Chapter 6: When the Psoas Strikes Back, The Vital Psoas Muscle

Muscle tension is related to stress and can become detrimental. This is evident in many situations, such as upper shoulder and neck strain caused by anything from uneasy feelings, to conflict, to poor posture. This is a superficial area of the body and therefore more noticeable. Less known is the stress in deeper muscles like the psoas. Trauma can be held there for many years.

As the psoas tightens, it affects posture, placement, walking, energy, and emotions. Reaching the psoas is problematic because of its sensitivity to other structures in proximity, as well as its deep location. Therefore, it is important that natural bodywork be done by the individual to release and relax the psoas.

1.CRP: The constructive rest position can be done by anyone and, once learned, repeated as often as necessary without an instructor needed as a guide. This and other exercises can be found in Chapter 2 of Part I: “Maintaining a Healthy Psoas.”

2.Body Scan: Lie down on the back in a quiet place, with the legs and arms outstretched. Close the eyes and begin to scan the body with the mind, sensing any tension. Start at the feet, slowly working through each joint and large muscle group; when a spot feels tense, stay there and breathe the tension away. When at the hips, pay particular attention to the deep hip crease (where the leg meets the pelvis) and really allow the stress to let go, then circle around to the sacrum and begin to release there. Continue scanning through the core and all the way up to the scalp. It really is that simple.

3.Tension/Release: Begin in the above position (no. 2). Starting with one leg, curl the toes and contract the muscles all the way up the thigh for a few seconds, then release. Repeat on the other leg, then the pelvic area, the torso, each arm, and the face. Finally rest, with increased awareness of release.

4.Savasana: This is a yoga pose (asana) that is done at the end of a yoga class. It is a complete rest position, usually done on the back, where the person completely lets go of not only bodily tension but also thoughts and emotions. The breath guides the person to a deep state of relaxation and opens the heart. The psoas is also released. See the end of Part III.

5.Meditation: Meditation is best done in a sitting position, with the hip flexor muscles relaxed and the spine lengthened to provide optimal conditions for energy flow. The above position (no. 4) can also be used if the hip flexors need to open.

Deep-seated conflicts held in the psoas can be profound; examples of this are found in the following case studies.

Ashley Ludman, Occupational Therapist, Yoga Teacher*

David entered the yoga studio for his initial evaluation session with hesitation. “I’m not sure what yoga can do for me,” he stated. “The surgery didn’t seem to do the trick. I am still in pain.”

David is a successful general contractor in his early 50s and is very well “put together.” He arrives early for his appointment, organized and ready to give this “yoga thing” a try after a friend suggested he come see me for a personalized therapeutic yoga program (his friend alleviated her back pain and frequent migraine headaches shortly after she began yoga practice earlier that year).

We started the evaluation through movement exercises. David began to share some of the background information that led him here. Prior to the moment that the “straw broke the camel’s back” when he was bending over to pick up something, David’s back discomfort had been growing into pain, and his orthopedic surgeon had suggested the surgical route. Months following his surgery, he was cleared to return to a restriction-free life. David was concerned that he continued to feel a nagging pain in his back that significantly limited his activities of daily living. The doctor assured David that the lumbar discectomy had taken care of the bulging disc, but David still had pain that kept him from surfing and often took his breath away if he moved into positions suddenly and without thinking it through first.

As I take David through passive range of motion, I notice a holding pattern in his hips, specifically his psoas and gluteal muscles. He continues to share other aspects of his life: work, family, demands. David has a reputation for high-quality, consistent projects; he has a full workload and many clients with large expectations. He tells me that he will often take on the demanding clients who angrily want and expect him to “jump” at unrealistic demands. “I have been dealing with this for years, I am pretty used to it by now,” he comments, about dealing with the stress of such a profession.

We continue to speak as I start to teach him some simple yoga postures. He notes that his muscles feel very tense, especially his hips. Lots of high and low lunges and postures to open his psoas are incorporated into his program. He learns and uses ujjayi breathing, and although he needs prompting of his breath throughout the yoga practice, this appears to be a good tool to settle his mind and soften out the nervous system when he becomes over-rigid and stressed.

He moves slowly and methodically, attempting all that I ask of him with a degree of fear that prevents him from fully softening into the poses. We begin to address the underlying emotion of fear, and David opens up a little further about his pain. “I guess, in a way, I am fearful of getting older and not being able to do the things that I love doing. It is challenging to be limited by this pain, especially in my job performance, because if I can’t do my job, I can’t care for my family the way that I need to.” He continues to describe the physical aspect of the limitation. “It feels as though there is something stuck deep inside of my back, and although the doctor assures me that the disc was stabilized, it feels as though something’s going to break if I push it too far.”

