Low Back Pain – Psoas Victim or OffenderJoseph Pilates identified that we spend a lot of time sitting and immobile, with sedentary jobs. This he suggested led to bad posture, which can result in issues within our bodies, including Low back Pain. And to be sure a large number of issues, including low back pain can very well be caused by our seated posture. Whilst seated obviously the hips are flexed, the hip angle reduced. The muscles that flex the hips are not working actively, they are sort of at rest, BUT in a shortened position. Remember that we are just animals, and for the brain to maintain a muscle in a lengthened state, requires more muscle tissues for this extra length. Muscle tissues is expensive energetically. So why would the brain waste this energy in having a muscle long, when it (we) spends almost all of its time in a shortened position. It doesn’t, that’s the point, it shortens the functional length of the muscles, by reducing the length. Now other factors can functionally shorten the hip flexor muscles as well. Increased ‘tone’, perhaps due to the dominant use of the hip flexor muscles. Remember when we use muscles more, there is greater need for the brain to keep those muscles continually and more regularly firing. Basically this is increased tone – tonus, which is just the muscle fibres taking turns to fire more often. Also a muscle may go into spasm, which again shortens the muscle.
Newton’s 3rd LawFor every action there is an equal and opposite re-action. So although the ‘intention’ is to keep the spine still and the line of pull should result in the bending or flexing of the hip; Newton’s 3rd Law means that the opposite action is also capable of being brought about i.e the spine gets pulled down and forward. With this forward pull may be brought about an anterior pelvic tilt and resulting over arching of the lower back – lumbar lordosis. We sit down with lets assume tight hip flexors, there is no effective pull in this position; the moment we start standing may result in extra pulling on the spine and rotation forward of the pelvis. This puts extra strain of the spine and associated muscles. This may than translate into low back pain, hamstring inflexibility etc. So as a general rule a lot of people fit into this category, that is we spend too much time hips flexed and or perform hip flexor dominant activities or sport. BUT, that does not translate into – Everybody has tight hip flexors, therefore everybody need to stretch them off or more correctly reduce their tone and or dominance. And that is where Pilates comes in! So many times people say they have tight hip flexors. Usually after visiting their Dr, physio or sports massage. Now this may very well be true, but have they been assessed for tight hip flexors? Or are well meaning people assuming one size fits all eg I had a bad back caused by tight hip flexors therefore your back is also due to overly tight hip flexors. They then decide to prescribe themselves with hip flexor stretches to perform. Missing the point that, even if they have tight hip flexors, it is usually more about reducing their dominance and tone than lengthening and stretching per se. It is in people’s best interest to have their hip flexors assessed by a suitably training professional. I myself perform this within my Postural Assessment. The reason being is that one size does not fit all and your issues may be the result of other issues within your body, or indeed elsewhere within your body. It is possible that, due to sitting passively, their hip flexors are actually weak, and are being asked to perform their normal job, in this weakened state. They are not ‘up to the job’ and something has to take up the slack – noticeably other muscles or muscle groups.
Hip Flexor Anatomy
Evolution – On all FoursBeing pedantic I would suggest that, yes it does do that, but it would be more correct to suggest that this is not its ‘function’. This is merely the result of us insisting upon walking upright. Its correct function is to act as a powerful spring bringing the hind legs forward with power (remember we used to run around on all fours). Go and watch your dog run, powerful hip flexors, strong glutes thigh muscles to push the legs away behind it, working against the hip flexors. Remember that evolution does not create things from new, evolution tinkers with what it has. As we progressively started to walk more and more upright, this particular muscle acted more and more as an unintentional hip flexor. So conversely you could argue, that the issues that people get as a result of the psoas, are not due to sitting down, but perhaps, more correctly, as a result that we evolved to and insist upon walking upright. postural assessment. Well a few including Trendelenburg and others. The one test / assessment that is relevant is the Thomas Test.
Thomas testThis simple test assesses the flexibility of the hip flexors collectively. It is a simple and quick test to perform. Now there are variations that can be done with this test, this is just one way:-
- I have my clients sit perched on the edge of a treatment coach
- They lie back resting their head and shoulders down bringing both knees to chest
- I then get then to lower one leg down keeping the other tight into their chest
- I watch for what the lowered leg is doing, does the knee fall below the hip
- Does the knee bend to 90 degrees without the thigh lifting up
Which Pilates Movements?
Spine CurlsSpine curls, work very well at addressing most hip flexor issues, as well as working the posterior chain; which again aid in relieving the load on the pelvic floor.
Knee FoldsKnee Folds – simple and straight forward. Especially beneficial if performed as Joseph Pilates liked , with a flat back.
Pelvic Tilts, Pelvic LiftsOne can regress it to even simpler but effective moves such as, posterior pelvic lifts or just good old posterior pelvic tilts. It is the activation and release combined, with control of these hip flexor muscles, that make these movements work in releasing and letting go of tight hip flexors.
Do I Need a Special Class?You can go to specialized physio, clinical Pilates classes, but frankly any reasonable Pilates Teacher ( a good one that is) session will do the trick just fine. Pilates is so effective in so many issues. I haven’t even mentioned the connection between psoas and emotional release – that’s perhaps for another blog. Much Love from Devon Paul & Tanja x
Exercises | Low Back Pain – the McKenzie / Williams Method
Exercises for Back Pain Using the McKenzie and Williams Method. Watch these low back exercises on how to fix Low back pain.
These orthopedic (chiropractic / physiotherapy) moves may be familiar if you have done Pilates or yoga before. Terrific for spinal mobility, treating and preventing sciatica, etc