Sunday, February 18, 2018

Back Pain? Check The Psoas

See the how the Psoas attaches to the spine
Here's a patient who came to our clinic this past week complaining of perpetual low back pain. He seemed more frustrated because he had not been able to do his "normal" exercise for over two weeks. The patient is young medical doctor in his mid thirties and among other things does a thousand sit ups a day (2 sets of 500 each).

At Physio and Sports Solutions, our challenge is always to find out the cause of the patient's problem. (and not just treat the pain). It's quite similar to detective work. We look for clues from the moment they walk into the clinic/ treatment room, how they sit/ stand when we are talking to them.

Next is asking the patient many questions about their condition, their exercise routine (if they have one) and their daily routine followed by a physical assessment.

When he told me about his 1000 sit ups a day routine (in addition to his 12-14 hours of desk bound job), I knew that this was a key component to his pain.

Physical assessment revealed exquisite discomfort to his Psoas and Illiacus muscles among other things. Now the Psoas muscle has been described as "the most important and vital skeletal muscle" in the human body for it connects the spine to the legs.

It is structurally the deepest muscle we have in the core/ tummy. They start at the thigh bone (see picture above) and finish at the 12th thoracic vertebrae and all five lumbar vertebrae. That's how it can cause your back pain!

Any force on the Psoas muscle (muscular contractions) is also thought to support our internal organs and work like hydraulic pumps allowing blood and lymph to pushed in and out of the area. Organs stimulated include the intestines, kidneys, liver, spleen, pancreas, bladder, stomach and the reproductive organs. This is why after my accident, every time my stomach hurts (usually from eating something that my stomach doesn't like), my back hurts too.

These deep organs are often referred to as viscera, and communication from theses organs to the brain is called visceral messaging. (My colleagues Sham, Ting Jun and Aized can do visceral manipulation if you need).
Connection between the diaphragm and psoas
Here's another remarkable fact. Your diaphragm (main breathing muscle) is connected to the spine where the Psoas muscle attaches. The diaphragm's medial arcuate ligament also wraps around the top of the Psoas along with fascia that connects to the other hip muscles.

These connections connect your ability to walk, run and breathe and also how you respond to fear and excitement - a direct influence on your fight or flight response.

So I addressed my patient's Psoas problem and got rid of his back pain without even touching his back.  As a medical doctor he and his previous physio had been attempting to treat his back for over a month with no real improvement. He was totally amazed as everyone else had told him it was his back that gave him problem.

Having back pain and not better after your back is treated? Make sure you get your physiotherapist/ healthcare practitioner to check your psoas and your internal organs/ viscera (although your healthcare practitioner may think you're nuts if they're not trained in that area).

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