a time, moving slowly up nearly the whole length of it, and have them fall asleep in the process. They were NOT experiencing pain.

    It is completely false that you’ll necessarily trigger an “instinctual contraction response.” That will only happen if you go in too fast, too soon. If you stay away from people’s edge’s of pain, fear & resistance, you will get in FAR deeper, and be able to stay in the tissues far longer.

    Another point is the psoas is directly reactive to the hip extensors (hamstrings & gluteals as well as lateral rotators) and abdominal flexors (rectus abdominus & obliques). The process of Structural Homeostasis produces various reactions. Given, for one example, that so many people have forward neck & head posture, and that, as Travell & Simons acknowledge, it is flattening of the lumbar spine that levers the head forward.

    The flattening of the lumbar is due, in great part, to excessive, chronic hip extension & lumbar flexion. Psoas then contracts to try and pull the lumbar spine forward. Which is too bad because doing so is a major cause of compression & eventual degeneration of the lumbar spinal discs. And of course, as the article points out, an over-contracted psoas can produce many symptoms of pain & dysfunction due to its neurological orientation.

    (BTW, In my personal case, when I get headaches or neck pain, and/or dizziness, releasing the psoas muscles always fixes it. This has been the key for a few of my clients with those symptoms, as well.)

    So, if there is any sign of hip extension, or loss of lumbar curve (which is nearly everyone I work with) I always take time to release tension in hip extensors & abdominal flexors first. The psoas will already begin relaxing & decompressing in such situations.

    RE: Psoas Minor … I have never had to consider it at all while straightening scoliosis, or anything else, for that matter. But I find some people tend to overcomplicate the problems of psoas quite a lot, especially when they start thinking about fascia. I have frequently demonstrated straightening scoliosis, and therapists & doctors are surprised how quickly many people respond, and that I usually work the opposite muscle the therapists were focusing on.

    I do not, BTW, believe psoas is a “true” postural muscle. It only gets inappropriately recruited, and it develops participation in “locking in” bad postural habits. I find that rebalancing the overall structure allows psoas to get back to what it’s really designed to do, which is lift the femur and contribute to controlling the lumbar curve in certain situations. When standing upright in a relaxed position, it should be VERY relaxed, yet ready for action.

  11. Michal on December 4, 2014 at 6:17 am said:

    Thank you for the information! It is very well written and enables a perfect path to understand Body-Mind connection!

    Thank you 🙂

Leave a Reply

Your email address will not be published. Required fields are marked *

Turtle Dance Bodywork

Address

10 Union Street
Natick Center, MA
01760

tel: (508) 380-3445
email: greg@turtledancebodywork.com

Contact Us

Your Name (required)

Your Email (required)

Subject

Your Message

captcha
Please enter the code above: