The Psoas Muscle and Yoga

by Baxter

If you have been around the yoga classroom for any reasonable amount of time, you have likely heard of the psoas muscle. But you may not have a good idea of where it is or what it does! You should though, as your daily activities—or inactivity if you are sitting a lot during the day—can actually create a short, tight psoas muscle that could use a bit of lengthening. So today I’ll introduce you to your psoas muscle in a deeper way than can sometimes take place in the yoga classroom, inform you of some of its roles in posture and movement and suggest a few ways to lengthen it, if it is on the tighter side of life.

The only other time I could find on the blog that we had talked about the psoas muscle was way back in January of 2012 (I Think I Have Sciatica), where we first introduced this drawing of the lower torso and pelvis which shows nicely the psoas muscle seen here with everything except the skeleton and select muscle removed.

The psoas is said to originate from the sides of the lumber vertebrae, possibly even starting as high up as thoracic 12 (T12), so it has multiple spots on the side of the spine where it attaches. It then travels downward, close to the midline of the pelvis, just in front of the sacrum and ileum, until it heads slightly lateral and anterior, so it can leave the pelvis by sliding right over the lateral pubic bone and just behind the inguinal ligament in order to dive down and laterally attach to the upper inside of the femur bone (at a bony bump known as the lesser trochanter of the femur). Now we can actually feel the greater trochanter with our hands, just about six inches below the side of our pelvic rim, but the lesser bump is not accessible - due to lots of muscles which make touching it almost impossible. And due to the fact that the psoas lies deep within the pelvis, it can be challenging to feel it - both literally and perceptually. 

Hopefully, with the help of the picture and my written description, you are starting to get oriented to where the psoas is. But what does this muscle do when it contracts and shortens? It depends a bit on which part of the set-up is stabilized and which part is free to move. And it also depends on whether it is working in concert with other muscles to help you walk (for instance), or to help you maintain upright posture when you are standing still.

Let’s look at it working alone first. If the spinal origins of the psoas are stable and not moving, the psoas is said to have the following effect on the femur bone (to which it attaches): it flexes the femur toward the belly, pulling it slightly medially toward the pubic symphysis, and rolls the thigh bone externally on its axis. If we wanted to take the femur bone in the opposite direction as a way of stretching it, we’d need to take it backward towards the buttocks, swing it slightly out to the side and internally rotate it. Doing a modified Locust pose (Salabasana), with the legs apart a bit and an emphasis on rolling the thighbones in would be an example of a pose that could lengthen the psoas.

When we stabilize the femur, as when you are sitting in a chair, and contract the psoas, the origin gets pulled forward and down, encouraging the forward folding action known as flexion of the lumbar spine. We use this action whenever we bend over to pick something up off the floor.  The psoas also works in concert with several other spinal muscles to encourage the upward lift of the spine that we cultivate in poses like Mountains pose. In that setting, it does not create excessive lumber flexion, but does allow the natural curve in the lumber area to be present. So that is a bit about what the muscle does (realizing that the psoas works with other muscles that flex the femur bone, such as part of the quadriceps).

When the psoas is overly tight and short, it can affect the lower back in a negative way (contributing to back pain), influence the ease of a neutral pelvic tilt and affect gait. There are passive ways to release tension in the psoas and more active ways to lengthen and stretch the psoas.

In The Psoas Book, author Liz Koch recommends “releasing” tension in the psoas by lying in Constructive Rest position (on your back, with your knees bent and the soles of your feet on the floor), with your feet about 1-2 feet from your hips, and staying there for a while (maybe 5-10 minutes) with close attention to sensations in the area of the back belly and hip joints, as you attempt to sense the releasing of tension in those areas. Another version of Constructive Rest involves having your calves on a support, like our Easy Inverted pose (see Easy Inverted Pose). Once you get better at sensing release in tension in this area, slowly move one foot further away from the hips without letting the pelvis tip or tuck and stop when tension is encountered in the areas you are observing. Gradually moving that foot until the leg is straight, if you can do so without changing the pelvic alignment. A more advanced variation involves folding one leg into the chest (in an upside-down Pigeon pose), without tipping or tucking your pelvis, and then again slowly extending the other leg long on the floor (it’s the lengthening leg that will stretch that side's psoas).

In my regular classes, I often take advantage of the back leg position in Warrior 1 to bring attention to the psoas of the back leg, as it needs to lengthen in order to keep the pelvis neutral (not going into dramatic anteversion or forward tip).  From there, doing drop knee lunges, both with the hands on the floor next to the feet for an easier version, but gradually coming up higher, with hands on blocks, and finally with hands on the front thigh, while letting the hips and torso move a bit forward while keeping the pelvis stable, are great ways to lengthen the psoas. The back leg in upright Pigeon pose also gives a good stretch to the psoas.

