back pain

Psoas - Get To Know Your Muscles

Psoas - Get To Know Your Muscles

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The psoas (pronounced ‘so-az’) is one of the deepest core muscles in the body.

As you can see in the picture below, the psoas is a long muscle, attaching above to the upper part of the lower back as well as the intervertebral discs.

It then travels down through the abdomen and attaches to the inner part of the hip, making it one of only two muscles that attaches the spine to the lower limb.

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FUNCTION:

The psoas has a number of diverse functions, making it a key factor in health.

There is still some controversy concerning it’s exact role in the body.

The psoas is partly a hip flexor - that helps bend your hip when you walk and run.

It also has an important role in stabilising the lower back and posteriorly tilts the pelvis.

HOW PSOAS BECOMES OVERLOADED:

The psoas can become tight from spending extended periods of time in the following positions:

  • sitting

  • sleeping in the fetal position

  • standing with a swayed back and wearing high heels too often

  • sitting in a kayak/canoe

The psoas becomes overloaded with repeated use in the following situations:

  • driving

  • kicking

  • cycling

  • excessive sit-ups

Visceral pain

As it passes through, and has some attachments to the internal organs, the psoas can also be activated when there is irritation internally, (in particular the colon).

Stress

The psoas tends to tighten in response to general life stress (activated during the fight / flight response). Think of the fetal position protective response - that is the psoas causing your spine to contract.

SYMPTOMS:

The psoas is known as the ‘Hidden Prankster’ due to it being responsible for a lot of lower back pain (especially related to disc pain), without many people being aware of it.

Pain from a tight psoas muscle may be projected in a vertical direction in a ‘gutter’ along either side of the lowerback as well as to the sacroiliac region and buttock (see red areas marked below).

Pain may be felt during sitting and walking.

Overload of the psoas can also lead to pain and tightness in the front of the hip. 

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TREATMENT APPROACH:

Physiotherapy assessment will involve a comprehensive movement assessment to determine the cause of your psoas issue.

Some common manual therapy treatment approaches include:

  • joint mobilisation to the lower back

  • dry needling to the psoas insertion point in the hip and upper attachment point in the back

  • deep tissue and manual myofascial release on the mid-section of the muscle (pictured below). It is very difficult muscle to dry needle direclty due to its deep location and proximity to major organs.

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SELF-CARE TIPS

  • avoid extended periods of sitting. Think about ‘time in the posture’ vs trying to find a perfect posture

  • consider a standing desk

  • avoid walking and jogging uphills and on sloped surfaces in the short-term

  • apply heat to the front of abdomen 10 minutes each day

  • sleep on side with pillow between knees, avoiding the fetal position with the hip flexed right up

  • use cruise control on long car trips to stretch the legs

  • learn to breathe through your diaphragm and manage your stress

    Some of the following exercises you may find useful:

Psoas stretch  -  gently ease into it tucking the pelvis under as you lean forward  (Picture credit:  Fiona Melder Photography )

Psoas stretch - gently ease into it tucking the pelvis under as you lean forward (Picture credit: Fiona Melder Photography)

Bridge stretch  -  tuck your pelvis, squeeze your glutes but don’t overarch your back. Breathe!  (Picture credit:  Fiona Melder Photography )

Bridge stretch - tuck your pelvis, squeeze your glutes but don’t overarch your back. Breathe! (Picture credit: Fiona Melder Photography)

Diaphragm breathing

As the psoas attaches to the diaphragm, when you breathe deeply you will naturally help decompress the psoas.

You can do this by putting your hands on the outside of your lower rib cage.

As you breathe in, expand the ribs from the sides, front and back - 360 degrees.

Aim for five seconds breathe in and five seconds breathe out for 1 minute.

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Building capacity in the Psoas

Weakness in the psoas causes decreased ability to flex the hip joint.

It’s really important for runners to have adequate capacity in the psoas.

Try this marching exercise below with a theraloop to help build some capacity in your hip flexors.

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Need some help with your lower back or hip pain?

We have a special interest in helping people overcome their pain and get back to what they love.

If you think we are the right fit for you and you wish to get relief right away, use our simple online booking system to make an appointment.  If you would prefer to speak to us directly,  call us 1300 657 813


6 Minutes To A Supple Spine

There are many options out there for addressing back pain.

