Hip pain, the psoas and what goes wrong

Hip pain, the psoas and what goes wrong
27 muscles cross the hip, no wonder why it is sometimes difficult to diagnose where pain and/or dysfunction are coming from. These 27 muscles need to fire in perfect harmony for the hip to have proper motion, leading you to perform at your highest level. Any dysfunction on the muscular level or joint level can hinder your power and performance. The hip joint is where the thigh bone (femur) joins the pelvis. This joint is an integrated system of muscle, joint and bone which makes it a very sturdy joint. If for some reason you feel a sudden pop or the onset of severe pain, it is better to see a doctor sooner than later due to the possibility of a tear. The iliopsoas (psoas) and rectus femoris muscles are two hip joint muscles that are commonly treated at Advanced Physical Medicine. Low back pain, groin pain or the sensation of hip weakness can all be attributed to tightening of these muscles. The fact is most of us have tight psoas muscles. This is due to our way of life, most of us spend the majority of the day sitting. Whether it be at a desk or in a car, sitting causes the psoas muscle to shorten. Let’s go over some quick anatomy of this muscle, the iliopsoas is actually made up of three muscles that merge: the psoas major and minor and iliacus. The psoas major starts in the lower third of the spine and runs in front of the spine to inside the top of the thigh bone (femur) in the groin area. As you can see in the picture, the psoas becomes more horizontal versus vertical while sitting, meaning it has shortened from it’s natural length. So next time you sit see how this muscle can become chronically short, especially if you hop right into the car following a workout. The rectus femoris is the muscle that gives definition to the front of the thigh. It starts from your hip bone (ASIS) and attaches down into your knee cap (patella). If the psoas tightens up, it can painfully press against the hip capsule which causes pain in the front of the hip. If the iliopsoas fatigues and shuts down, it forces the rectus femoris to overwork. This causes pain or soreness in the front of the thigh. Another thing that can happen when the psoas shortens (tightens), is it can pull the spinal column forward which increases the natural curve of your low back which forces the back muscles to constantly pull back to keep the spine straight which results in low back pain and spasm. If you are active, like many of our patients are, chances are you have strained a muscle before. Overdoing it can lead to a muscle strain, however if you keep straining the same muscle or region your body is trying to tell you something. Overuse can lead to dysfunction of a muscle or joint which in turn causes inflammation, pain and impaired performance. You may not have developed any pain yet but your performance may be hindered by tight dysfunctional muscles. Pain and inflammation usually develop after dysfunction when trauma is not present. At Advanced Physical Medicine we commonly treat tight, painful and dysfunctional psoas and rectus femoris musculature. One patient with years of chronic low back pain and stooped posture was told by a prior doctor that she needed bilateral hip replacement surgery. Little did she know both of her psoas and rectus femoris muscles were extremely tight and fibrotic. Treatment including stretching, instrument assisted soft tissue mobilization, chiropractic adjustments and core strengthening exercises helped her musculature loosen up. In turn her posture became more upright and her low back pain decreased. It really is amazing how much of an effect muscle, joint and fascia have on our bodies. Everything needs to work together properly and when it doesn’t problems arise. Some tips to keep your psoas and rectus femoris loose: Stretch! A great stretch is to stand in front of a bed or couch in a forward lunge position. Place the top of your foot on the couch or bed. Then lunge forward with the other leg with your hands on your hips. Now drive your hips slightly forward and down towards the floor. This should be a gentle stretch and held for 15 seconds. Get up and walk around. Sitting is the absolute worst for these muscles. Try to get up and walk around during the day. Foam Roll. Foam rollers are great for tight muscles. Lie on your stomach with the foam roller at groin level. Try to really roll your hip region up and down, from over your pelvic bone to mid thigh. Keep your core strong. DeStefano, Rob. 2009. Muscle Medicine. NY, NY. Fireside Original article and pictures take http://www.apmct.com/general/hip-pain-the-psoas-and-what-goes-wrong/ site