Back Pain and Tight Hip Flexor Muscles: The Relationship Homestructural integrationBack Pain and Tight Hip Flexor Muscles: The Relationship

Whether active and athletic, sedentary, or somewhere in between, it is not uncommon to experience lower back pain at some point in one’s life. Teens experience it as do folks in every other decade. Common sources of the symptom include overexertion/over-exercising, improper gait, poor posture, sedentary lifestyle, etc. What many do not realize is that much lower back pain can be traced back to the muscles of the hip; that is, when the hip flexor muscles are overly tight, they can lead to pain in the lower back. There is, indeed, a relationship, between lower back pain and tight hip flexor muscles and this will be elucidated below.

Where is my Psoas? What Does it Do?

The deepest hip flexor is the psoas, also known as the iliopsoas as it is often called in conjunction with the smaller muscle, the iliacus, which is on the inside of the Ilium (Iliac fossa). The psoas is attached to the lesser trochanter of the femur on the inside of the upper leg, and it attaches to vertebrae of the lumbar spine, L1 – L5, and T 12 in the lower back. Furthermore, the iliopsoas is the strongest hip flexor, and if the femurs are fixed, it will also flex the trunk, e.g., such as in doing a sit up. (Not a recommended way of strengthening the core, in my book.) Other assistant hip flexors include rectus femoris, sartorious, adductors and tensor fascia latae. Together with the Iliopsoas, these are the muscles that lift your leg when you walk, run or ascend stairs. However, we will focus our attention on the iliopsoas and why shortness/tightness there can lead to low back pain.

The iliopsoas is a key muscle not only for dancers to achieve the lift in their jumps, but also for athletes in running or jumping. It is the key muscle for great posture and length in the spine and back. Without adequate length in the psoas, one cannot walk tall, and one can experience a hunched back and a lack of movement in the hips and legs. One could, in fact, say that without proper length in the psoas, one would be found lacking in both physical poise and grace.

The Locked Short Psoas

When the iliopsoas gets into a shortened state, also known as ‘locked short,’ it will take the pelvis into an anterior tilt. The ASIS (the bony bump on the front of your hips) will lower down towards the ground. The hamstrings will get overstretched, or ‘locked long.’ There will be an increase in lordosis in the lumbar spine, which will, in turn, affect the alignment of the whole spine and can cause both forward head posture and pain between the shoulder blades. In this structural pattern, the abdominals are often pushed forward and weak. (Sometimes short piriformis is part of this pattern as well, but more about that some other time.)

Two of the primary causes of a locked short psoas are (a) sitting for long periods of time or (b) over exercising and not stretching properly. Proper core strength is also important for a balanced psoas, so weak abdominal muscles as well as weak back extensor muscles contribute to this dysfunctional low-back pattern. In the following clip we will see the location of psoas and an explanation of why it can cause low back pain.



Pathways to Relief: Structural Integration, Active Isolated Stretching, Bodywork

Structural Integration and myofascial bodywork can greatly help with lengthening of the iliopsoas by separating the fascia (the connective tissue) in between muscle groups, breaking up adhesions in the fascia and adhesions binding to muscle or bone and lengthening taut fascia along the iliopsoas line. Expect 3-5 sessions to see lasting improvements and 10 – 12 sessions to permanently change a dysfunctional pain pattern in the low back and core due to tight psoas.

A structural integrator will use a system of usually 10-12 one-hour long sessions to change dysfunctional postural patterns in the body by manipulation of fascia and taut muscles. The SI practitioner will start building support from the feet and legs into the pelvis, core and back, and finally the neck by putting the head on “top”. This work was pioneered by Dr. Ida P. Rolf and later carried on by her students and now taught by Structural Integration schools all over the world. By combining myofascial work and active therapeutic movement, which provides an instant neuromuscular re-education to muscles and nerves, the dysfunctional postural patterns can be changed and reversed in a short period of time.

Stretching and Strengthening the Psoas

To allow the new functional pattern to “hold” and prevent further discomfort, it is also important to lengthen the psoas. In the next clip, we will see examples of how to stretch the psoas with active isolated stretching or AIS. This is a stretching technique where one holds the end-range of the stretch for two seconds then comes out of the stretch; this is repeated 10-12 times. By holding for two seconds at the end-range, we avoid activating the stretch-reflex, a defensive mechanism our bodies have to prevent the tearing of muscle tissue. Make sure to avoid bouncing or ballistic stretching, as this may cause injury, and go slowly and breathe deeply.  (Note:  Due to Louisiana massage law, the word ‘stretching’ does not apply for Louisiana LMT practitioners. In Louisiana, ‘lengthening’ or ‘range of motion’ should be used instead.)



To properly change the dysfunctional pattern of locked short psoas, we also need to strengthen the core muscles. It’s difficult for many people to strengthen abdominal muscles without causing strain on the lower back and neck. In this clip, we will see active isolated movements to strengthen the core without causing tension in the lower back or neck. It’s important to bring the navel in towards the spine to properly engage abdominal muscles and to protect the low back in doing these exercises. These exercises will also strengthen the iliopsoas without causing shortness in the tissue. One will also experience the lengthening of the hamstrings and the gluteus muscles.



Working with the “Organ” of Posture

Keep in mind that massage therapy is not the same as myofascial work . When I talk about psoas’ tightness causing pain in the low back, I am also talking about the fasciae layer around the muscle and the surrounding bones. It is this fasciae layer, in fact, that SI practitioners are trained to work with. Dr. Ida Rolf said that fascia is the “organ” of posture, and it can be manipulated into letting go and freeing up space within the body, and thereby allowing for greater functional movement. Fascia is a highly adaptable tissue, and due to its elastic properties, we know it can lengthen, but some recent research has also shown that deep fascia may contract as well, a very interesting finding. Perhaps that may explain the “super human” strength that can occur in an emergency with the fight or flight response, but more about that some other time.

To find a Structural Integration practitioner in your area, go to:* or on the gulf coast of Mississippi, contact Magnus (LMT 144, LA 6971).  One can also check out the SMT practitioner directory. These are not certified SI practitioners but licensed massage therapists trained by Magnus in Synergetic Myofascial Therapy. Level 1 practitioners can administer the first 3 sessions and Level 2 practitioners have 6 sessions in their tool box.



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