But the one approach that has the best scientific support is exercise ✅

We are taught early on how to care for our teeth to prevent tooth decay.

But no one ever told us how to take care of our spines 🤔

Unfortunately this can lead to ongoing spot fires 🔥 and niggles, as the underlying issues aren't being addressed.

Below you'll find a short 6 minute set of exercises - that you can do once or twice per day to keep your spine healthy, supple and strong 👇

We have our own strengths and weaknesses so getting a personal assessment / set of exercises from your Physio would be best, but this would be a pretty good start.

Let me know how you go in the comments and please tag anyone you know who might benefit 🙌

Prevention is better than cure!

Here’s an outline of the moves:

  • Heel taps

  • Bridge

  • Single leg bridge

  • Hip abduction, clams

  • Side plank

  • Plank

  • Cat-cow

  • Superman

  • Child’s pose

  • Pigeon pose

  • Thoracic foam roller

  • Hip flexor stretch

The solution to keeping your spine healthy lies in finding the balance of mobility and stability.

Each part of our body has a specific function (as the picture below shows).

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This is know as the joint by joint approach.

Focusing on the giving what the body what it needs will lead to more efficient movement and a suppleness that you will leave you feeling energized and strong.

Research has showed that people who just focus only on stretching only had a higher incidence of lower back pain.

And people who focused only on strengthening (e.g machine based weights at the gym) had a higher incidence of back pain.

So this set of exercises has been specifically formulated to switch on the deep core stabilisers and creating mobility in the hips and back.

Doing this regularly will certainly help keep your spine supple and strong.

Let me know how you go in the comments.




Need some help with your lower back pain?

If you think we are the right fit for you and you wish to get relief right away, use our simple online booking system to make an appointment.  If you would prefer to speak to us directly,  call us 1300 657 813

5 quick tips for sudden onset lower back pain

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1. Stay calm and confident

Twinges in the lower back are extremely common and can be thought of as like the 'common cold' of the spine.

A bad cold can certainly knock you around and make you feel pretty crappy.  With a cold, you know you're going to get better so you just accept it is part of life and don't stress too much over it.

On the other hand, a lower back flare up can sometimes leave you feeling rather vulnerable and fearful of damaging your spine.

Some typical thought patterns may be along the lines of:

  • 'Am I ever going to get better?'  
  • 'Did I bulge a disc?'  
  • 'Do they even heal?'  
  • 'I may do more damage if I keep moving'

Negative thought patterns can trigger off a cascade events that can put your body into a 'fight or flight' state where some muscles get tight (superficial power muscles) and others (deep stabilisers) tend to become inhibited.

We know from pain research that the intensity of pain you experience correlates with the THREAT of tissue damage, not ACTUAL tissue damage.

Any way you can reduce the perception of threat can go a long way towards getting you on the right track with greatly reduced pain.

Spending a few minutes on these re-activation exercises will help no doubt help engage the core muscles.

But really it's more about pushing through the mental barriers and regaining confidence in your body's ability to heal.

"Your Body is an Incredible Self-Healing Machine" (Kelly Starrett).

It is amazingly robust and resilient.

We just need to set up the right environment for quality healing to take place.

2. Keep moving and stay at work if possible

If your back pain is more severe, you may need 1-2 days of rest and time off work, but then you gotta get moving. 

Staying active (and even trying to get your heart rate up a little) will increase blood flow through the body and promote the healing response. 

Being at work can be a good distraction from the pain and means you're not sitting around at home feeling sorry for yourself.

Take frequent short walks when you're at work. 

3. Change your position frequently

Don't be  sitting or standing in any one position too long.

If you have to sit at work, once again vary the position as much as possible.

Slumping is fine occasionally.

Don't get into the trap of holding yourself bolt upright in the 'perfect' posture.

Learn to chill a bit.

"Variability of posture trumps a perfect posture".

4. Book in to see your Physio

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Try and find a Physio who spends time observing your movement patterning and who can perform some targeted manual therapy and dry needling to get things moving again.

Getting some personalised advice and treatment early on often pays big dividends in preventing ongoing issues and can save you a lot of hassles down the track.

