Lower back pain is one of the most common reasons someone seeks out acupuncture, oftentimes after trying other approaches. Direct massage to the lumbar region is frequently used to relieve lower back pain. Although this will often alleviate symptoms for some people, there may be some who do not see improvement or frequently have recurring symptoms.
Two muscles deep in the abdomen that are often overlooked when treating the lower back are the iliopsoas and the quadratus lumborum. The iliopsoas is the largest hip flexor in the body and is the only muscle that connects the spine to the legs. Quadratus lumborum is the deepest abdominal muscle and attaches the lumbar spine to the lower ribs and hips. Trigger points in both of these muscles can mimic sciatica, referring pain into the groin, hips, glutes, and legs. In this mini-series we will look at the anatomy of both muscles and how you can massage and stretch them at home to help relieve lower back pain.
First, let’s take a look at the anatomy of the iliopsoas muscle:
There are three parts to this muscle: Iliacus + Psoas Major + Psoas Minor.
The iliacus muscle fans out across the inside of the hip, while both the psoas major and minor cross through the pelvis and attach to the transverse processes of the lumbar spine. The iliacus and psoas muscles intertwine and form what is known as the iliopsoas, which attaches to the lesser trochanter of the femur. Together, these muscles work to flex the hip and spine, tilt the pelvis anteriorly, and assist in lateral flexion of the lumbar spine.
Indications of a Tight Iliopsoas
The most common symptom of a tight iliopsoas is lower back pain. You may also have pain in the following areas:
Down the leg
Across the top of the hip bone
You may experience the most pain during the following:
After sitting for long periods
After walking for long periods
While standing from a seating or bent forward position
During abdominal exercises
You might have a tight iliopsoas if you:
Have an increased lower back curve
Have an anteriorly tilted pelvis
Are hunched over at the lower back
Follow these simple steps to isolate and stretch your iliopsoas.
Start by coming into a standing lunge with your feet hip-width apart. Get into as low of a lunge that is comfortable for your body.
Square your hips straight forward.
Tuck your tail bone as much as possible. In this position you should already begin to feel a stretch in the lower attachment of iliopsoas in the front of your hip/upper thigh.
Raise your opposite arm. Example: if you are stretching your left leg back, then raise your right arm. This will move the stretch up into your abdomen where the main belly of the iliopsoas muscle lies. It is ok to raise both arms if it is more comfortable or better for your balance.
To reach more of the ilacus portion of the muscle along the inner hip bone, give a slight gentle bend to the opposite side to open up the hip you are stretching. Example: if you are stretching your left leg back, then gently lean to your right.
*If you are having a hard time isolating iliopsoas in this stretch do not lean backwards. This will put strain on the lumbar spine and can possibly aggravate lower back pain. Instead, make sure your hips are squared forward and tucked as much as possible. Or try getting lower in your lunge. You can bring your knee to the ground if it helps you to get a wider lunge or if it is better for your balance.
For those with knee problems or for a more gentle stretch of the iliopsoas you can use a bed or table.
Lay on your back with the bottom of your sacrum at the edge of the bed so your glutes are hanging over the edge.
Laying in this position can cause the lower back to arch significantly. It is really important to tuck your tail bone, engaging the lower abdominal muscles, to help support the lower back. This will also help to isolate the stretch into the iliopsoas.
Bring one knee up to your chest and clasp your hands around your knee. Pull the knee toward your body to further reduce the arch in your lower back.This will also help to assist the stretch in the leg that is pointing down toward the ground.
Lay in this position as gravity gently opens and stretches the iliopsoas muscle.
When you are done stretching both sides, gently roll to one side of the body and use your arms to push you in to an upright position.
*If you are having a hard time isolating iliopsoas in this stretch, make sure you are tucking your tail bone as much as possible. You can also try scooting closer to the edge of the bed so your leg falls closer to the ground, which will stretch the hip even further. This approach is gentle since you are using gravity to stretch the iliopsoas, so it may not be felt as intensely as the lunge stretches.
Self-Massaging the Iliopsoas
Locate the iliopsoas approximately one inch beside and one inch below the belly button.
Lie face down on a ball in this location and slowly place your body weight to a degree that is comfortable for you. Play with different ball sizes to find what is most comfortable/effective for you. I prefer a ball that is about the size of a small cantaloupe because it is large enough to reach the proper depth. A smaller ball is nice for massaging more of the iliacus portion of the muscle inside the hip.
Slowly roll around on the ball until you find a tender spot. Hold here until the tenderness dissipates.
Work to release the muscle by slowly lifting and lowering your straight leg on the same side of the ball. Coordinate this movement with your breath, raising the leg during inhalation and lowering the leg during exhalation. There is no need to lift the leg a large amount. Even a small one inch lift will be enough to activate the iliopsoas. Work within a range that is comfortable for your body.
*If at any time you feel a pulse from your deep aortic branches, immediately and gently move the ball to a different position!
Strengthening the Iliopsoas
Abdominal exercises that involve flexion of the hip and focus on the lower abdomen will help strengthen the iliopsoas. When doing abdominal exercises be sure to keep your back straight, pelvis tucked, and hips straight. The more you focus on good posture and form the more you will isolate your deep lower abdominal muscles to strengthen them.