What Is the Psoas Muscle?
The psoas (pronounced so-ezz) muscles are two large muscles in your lower back. You have one on either side of your spine. They're the main muscular connection between your torso and lower body. They work with other muscles in your body to help you make motions that use your back, belly, and legs at the same time, such as standing, walking, and climbing.
Your psoas muscles are long — up to 16 inches. They extend from each side of your lower spine, down through your hips, and connect to your thigh bone, called the femur. You use them every day when you:
- Stand
- Walk
- Run
- Jump
- Dance
- Maintain an upright posture
Psoas major vs. minor muscles
The psoas minor is another muscle in your core. It starts at the cartilage that connects the last bone in your mid-spine and the first bone in your lower spine. It runs in front of and to the outside of your psoas major muscle.
Along with the psoas major and iliacus muscles, the psoas minor forms the iliopsoas muscle complex, which helps you hold your lower back stable when you flex your hip as you stand, sit, walk, and run. We don't know as much about what the psoas minor muscle does compared to the psoas major muscle because not everyone has this muscle. Only about 40%-60% of people have a psoas minor muscle.
What Does the Psoas Muscle Do?
Your psoas major muscle is one of your core muscles. Your core muscles are the muscles in your torso and hips that surround your spine, pelvis, and the organs in your belly. They're necessary for your ability to balance your trunk over your hips when you stand, sit, and walk. They help distribute the weight of your upper body over your hips and spine as you move. You need a strong and stable core to function your best daily and to prevent injuries.
Your psoas muscles are stabilizer muscles in your inner core. They help connect your upper body and your lower body by joining your spine to your pelvis and thigh bones. They help you:
- Hold your lower back stable while you're sitting down
- Pull your upper body up when you go from lying down to sitting
- Flex and move your hips when standing or lying down
- Lift your thighs so you can walk and climb
- Stabilize the top of your thigh bone when you move your hips
What Is Psoas Syndrome?
Psoas syndrome is an injury or irritation of one of your psoas muscles. Other names include iliopsoas syndrome, jumper's hip, and dancer's hip. It’s rare and commonly misdiagnosed. Anyone can get it, but it’s more common in athletes, especially runners, dancers, high jumpers, and people who have had a total hip replacement.
Psoas syndrome can occur on its own or as a secondary injury in people with bursitis, osteoarthritis, or rheumatoid arthritis in the hip. It usually results from overuse of the muscle or an injury.
Psoas Syndrome Causes
The most common causes include:
- Plyometric exercises (also called the stretch-shortening cycle or jump training), which use a series of explosive bodyweight resistance movements, such as jumping in place, box drills, kettlebell swings, and crunches
- Exercise that involves repeated hip flexion, such as squats, lunges, mountain climbers, and kettlebell swings
- Having inflammatory arthritis, such as rheumatoid arthritis or degenerative arthritis
- Long, frequent periods of sitting — which causes your psoas muscle to shorten and tense up — followed by physical activity
- Complications from surgery
Psoas Syndrome Symptoms
The most common symptom is pain, such as:
- Lower back pain, especially at the border between the bottom of your spine and your butt
- Pain in your butt
- Pain radiating down to your knee
- Stiffness or tightness in your lower back
- Groin pain
- Hip pain
- Pelvic pain
You may notice pain especially when you change positions, such as moving from sitting to standing. You may also have trouble standing fully upright or holding yourself upright. Your pain may get better when you rest, but will be worse when you’re walking, running, jumping, or climbing.
Aside from pain, you may also have:
- A feeling like something in your groin is catching or slipping when you flex your knee at a 90-degree angle
- Snapping noises in your hip when you straighten your leg or stand up
- Trouble walking, such as limping or shuffling
Also, if your psoas muscles remain weak or injured for a long time, your surrounding muscles and tendons will have to do more work to compensate. This can lead to more injuries.
Psoas Syndrome Treatment
Treatment of psoas syndrome depends on how severe the injury is and if there are any other injuries in this region. In most cases, the main treatment is to use physical therapy to stretch and strengthen your psoas muscle.
Medications
Your doctor will likely recommend over-the-counter pain relievers, such as ibuprofen and acetaminophen, to help manage your pain.
Corticosteroid injections
In some cases, you’ll need corticosteroid shots in your psoas muscle to help your healing process. In cases of psoas syndrome that develop after a total hip replacement, 50% of people will need corticosteroid shots to recover.
Physical therapy
Physical therapy is the typical treatment for psoas syndrome. It's usually focused on stretching and strengthening your spine and hip joints as well as your psoas muscles. There are very specific exercises that your physical therapist will use to work with this muscle. Note that some of these are dangerous to try on your own since you can cause further damage to the region.