5. If you're flare-ups are becoming more frequent or intense, this is a pretty good warning sign that something needs to change

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"Pain is a request for change" - Perry Nickelston

If you're able to, find some space and time in your life to re-build your movement immunity and resilience through things like:

  • gym
  • pilates
  • running
  • yoga
  • home stretching / strengthening program
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Sensibly and gradually re-building the capacity of your body will be the most reliable long term strategy of overcoming chronic back pain. 

A Physiotherapist can help get you on the fast track and we'd love to assist you your journey.

Bookings:

If you think we are the right fit for you and you wish to get relief right away, use our simple online booking system to make an appointment.  If you would prefer to speak to us directly,  call us 1300 657 813

 

Please tag a friend that may benefit from this and please leave any comments or questions below...

 

 

5 Ways To Protect Your Lower Back During Yoga

Yoga provides many benefits to the body, mind and spirit.  Without a doubt, yoga helps form the basis of a good movement foundation.  The postures, breathing and intuitive style can bring deep relaxation and alignment to the body. 

But if you go into Yoga with the idea that is completely safe, you may need to re-adjust your expectations.

At first glance, Yoga may seem less risky than other sports such as running and football.  However, like any other form of movement, Yoga can place stresses on the body that if not well understood can lead to injuries, frustration and ongoing pain. 

 

This blog post was written in the hope that you will get the maximum benefits out of your yoga practice and keep yourself safe in the process. The following information is based on my experience as a Physio treating people who have experienced issues in their yoga practice.

 

1.  Check your ego at the door;  don't push your body too far past it's limits.

Awareness and mindfulness are the foundation of keeping your body safe. 

Listen to your body.  This can be difficult, especially in a class situation.   In the clinic, we commonly hear of someone who, when feeling good in Yoga, just pushes themselves a little bit too far and feels something 'pop' or maybe they wake up the following day with a new pain. 

I understand that progressing your practice involves pushing your body a little bit further and testing the boundaries.  Finding the right balance is always a challenge.  Naturally there will be some soreness and (hopefully) only minor injuries.  But there is a difference between slowly and safely progressing your practice under the supervision of an experienced teacher and taking things too quickly and overloading the body.

It takes great patience and respect of your body to be able to gently improve over time

Try and aim for the mid-zone (see picture below) that will give you the benefits from your practice, without the risk of injury.  A good teacher can be invaluable to guide you and most importantly, pace you at a level that is appropriate for you.

From the book,  The Story of the Human Body, Daniel Lieberman

From the book, The Story of the Human Body, Daniel Lieberman

Pay close attention to how your feel during your class in certain positions, straight after class and then the following morning.  Keeping a diary may help you identify certain triggers.

Signs that you may have pushed your body too far:

- acute pain or pain that niggles for more than a few weeks

- sharp, shooting pain that gets worse with movement

- numbness and loss of sensation or pins and needles

- pain at night that keeps you awake

 

2.  Get yourself assessed before you embark on your Yoga journey.

Don't come to yoga expecting it to magically fix all of your bodily ailments.  If you're in pain or haven't worked out in a very long time, it may be wise to get assessed by a Physiotherapist, who is medically trained to assess your suitability to start a yoga practice. 

Evelyn Krull, Principal Teacher and co-Founder at Yogita Yoga states,

Prior to starting a yoga practice, any back pain should be assessed by a qualified practitioner and ideally the yoga teacher and GP/physio/chiro work in conjunction with each other. Yoga is not able to diagnose or treat but can correct movement patterns and introduce a physical practice that provides for a strong and healthy body during all ages

You may need some specific corrective exercises and treatment and then when you are ready, you can safely maintain your body with Yoga.

Also, if you are new to yoga or having some specific difficulties, it would be wise to have some one on one sessions with your teacher for specific guidance and instructions.

 

3.  Breathe - proper diaphragm breathing during yoga will help stabilise and protect your spine. 

“If breathing is not normalized, no other movement pattern can be” - Karel Lewit
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According to Pavel Kolar, Prague based Physiotherapist and researcher,  abnormal stabilizing function of the diaphragm may be an important cause of spinal disorders.  Please see this article for more details. 

The research has suggested that activation of the diaphragm signals the other deep spinal stabilisers to activate in a coordinated fashion. 

All active yoga postures rely on the development of strong transverse abdominis (TA) muscles which is partly achieved through the deep and full breathing as the diaphragm shares an attachment with the TA and as such, by breathing fully, the TA is toned and strengthened constantly - Evelyn Krull Yoga Teacher

To breathe into the diaphragm, place your hands on your lower ribs and breathe deep, trying to expand your hands away.  You're aiming to expand 360 degrees - from the front, side and back.

