If there is one muscle in the body that is capable of causing back pain ( and neck pain indirectly ), perhaps more than any other, it is the Psoas ( pronounced ?so-as? ) muscle. Once we have seen where it attaches, it should become clear how it can cause problems if not treated properly.
The first attachment, called the inferior attachment ( more towards the feet ) connects to the same place as the iliacus muscle, i.e. at the lesser trochanter ( the small piece of bone on the inside of the thigh ). It is the other end of the muscle that we are most concerned with.
We can see from the previous weblink that the psoas attaches dirctly to the spine. It attaches to the last verterbra of the thoracic ( upper back ) curve ( T 12 ) and to all the vertebra of the lower back ( L1-L5 ). If you are not sure as to what the terms L1-L5 and T12 mean, there is a previous theory post covering this, with a link at the bottom.
Bye the way, if you are reading any of these posts, and a weblink is broken, just use Google Images and put the appropriate word in, e.g. ?psoas?.
The psoas also attaches directly to the disks in between the vertebrae.
If we look at a vertebra from the back, it has a ?bumpy bit? in the middle. You can feel that when you run your fingers up and down your back. Those bumpy bits are called ?SPINOUS PROCESSES?. However, there are also thin pieces of bone running to the left and right of the vertebra. These pieces are called ?TRANSVERSE PROCESSES?. ?Transverse? just means ?to the side? and ?process? just means a piece of bone that is sticking out.
The Psoas also attaches to the transverse processes of the vertebrae.
Now, let?s imagine that you are in the action of sitting down at a desk. Multiple muscle groups work to achieve this seemingly simple task. The psoas muscles will contract as we sit down, and depending on how good or bad our ergonomic position is, those muscles will remain contracted to a lesser or greater degree. Over time, if we do nothing to correct this, adhesions and knots will form.
When we are young, our soft tissues recover fairly easily. However, as we get older, our tissues harden, naturally ( that effect can be minimized at any age with proper stretching an diet as I?ll discuss in another post ).
If both psoas muscles ( left and right ) were to contract to the same degree, the spine would change shape. In most cases, the lumbar curve would increase in size. This is not good. We have spoken at length in previous posts about the possible damage that can be caused ( increased pressure on disks, dehydration and degeneration of disks , decreased size of foramen holes, possibly causing nerve pinching etc ). As the lumbar curve increases, back muscles tighten up also for reasons given previously.
Unfortunately, most people do not have the same tension in the left psoas as the right psoas. For the vast majority of people, the right psoas will be tighter than the left psoas. This creates some major problems. Firstly, the psoas also controls rotation of the ilium or hip bone, just like the iliacus mentioned in the last post. We will see later in a post on x-rays ( using x-rays of myself and a few others ) that this one sided movement will cause one hip to increase in height as viewed from the front. This will cause a chain reaction through the whole body. As that tight psoas contracts, it will pull the rib cage downwards. The shoulder is attached indirectly to the rib cage/spine. That side of the shoulder will pull downwards. This tends to pull the neck down on that side ( everything is connected ). As mentioned before, the body will try to do whatever it takes to keep the eyes level. It starts tightening other neck muscles to keep the eyes and head level. This is why we are talking about this muscle in the section on postural analysis. That one muscle can cause changes in symmetry all through the body. Also, the femur moves as the ilium rotates. This affects leg length appearance.
When the stronger, or tighter psoas comes into play, it acts like a bowstring. The psoas is the string and the spine is the bow. When it becomes tight and is tighter than the opposite one, the spine bends. Instant scoliosis. Scoliosis is a complex subject, and I won?t go into all the details, but a tight poas on one side is a major cause ( that was what caused mine ). Another problem can now occur. Due to the combined effects of the hip going higher and the ribcage going down, another muscle called the ?QUADRATUS LUMBORUM? or QL, which connects to the bottom of the rib cage and the top of the hip can become contracted, making a bad situation worse. The QL can also become tight without influence from the psoas.
Let?s put this together and look at an actual case of a family friend whom I worked with some time ago ( the metal pieces at the top are brassiere clips and not implanted spinal hardware )
Firstly, look at the hip heights left and right. If you wish, you can print out the picture and draw a horizontal line from the top of the hip shown on the left of the picture across the page, or lay a ruler on the computer screen. You will see that the line will not hit the top of the hip on the other side. The discrepancy is due to the rotation of the hip on one side ( left side of your screen, but actually her right hip, marked ?R? ). That tight psoas has acted like a bowstring, and pulled the spine out of position left to right, creating a scoliosis of the spine. Since the disks are now no longer of the same height on both the left and right sides ( one side will be ?squashed? ), all sorts of bad things like disk herniations can occur. We will discuss more about this in a separate post on X-rays.