This list of ways to work with your psoas is by no means complete. You might look at Mary Pullig Shaztz, MD’s book Back Care Basics for her approach to psoas stretching in the face of back pain. And Jean Couch’s classic The Runners Yoga Book is sure to have a few suggestions as well.  And if our readers have any favorites, please write a comment back to us! Happy stretching!

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"I think I have sciatica"

by Baxter

If I had a dime for every time I have heard this from friends, students and patients, I would be doing all right! Usually, any time someone gets a pain in the back that travels below the buttock, they believe they are suffering from sciatica. And some of them may be right, but others could have something else going on. So before we go any further, let’s step back and try to define what sciatica is, which is easier than that might seem, as it is really a symptom, not a medical condition or disease. What that means is that even if you do have sciatica, you are just at the beginning of a journey to find out the underlying cause of you symptom.

Sciatica gets its name because of the relationship to one of the body’s important nerves, the sciatic nerve, which is really made up of several nerve roots from the lower lumber and sacral region of the spine. These separate nerve roots emerge from the sides of the spine and join together to make a bigger nerve that travels down the back of the legs all the way to the feet. It has a couple of jobs: it supplies sensation to the muscles of the backs of the knees and lower legs, and it also provides sensation to the backs of the thighs, part of the lower legs, and the soles of the feet.

Let’s take a look at what the NIH, National Institutes of Health (see here) have to say about sciatica:

Sciatica refers to pain, weakness, numbness, or tingling in the leg. It is caused by injury to or pressure on the sciatic nerve. Sciatica is a symptom of another medical problem, not a medical condition on its own.

Sciatica usually affects people on just one side of the body. And it turns out that the "symptom" called sciatica is actually a constellation of other symptoms. Here’s what the NIH has to say about that and the pain associated with sciatica:

Sciatica pain can vary widely. It may feel like a mild tingling, dull ache, or a burning sensation. In some cases, the pain is severe enough to make a person unable to move. The pain most often occurs on one side. Some people have sharp pain in one part of the leg or hip and numbness in other parts. The pain or numbness may also be felt on the back of the calf or on the sole of the foot. The affected leg may feel weak. The pain often starts slowly. Sciatica pain may get worse:

• After standing or sitting
• At night
• When sneezing, coughing, or laughing
• When bending backwards or walking more than a few yards, especially if caused by spinal stenosis

Okay, so far so good.  But that, again, is a pretty broad set of symptoms that could account for this thing we are calling sciatica.  So, if we are going to put our finger on the underlying cause, what are the most common culprits?

A few of the more serious and common causes include a slipped disc in the lower lumbar area of the spine, Piriformis Syndrome (a condition associated with a deep muscle in the buttock area beneath the gluts that comes in contact with the sciatic nerve as it heads down the leg), pelvic injury and fracture (which could include sacroiliac dysfunction, a not uncommon problem for yoga students) and tumors.

Interestingly, a lot of cases of sciatica will resolve on their own without a lot of testing or heavy duty treatment. In the old days, they used to recommend bed rest for these kinds of symptoms, but we know now that it is prudent, after a brief period of rest, no more than a few days, that gradual return to everyday activities can be helpful, with gentle spinal movement and core strengthening very helpful for recovery. This is, of course, one way yoga can help. In fact, yoga is an excellent way to promote gentle spinal movements, safely strengthen the abdominal area and the lower back muscles, as well as stretch several muscle groups that are associated with general lower back pain that could include sciatica, such as the psoas and the piriformis muscles.

In addition to acute treatment with over the counter meds like ibuprofen and acetaminophen, as well as ice and heat, the NIH also makes the following recommendations for early treatment:

Bed rest is not recommended. Reduce your activity for the first couple of days. Then, slowly start your usual activities after that. Avoid heavy lifting or twisting of your back for the first 6 weeks after the pain begins. You should start exercising again after 2-3 weeks. This should include exercises to strengthen your abdomen and improve flexibility of your spine. (Go yoga!)

If your symptoms are not improving, you are having weakness in one leg, you noticing a foot is kind of drooping when you walk, or you have difficulty controlling your bowels or bladder, don’t put off a visit to your doc—schedule is as soon as you can. In these situations, you might need more evaluation, which might include X-rays, MRIs or local injections to help reduce swelling around your nerves if they are determined to be the culprits.

And if you are going to utilize yoga as a healing tool, look for the most qualified and experience teacher around to work with. Later this week I will share the experiences of a good friend and colleague of mine who had sciatica arise during a retreat a few years back and the almost miraculous technique he learned to eliminate this symptom.

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