As we spend more time sitting, driving, and working at a desk, the prevalence of postural related lower back pain is increasing. One of the primary contributors to lower back pain in relation to sitting is shortened hip flexors. As we sit for hours each week, over time the psoas becomes chronically shortened and weak. Left unaddressed, the psoas will cause postural and biomechanical impairments.
The psoas attaches from the anterior transverse processes of the lower thoracic and upper lumbar spine to the upper region of the anterior femur. Thus, they cannot be stretched by just bending the knee in traditional quadricep stretches and are often left out in daily stretching programs. The hip must be extended to target the short hip flexors.
When the psoas is tight, it tilts the pelvis anteriorly and extends the lower back. This creates a compression force on the lower back which can be painful as the space between the vertebrae is reduced. In addition, the anterior tilt of the pelvis affects the length tension relationship of the abdominals and gluteal musculature. This affects the motor control and strength of key stabilizing muscles for the lumbar spine. Lack of muscular strength and motor control can cause lower back pain during dynamic motion as the joints will bear more of the loading forces.
A shortened psoas can cause lower back pain in any activity where the hip is drawn into extension or the lower back extends. These activities include walking, running, rising out of a chair, and swimming. It also can cause pain in activities that passively move the hip and back into extension, such as sleeping on your back.
To stretch the posas, you must target hip extension. Caution should be exercised when beginning to stretch the psoas, as poor motor control at the abdominals and tightened short hip flexors can cause the lumbar spine to extend during attempts to stretch your targeted muscle group. To stretch the psoas, stand facing a stair or curb. Take your right foot up onto the step, leave your left foot behind and make sure the foot is straight. Tuck your tailbone down to the floor, and engage your lower abdominals. Then, begin bending into the right knee keeping the left leg straight. You should feel a stretch in front of the left hip. If you feel any back pain, cease activity.
If you sit for a long duration of time during the day and have lower back pain, consider contacting a health care provider or qualified fitness professional to help you learn how to stretch the psoas and then follow up with hip and abdominal strengthening. It is always important to strengthen after stretching to functionally utilize newly achieved range of motion after stretching. It is also important to learn to stretch the psoas in all three planes of motion to ensure length and motor control in all of your daily activities. As always, contact a professional before beginning a new exercise program.
Carla Pryor PT, DPT, OCS, RYT 200. Co Owner of Redefine Health and Fitness located in North County San Diego. Redefine is a wellness based company focused on providing excellent comprehensive and research driven care to assist clients in meeting their fitness and nutrition goals. Contact firstname.lastname@example.org for further inquiry.