Look at the pubic bones which we discussed in another post. They are not aligned vertically. The pubic symphysis is in the gap between the two. It acts like a disk or joint. Because it is made of soft tissue, we cannot see it on an x-ray:
The doctors wanted to put steel rods down her spine. Totally unnecessary. Analyze the problem from an engineering point of view, then find which muscles are responsible, then correct the imbalances. No surgery, no drugs.
I charge no money when I try to help people. I tell them though that I would like them to agree to have their pictures ( photos and x-rays ) put on the internet anonymously in order to help others. If someone is insistent ( which has never happened so far ), then I wouldn?t put the pictures up. The chap in the following was in truly terrible pain from scoliosis. He is a computer programmer who spent years at a desk. Within 18 months, his spine went from normal to what you see in the following ( once the muscles trying to prevent abnormal spinal movement get ?overwhelmed? things go downhill rapidly ):
Look at the ?tension? in his neck muscles
The next picture shows him after only two months of purely muscular therapy. Not quite a 100% at this point, but major improvements. To quote some of the world?s leading orthopaedic surgeons , ?Scoliosis is not correctable outside of braces and surgery??..really !! Haven?t spoken to him for a while, but last time we chatted, he was back at work:
So, postural analysis will allow us to see what is balanced and what is not balanced throughout the body by analyzing photos and also by placing the person against a grid as we saw in the first of these three posts about the subject. This is all pure engineering. No magic about it.
WE MUST LOOK AT THE BODY AS A WHOLE UNIT, NOT JUST ONE MUSCLE INDIVIDUALLY, AND WHAT IT DOES LOCALLY. THIS IS THE BIGGEST MISTAKE MOST DOCTORS AND THERAPISTS MAKE. THE BODY IS CONNECTED HEAD TO TOE VIA BONES MUSCLES AND MOST IMPORTANTLY, FASCIA. THE OLD SONG ABOUT THE ?LEG BONE IS CONNECTED TO THE KNEE BONE?.ETC ???.VERY TRUE.
Here?s a real example:
Shortly after getting my pelvis put back in place and my spine ?untwisted?, I had to learn to walk again. The right leg was not responding to commands from the brain. I spent hours and hours literally ?willing? the leg to move. It worked. After only a couple of weeks of walking, I started developing very sharp pains in my feet. It got so bad that I couldn?t even put my feet on the carpet in the morning getting out of bed. This was a bitter blow for me. To be able to walk after six months then to have it taken away from you weeks later is a trully awful feeling. One of the lowest points of my life. I gave myself two days to feel sorry for myself and then put that behind me. I was determined to conquer this problem in the same way as all the others. I went to see a foot doctor. He told me that like my hands, my feet had turned into ?claws?. The muscles on the bottom of the feet as well as tissue called the PLANTAR FASCIA had contracted so much that I was walking on the tips of my toes and my heels. The rest of my feet weren?t even touching the ground. He said my case was so bad that I would need major surgery, involving cutting a number of tendons in my feet. There are major side effects to this type of surgery. I was told that I would be able to walk after the surgery, but with a limp.
I called the therapist who had gotten me walking the first time. First question he asked was ?Did the doctor have any anatomical models in his office ??. Thinking that was a bit strange, I replied ?Just a model of a foot?. ?Exactly? he said. ?The foot doctor thinks no further than the foot, and the knee doctor thinks no further than the knee?.we have to look at the whole system?.come down and see me?. Al explained that the foot condition was a SYMPTOM, not a CAUSE. My problem was with a muscle called the SOLEUS at the top of the back of my lower leg under the calf muscles. That had become rock hard from barely moving in six months. The soleus connects to the Achilles Tendon, which runs down the back of the leg. The Achilles Tendon in turn connects to tissue called the PLANTAR FASCIA at the bottom of the foot. That in turn had contracted when everything above it ( soleus and achilles ) had contracted and pulled on it. After a few weeks of treatment, I was back to walking normally again.
Please read very carefully what the writer has to say about his visit to the exhibit mentioned:
Previous theory posts:
In the next post, we?ll discuss stretching. This will be followed by the use of X-rays as a diagnostic tool ( and why the vast majority of all back x-rays taken in the world are performed incorrectly ), then a posting on choosing a therapist, along with what questions to aks him and what should be ?contractually agreed to? before treatment. We?ll also be covering the best self-help tools and books that I have found, along with the worst things you can do with regard to neck and back pain. We all have to use computers. However, we can learn to negate their bad effects on our bodies, as well as correct existing problems. We?ll also talk about ergonomic chairs, and why they are a good thing, but not the complete solution. Again, I had no desire to learn any of this, but I had to after being told ?You will be in a wheelchair in six months and paralyzed within two years? by multiple doctors. They were all wrong, every last one of them.