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The Psoas Muscles and Abdominal Exercises for Back Pain
The Psoas Muscles and Abdominal Exercises for Back Pain ©2004
Lawrence Gold
certified practitioner
The Dr. Ida P. Rolf
method of Structural Integration
Hanna Somatic Education®
See also:
"What You Can Do about
Your Own Back Pain"
"What's the Prognosis on Your Back
Pain?"
Common opinion notwithstanding, the proper purpose of
abdominal exercises is to improve coordination of the abdominal
muscles with the other muscles of the trunk and legs (which
include the psoas muscles), to improve alignment, and not to
strengthen the back (a nonsensical proposition if one thinks
about it). When the psoas muscles achieve their proper length
and responsiveness, they stabilize the lumbar spine, giving the
feeling of better support and "strength," and cause the spine
and abdomen to fall back, giving the appearance of "strong"
abdominal muscles. To improve psoas functioning, a different
approach to abdominal exercises than the one commonly practiced
is necessary. Instead of "strengthening," the emphasis must be
on awareness, control, balancing and coordination of the
involved muscles - the purview of somatic education.
A discussion of the methods and techniques
of somatic education is beyond the scope of this paper, which
confines itself to a discussion of the relation of the psoas
muscles, abdominal exercises, and back pain. (For a view of
self-help techniques, click excerpt. For a discussion of methods and
techniques techniques of somatic education, article.)
The Relationship of Psoas, Abdominal Muscles and Back Pain The
psoas muscles and the abdominal muscles are agonist and
antagonist as well as synergists; a free interplay between the
two is appropriate. The psoas muscles lie behind the abdominal
contents, running from the lumbar spine to the inner thighs near
the hip joints (lesser trochanters); the abdominal muscles lie
in front of the abdominal contents, running from the lower
borders of the ribs (with the rectus muscles as high as the
nipples) to the frontal lines of the pelvis.
Take a moment to contemplate each of these relationships.
In the standing position, contracted psoas muscles (which ride
over the pubic crests) move the pubis backward; the abdominal
muscles move the pubis forward. (antagonists)
In walking, the ilio-psoas muscles of one side initiate movement
of that leg forward, while the abdominals bring the same-side
hip and pubis forward. (synergists)
The psoas major muscles pull the lumbar spine forward;
the abdominal muscles push the lumbar spine back (via pressure
on abdominal contents and change of pelvic position).
(antagonists)
The psoas minor muscles pull the fronts of attached
vertebrae (at the level of the diaphragm), down and back; the
abdominals push the same area back. (synergists)
Unilateral contraction of the psoas muscles causes rotation of
the torso away from the side of contraction and sidebending
toward the side of contraction (as if leaning to one side and
looking over ones raised shoulder); abdominals assist that
movement.
Now, if this all sounds complicated, it is -- to the mind. But
if you have good use and coordination of those muscles, it's
simple -- you move well.
Words on Abdominal Exercises
Exercises that attempt to flatten the belly (e.g., crunches)
generally produce a set pattern in which the abdominal muscles
merely overpower psoas and spinal extensor muscles that are
already set at too high a level of tension.
High abdominal muscle tone from abdominal crunches interferes
with the ability to stand fully erect, as the contracted
abdominal muscles drag the front of the ribs down. Numerous
consequences follow: (1) breathing is impaired, (2) compression
of abdominal contents results, impeding circulation, (3)
deprived of the pumping effect of motion on fluid circulation,
the lumbar plexus, which is embedded in the psoas, becomes less
functional (slowed circulation slows tissue nutrition and
removal of metabolic waste; nerve plexus metabolism slows;
chronic constipation often results), (4) displacement of the
centers of gravity of the body's segments from a vertical
arrangement (standing or sitting) deprives them of support;
gravity then drags them down and further in the direction of
displacement; muscular involvement (at the back of the body)
then becomes necessary to counteract what is, in effect, a
movement toward collapse. This muscular effort (a) taxes the
body's vital resources, (b) introduces strain in the involved
musculature (e.g., the extensors of the back), and (c) sets the
stage for back pain and back injury.
The psoas has often been portrayed as the villain in back
pain, and exercise is often intended to "knock the psoas out"
(overpower it). However, it is obvious from the foregoing that
"inconvenient" consequences result from that strategy. A more
fitting approach is to balance the interaction of the psoas and
abdominal muscles.
When the psoas and the abdominal muscles counterbalance each
other, the psoas muscles contract and relax, shorten and
lengthen appropriately in movement. The lumbar curve, rather
than increasing, decreases; the back flattens and the abdominal
contents move back into the abdominal cavity, where they are
supported instead of hanging forward.
It should be noted that the pelvic orientation, and thus the
spinal curves, is also largely determined by the musculature and
connective tissue of the legs, which connect the legs with the
pelvis and torso. If the legs are not directly beneath the
pelvis, but are somewhat behind (or more rarely, ahead of the
pelvis), stresses are introduced through muscles and connective
tissue that displace the pelvis. Rotation of the pelvis, hip
height asymmetry, and/or excessive lordosis (or, more rarely,
kyphosis) follow, all of which affect the psoas/abdominal
interplay.