His perception of visceral sensation was valid, and we continued to work on opening up the lumbar region, specifically the psoas, with movements such as spinal articulations. Over continuous sessions, I observed David’s movement becoming more fluid. He was able to consciously create better muscle balance, incorporating deeper core integration, rather than firing off the psoas to do the primary job of articulation.

The most challenging aspect of his practice as he progressed was a full articulating sit up from supine. We began slowly, by practicing first the roll down from a seated Staff Pose (Dandasana), addressing his awareness of lengthening the psoas in the direction of the legs and spine during the exercise. Initially, as he progressed to the reciprocal movement (rising from supine), he would use his hands to push up from the floor. We found that if he placed a folded hand towel under his lumbar spine, he had better access to the full sit up movement while limiting the use of his hands to assist him up.

Then, it happened. One day, David came up to sitting, effortlessly articulating his spine with no pain. We both looked at each other, and he breaks down into tears. “I’m so sorry,” he sobs, “I don’t know where this is coming from.”

“This is an emotional release,” I explain. “Our bodies have a way of holding emotions deep within the cells, and oftentimes it is the emotion that actually holds the pain. Once we release what we have been holding on to, the pain leaves with it. It is good for you. Do you feel how much your body has already changed?”

“Now you are sensing that there is another layer to your strength. Beneath the external layer of what we can see, you experienced a deeper strength that also gives you the permission to surrender the clasping and holding.” David walked out of the yoga studio that day with lightness in his step. His face seemed to soften a bit more. His entire body moved with a greater fluidity. It was as if he finally allowed himself to surrender.

Months later, after David had the opportunity to put his practice “on the mat” into practice “off the mat,” we spoke again about letting go of fear. “Actually, I realized that beyond the emotion of fear, there was the issue of control that I had to address. I couldn’t control every situation that was presented to me. It was the fear of not being in control that became the trigger for the pain. Luckily, now, I am able to sense it before it sets in, and I have tools to work with it. It is never completely gone, because it is such a deep pattern in my life, but I know now how to relate to it, and how to relate to myself.”

Jo Ann Staugaard-Jones

I began work on this book in February of 2010, after over 30 years of intense study of modern dance, Pilates, and yoga, and an insatiable desire for sports like softball and gymnastics in the earlier days, and downhill skiing from college onward. I approached life through the physical realm – a true believer in health and physical education for all, always “on the go.” Throughout my career I searched for different means of bodywork: Bartenieff Fundamentals, Alexander Technique, Feldenkrais, and Body-Mind Centering. Eventually, as a dance and kinesiology professor, I developed a strong advocacy for injury prevention through awareness. I had my own overuse injuries to contend with (knees especially) and worked to treat them naturally.

Last summer my right sacroiliac joint was acting up; it became chronic, so I sought treatment through physical therapy and chiropractic sessions. In my first visit I relayed my belief that the spot on my SI joint was directly behind scar tissue on the front of the body. After being evaluated, the therapist agreed: not only was it related, but scar tissue had begun to interfere with none other than – my psoas major! I have had three abdominal surgeries over my lifetime – two on my right side, and the other a cesarean.

The Cesarean Issue

The scar tissue of the cesarean was directly related to my sacroiliac pain. Whenever the SI joint is affected, one can surmise the psoas is also a culprit and involved in some way. Imagine the emotional issue of the surgery, as well as the realization of the full impact of the condition over a length of time.

The post-cesarean treatment is: go home and begin to lift and hold the baby, carry the baby, and change the baby, along with all the other jobs women do. This is after having the abdominal muscles cut through to pull a fetus out. There was no physical therapy prescription, or even exercises to follow, except to “get up and move.” Many years later, this travesty results in restriction of movement, poor posture, and a multitude of other complications. The compensation is a beautiful human being, thank goodness.

The causes of some injuries/conditions are stated as “incisions,” which are actually injuries to the body in themselves. Lower abdominal incisions include cesareans, appendectomies, abdominal hysterectomies, inguinal hernia surgery, and abdominoplasty (tummy tuck). These not only affect the muscles, but can damage nerves as well. Laparoscopic procedures have lessened the invasion, but not entirely.

My treatment involved many hours of manipulation and pressure to the scar tissue and the psoas. The psoas at first reacted in an extremely painful way: the response of the “fight or flight” muscle was fight. Over time this subsided, and the therapist was able to gently soften the restrictive tissue. Only a qualified therapist should attempt this kind of work, and it is hard to tell who is. My theory is: if it is painful don’t do it, unless you trust the person implicitly.

