The Psoas and Low Back Pain

If you ever have low back pain that is worse when you first stand up after sitting for a long time and
then it gets better as you walk around, you probably have a tight psoas. Other signs would be worse
pain when lying flat on your back that is somewhat relieved by sleeping on your side in a fetal
position.

This pain can be crippling when the psoas is very tight. It can be very painful just to try to walk a
short distance and anti-inflammatory meds don’t do much to relieve the pain. The problem isn’t
inflammation; it’s muscle shortening and the resulting tension. Tension on the lumbar spine!

A tight psoas causes lumbar pain and an increased lordosis (arch) in the low back. It will make you
feel like you are walking like a duck with your butt sticking back.

You might be thinking, “How can tight hip flexors make my low back hurt?”.

To understand this we have to look at the origin and insertion of the psoas. Its origin is on the
vertebral bodies of from T12 to L5 and that includes the intervertebral disks. The psoas travels down
to the iliac fossa of the pelvis where it interdigitates with the iliacus (which is why the muscle is
often called the iliopsoas) before attaching to the lesser trochanter of the femur.

The iliopsoas is the strongest hip flexor on the body and it stays in a shortened/flexed position when
we sit. So it’s not hard to imagine how people who sit all day at work then sit in their car and then sit
on their sofa at night for a few hours are good candidates for some psoas shortening.

If we take a look at the iliopsoas it’s easier to understand what I’m talking about. The muscle goes
from the back of the body to the front. It’s a pretty interesting design really.
How many people are putting heating pads on their low back or getting massages of their lower
backs and bending over to touch their toes to try to stretch that tight low back out when really the
problem is in the front?!

From an acupuncture perspective there are different approaches I’ve heard of and tried. One way to
treat a tight psoas is from the front at GB27. I like to put a 2-3” needle in a lateral direction into the
iliacus muscle and stimulate the iliacus to get a sensation in the psoas. This may cause some
twitching of the psoas if it’s highly reactive from being tight. A gentler approach would be to use
some e-stim on the same needle at GB27. That can be paired with TFL at GB29 (another hip flexor
that can get pathologically tight) or to another point on the Dai Mai, GB28 or something on the thigh
or leg. Update: My new favorite way to release the psoas is from BL24 with a 3″ needle. The motor
point can be reached this way and is very effective in releasing a tight psoas.

The innervation of the iliopsoas is from the femoral nerve. TFL is innervated by the superior gluteal
nerve and points on the quads (leg extensors) will be femoral nerve so you can choose your treatment
based on whether you want to stick with the pathway of the femoral nerve or if you want to get both
femoral and the superior gluteal nerve pathways in the treatment. From a TCM perspective you could
stay on the Gallbladder meridian with GB27, GB29, GB31 or GB34 or include the Stomach
meridian with ST31 ST32 or ST36 .

A quick Google search on “psoas stretch” or “psoas self-massage” will point readers to good
resources for self-treatment of a tight psoas. A psoas stretch can give quick relief. When a tight psoas
is the source of low back pain, the first time stretching it will usually increase the pain a little. But
that’s how you know you are on the right track. Pulling on a tight muscle will naturally increase the
tension temporarily. It’s worth being persistent on these stretches. It will pay off in hours or days.