Sometimes using a theraband around the lower rib cage can help facilitate the diaphragm activation. 

 

4.  Focus on flexibility where you need it most.

The Joint-by-Joint approach was coined by Mike Boyle and Gray Cook and provides a general guide to each joints main role in the body.  All joints require a degree of flexibility and stability, but each joint has a major role.  For example:

 

We can see that the main function of the lower spine is stability. 

It is designed to be a stable core base for the rest of our body to function in the world. 

Stretching the lower back may indeed provide some short term relief from pain, but will do nothing to help in the long run. 

Many yogis become hyper-mobile through their spines and lower back.  This allows excessive movement through the vertebrae. 

This will likely end up leading to overload of the joints, discs, ligaments and muscles. 

The real problem is weakness in your spinal stability muscles and you need to so some specific strengthening to help. 

Often times due to excess sitting, driving and poor posture, the upper back and hips become overly tight, therefore the lower back muscles are forced to do more of the work of movement. 

Rather than always trying to stretch the back out, focus on stretching the upper back and hips and the lower back will generally take care of itself (see below).

 

5.  Take care with forward bends.

Repeated lumbar flexion (bending forwards) can cause excess pressure on the lower back, in particular the inter-vertebral disc.  Discs are the cartilage-like structures that cushion between the vertebrae. 

The way we move and the positions we regularly adopt are reflected by changes in pressure in the discs (see picture below for more info). 

The lowest pressure occurs when we're lying flat and the highest when we're standing and sitting with a forward flexed spine. 

Disc injuries are common but don't always cause symptoms (70% of people have disc degeneration on MRI but only a few have symptoms).  Discs are generally very resilient and withstand most day-to-day positions.

However, over the years, micro-traumas and chronic muscle imbalances can lead to excess pressure on the discs.

Evelyn Krull states, "In my experience, the vast majority of people who come to yoga have experienced or are experiencing forms of lower back pain.  In most cases, the pain is not directly associated with trauma but due to:

  • lifestyle imbalances, primarily sitting for long periods of time while flexing the spine and
  • having the knees elevated above the hips (shortened psoas) as it is common in car seats

Going to yoga class and repeating forward bends is likely to further compress the discs and lead to pain.

 

These poses in particular can cause potentially high pressure in the lower back:

  • Uttanasana (Standing forward bend)
  • Urvha Mukha Uttanasana (Halfway lift)
  • Janusurasana (Head to Knee Pose)

According to Duncan Peak, author of Modern Yoga, to protect the lower back it's important to:

  • bend the knees as much as necessary so you are hinging from the hips
  • during sitting forward bends, keep your knees bent to avoid over stretching the hamstrings and lower back
  • sit on a block to raise the hips
  • don't aggressively stretch the hamstrings that can further sensitise the disc
Image courtesy of  sequencewiz.org

Image courtesy of sequencewiz.org

Unfortunately, once you have a disc injury it is a chronic condition

The focus becomes maintaining and preventing flare-ups. 

You will need to pay extra attention to your body and it's response from certain positions. 

Sometimes it's not until the day after that you will feel symptoms so it's a great idea to keep a movement journal so you can track and monitor your progress.

If you have a disc problem, try and maintain a neutral spine during your yoga practice.

Image courtesy of  up4yoga.com

Image courtesy of up4yoga.com

Some other tips for avoiding lower back pain:

  • take care when sitting for prolonged periods on the ground.  Often this can place pressure on the hips and lower back
  • it's not a good idea to bend forwards aggressively first thing in the morning when the discs are swollen and vulnerable to compression.  Leave them until later in the day
  • avoid sitting cross legged for long periods especially if you have tight hips.  Sit on a chair or lie on your back instead

 

If you have a flexion related disc problem, sphinx pose (see picture) can be a very useful pose to decompress the spine.  It can be nice to rest here for 5-10 minutes with a heat pack across your lower back to stimulate the blood flow. 

Upward dog often seems to jam up the facet joints and is best avoided in the short term if you have lower back pain.  

 

Now it's your turn. 

What has been your experience in dealing with lower back pain during Yoga?

Please share your tips and constructive advice...