Where movement, visceral function, and
freedom from back pain
are concerned, proper support from the legs is as important as
the free, reciprocal interplay of the psoas and abdominal
muscles.
More on the Psoas and Walking
Dr. Ida P. Rolf described the psoas as the initiator of
walking:
Let us be clear about this: the legs do not originate
movement in the walk of a balanced body; the legs support and
follow. Movement is initiated in the trunk and transmitted to
the legs through the medium of the psoas.
(Rolf, 1977: Rolfing, the Integration of Human Structures, pg.
118). A casual interpretation of this description might be that
the psoas initiates hip flexion by bringing the thigh forward.
It's not quite as simple as that.
By its location, the psoas is also a rotator of the thigh. It
passes down and forward from the lumbar spine, over the pubic
crest, before its tendon passes back to its insertion at the
lesser trochanter of the thigh. Shortening of the psoas pulls
upon that tendon, which pulls the medial aspect of the thigh
forward, inducing rotation, knee outward.
In healthy functioning, two actions regulate that tendency to
knee-outward turning: (1) the same side of the pelvis rotates
forward by action involving the iliacus muscle, the internal
oblique (which is functionally continuous with the iliacus by
its common insertion at the iliac crest) and the external
oblique of the other side and (2) the gluteus minimus, which
passes backward from below the iliac crest to the greater
trochanter, assists the psoas in bringing the thigh forward,
while counter-balancing its tendency to rotate the thigh
outward. The glutei minimi are internal rotators, as well as
flexors, of the thigh at the hip joint. They function
synergistically with the psoas.
This synergy causes forward movement of the thigh, aided by
the forward movement of the same side of the pelvis. The
movement functionally originates from the somatic center,
through which the psoas passes on its way to the lumbar spine.
Thus, Dr. Rolf's observation of the role of the psoas in
initiating walking is explained.
Interestingly, the abdominals aid walking by assisting the
pelvic rotational movement described, by means of their
attachments along the anterior border of the pelvis. Thus, the
interplay of psoas and abdominals is explained.
When the psoas fails to lengthen properly, the same side of
the pelvis is restricted in its ability to move backward (and to
permit its other side to move forward). Co-contracted glutei
minimi frequently accompany the contracted psoas of the same
side, as does chronic constipation (for reasons described
earlier). The co-contraction drags the front of the pelvis down.
The lumbar spine is bent forward, tending toward a
forward-leaning posture, which the extensors of the lumbar spine
counter to keep the person upright; as the spinal extensors
contract, they suffer muscle fatigue and soreness. Thus, the
correlation of tight psoas and back pain is explained.
As explained before, to tighten the abdominal muscles as a
solution for this stressful situation is a misguided effort.
What is needed is to improve the responsiveness of the psoas and
glutei minimi, which includes their ability to relax.
A final interesting note brings the center (psoas) into
relation with the periphery (feet). In healthy, well-integrated
walking, the feet assist the psoas and glutei minimi in bringing
the thigh forward. The phenomenon is known as "spring in the
step."
Here's the description: When the thigh is farthest back, in
walking, the ankle is most dorsi-flexed. That means that the
calf muscles and hip flexors are at their fullest stretch and
primed for the stretch (myotatic) reflex. This is what happens
in well-integrated walking: assisted by the stretch reflex, the
plantar flexors of the feet put spring in the step, which
assists the flexors of the hip joints in bringing the thigh
forward.
Here's what makes it particularly interesting: when the plantar
flexors fail to respond in a lively fashion, the burden of
bringing the thigh forward falls heavily upon the psoas and
other hip joint flexors, which become conditioned to maintain a
heightened state of tension, and there we are: tight psoas and
back pain. (Note that ineffective dorsi-flexors of the feet
prevent adequate foot clearance of the ground, when walking; the
hip flexors must compensate by lifting the knee higher, leading
to a similar problem.)
Thus, it appears that the responsibility for problems with the
psoas falls (in part, if not largely) upon the feet. No
resolution of psoas problems can be expected without proper
functioning of the lower legs and feet.
SUMMARY
The psoas, iliacus, abdominals, spinal extensors, hip joint
flexors and extensors, and flexors of the ankles/feet are all
inter-related in walking movements. Interference with their
interplay (generally through over-contraction or
non-responsiveness of one or more of these "players") leads to
dysfunction and to back pain. The strategy of strengthening the
abdominal muscles has been shown to be a misguided effort to
correct problems that usually lie elsewhere - which explains
why, even though abdominal strengthening exercises are so
popular, back pain is still so common. Sensory-motor training
(somatic education) provides a more pertinent and effective
approach to the problem of back pain than abdominal
strengthening exercises.
Click to inquire about the somatic training program: Free
Your Psoas.
For a discussion of somatic education, the reader is referred
to "Clinical Somatic Education - a New
Discipline in the Field of Health Care," by Thomas Hanna,
Ph.D.
About the author:
Since 1992, Lawrence Gold has held certification to practice
Hanna Somatic Education® and the Dr. Ida P. Rolf Method of
Structural Integration. For two years, he served as an Associate
Instructor with the Novato Institute for Somatic Research and
Training and has written and published an advanced handbook of
practice for professional practitioners and self-care
instructional programs for back pain and general health, for the
general public.
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