The full treatment was more “wholesome,” involving stretching and strengthening of many muscles around the area, with exercises intended to develop the glutes, abdominals, psoas, hip flexors, and spinal extensors. This therapy was successful – just 25 years too late. The moral of the story is that any woman who has just given birth, even if naturally, should be in a healing situation with some kind of rehabilitation, be it physical, emotional, or spiritual.

Dr. Gary Mascilak, D.C., P.T., C.S.C.S.

A 41-year-old male was presented to my office for consultation with chief complaints of right-sided testicular pain for approximately 3 to 4 months. He noted that the pain was progressive in nature and worsened with sitting, and rated the pain as a 7 out of 10 (10 being the highest amount of pain).

Lab findings were normal, with the exception of a mild elevation of liver enzymes (SGOT and SGPT). A thorough history was taken and an evaluation performed. Postural inspection revealed a moderately increased lumbar lordosis with a low right iliac crest. Leg length assessment revealed a 5/16” structural short right leg. A pelvic obliquity was also evident, with a left posterior and right anterior innominate identified. Foundational assessment revealed hyperpronation influences greater on the left than on the right. Trunk active ranges of motion were essentially within normal limits, as were the hips, with the exception of poor hip extension on the right, measuring only 10 degrees. Orthopedic maneuvers were all unremarkable, as was neurologic testing, apart from mild hypoesthesia in the L1/L2 dermatomal distribution along the inguinal and upper anterior thigh.

Palpation revealed marked tenderness and hypertonicity (extreme tension) of the right psoas major, with reproduction of the patient’s chief complaint of “groin and testicular pain.” (An increased lumbar lordosis can also be the result or the cause of a tight/hypertonic iliopsoas.)

Treatment consisted of moist heat application to the psoas, followed by myofascial release with simultaneous active movement of the antagonist (gluteus maximus) into hip extension, providing neurologic inhibition of the treated psoas. The goal was to free the entrapped genitofemoral nerve, which anatomically pierces the psoas major and supplies sensation to the upper anterior thigh and groin region, but in this case was causing pain due to compression. This myofascial type of release was followed by triplane stretching of the iliopsoas and activation of the inhibited gluteus maximus using a variety of exercises. The patient returned 2 days later and reported an 85–90% reduction in pain. Two follow-up treatments were scheduled to release the psoas and surrounding soft tissues, as well as for reviewing and progressing the home exercise program. Imagine his release of mental anguish along with physical pain.

Many therapists have found nerve entrapment, or compression, to be the source of pain in instances that might be curable without surgery. The expression “pinched nerve” usually refers to carpal tunnel syndrome, cubital tunnel syndrome, or sciatica, but it is applicable to any pressure on a particular nerve or group of nerves.

The causes are specific to the area of concern, and can range from degenerating discs, bone spurs, arthritis, and muscle dysfunction, to injury and emotional trauma causing muscle tension, such as with the psoas. Each scenario is specific.

A painful condition, lumbar spine stenosis is usually caused by degenerative arthritis or a disc disease called spondylosis. The lumbar spine is made up of many joint facets where nerves coming off the spinal cord travel through the spinal canal and openings (called foramina) on the side vertebra. When the canal or a foramen narrows or is compromised, the nerves are compacted. These nerves have an effect on the lower extremities through the path of the lumbar plexus, located behind the psoas major. Discomfort or pain is felt in the hips and legs when the nerve is compressed.

The idea is to open up the nerve passageway affected by stenosis or carpal tunnel syndrome, or any area where a nerve is inhibited. Treatments range from medications for reducing inflammation and pain, to injections, or even surgery. Depending on severity, this author would always choose physical therapy first as a less invasive alternative to medicine and surgery. As described in the above case histories, surgery was involved or suggested, when in fact the most effective treatment could have been natural bodywork, including work with the psoas. It has been proven that nerve entrapment can be opened through muscular release. I am not suggesting that this is the case with spinal stenosis, but prevention through diet and bodywork and early detection can certainly reduce the number of cases and surgeries.

The nervous system is extremely complex. Try to follow the pathway of just one component: the genitofemoral nerve. This nerve

There are many other psoas stories – positive proof that working with the release of the psoas can achieve dramatic results. Some of the best psoas work is done by Liz Koch, international educator and somatic practitioner. Her website is www.coreawareness.com. As she explains:

We are now ready to begin the journey into the spiritual aspect of human (and psoas) potential, Part III.

*Ashley Ludman is owner and director of Seaside Yoga in Wilmington, North Carolina and Nosara, Costa Rica. She began working as an occupational therapist in 1996. A yoga therapist and teacher trainer, she is versed in Tantric philosophy and meditation. She can be contacted through her website: www.seasideyoga.com.