Another method of physical therapy is called osteopathic manipulation treatment (OMT). This is performed by doctors of osteopathy (DOs). OMT aims to help your body heal by aligning and balancing your bones and muscles. During OMT, your doctor will apply gentle pressure to manipulate your soft tissues, muscles, and joints into better alignment.
Surgery
If your symptoms don't get better with medication, steroids, and physical therapy, your doctor may suggest surgical release of your psoas tendon. Your psoas tendon attaches the psoas muscle to the long bone in your thigh (femur). The exact surgical procedure will depend on the extent of your injury. Your surgeon may surgically release your psoas tendon or lengthen the muscle itself.
Psoas Stretches
You can help relieve pain and tightness in your psoas by stretching and strengthening your psoas muscles. Research shows that exercises focusing on hip rotation can help relieve pain and improve your ability to do exercise involving your psoas muscles. In addition to exercises and stretches your physical therapist recommends, try the following to help target your psoas:
Lunges
Lunges help stretch and strengthen your hip flexors, psoas muscles, and rectus femoris muscle in your hip. To do a lunge:
- Stand with your feet hip-width apart.
- Step forward and anchor your front foot
- Bend your back knee toward the floor.
- Keep your back straight. Aim to bend both knees about 90 degrees, but don't let your front knee go past your toes.
- Do two sets of 10 repetitions with each leg forward.
Leg lifts
Leg lifts are a safe way to strengthen your psoas muscles. To do leg lifts:
- Stand with your feet shoulder-width apart.
- Bend one leg at the knee with your toes pointed down. Lift this leg.
- With your other foot anchored on the floor, lift your bent knee and hold for a few seconds.
- Lower your leg.
- Repeat lift at least 10 times, or as many as you can, with each leg.
Pelvic tilts
Pelvic tilts can help strengthen your core muscles, especially your abdominal muscles. To do a pelvic tilt:
- Lie down on your back on the floor.
- Plant your feet firmly on the floor with your knees bent.
- Tighten your belly muscles to flatten and press your lower back to the floor so your pelvis tilts up toward the ceiling.
- Hold for 10 seconds and release.
- Repeat two to three more times.
Bridge pose
Bridge pose stretches and strengthens your hamstrings, quadriceps, hip flexors, gluteal muscles, and lower back. To do a bridge pose:
- Lie down on your back on the floor.
- Plant your feet firmly on the floor with your knees bent.
- Rest your palms flat on the floor near your hips.
- Lift your butt as high as you can while keeping your back straight.
- Slowly lower your butt back to the floor.
- Do five sets of 20 repetitions.
How to Protect the Psoas Muscle
Some of the best ways to help prevent muscle injuries are to warm up and stretch before you exercise or do any vigorous physical activities.
Warm up. Warming up before you exercise helps prevent injuries by:
- Gradually getting your body ready for physical activity
- Gently stretching your muscles and tendons
- Gradually bringing your heart rate up to meet the demands of exercise
Take about 5-10 minutes before your workout to stretch gently, then walk up and down some stairs, jog in place, or do lunges or squats.
Stay physically active. If you haven't been active in a while, don't start exercising way more than you usually do. This can make you more likely to injure yourself. Ease into a new exercise routine and increase the intensity of your workouts gradually. Ask your doctor, physical therapist, or trainer to help you design a realistic workout schedule so you can meet your goals and avoid injury.
If you have a psoas injury, you may need to adjust how you exercise for a period to allow yourself to heal. For instance, you may want to avoid doing full squats (where you lower your butt past your knees) or running on an incline until you are fully healed.
Improve your flexibility. This can help protect your muscles from injuries by making your muscles more flexible and able to bounce back if stretched too far. Make sure you're stretching your major muscles before and after a workout. Aim to stretch your back and legs for three to five days a week for at least five minutes.
Avoid repetitive activities. Doing repetitive movements where you're jumping or have your hips flexed can increase your risk of developing psoas syndrome. If you engage in workouts or sports that put a strain on your psoas muscle, ask your doctor or physical therapist for alternate exercises to do while you heal. If you get psoas syndrome often, you may need to permanently alter your workouts to avoid injuring yourself.
Takeaways
Your psoas muscles are two large muscles in your lower back on either side of your spine. They work with other muscles in your body to help you make motions that use your back, belly, and legs at the same time, such as standing, walking, and climbing. Psoas syndrome is an injury or irritation of one of these muscles. This can cause pain in lower back, butt, groin, or hip. One of the most effective treatments for psoas syndrome is physical therapy to help stretch and strengthen your psoas muscles.
Psoas Muscle FAQs
How does the psoas major muscle relate to back pain?
Having an injury or irritation of your psoas major can cause lower back pain. It's not the most common cause of lower back pain, but if you have symptoms for more than a week, it's time to go for a checkup with your doctor.
Is walking good for psoas syndrome?
Yes, walking can be a good way of strengthening your psoas muscle. But take it easy. If you're having a lot of pain, rest until you feel better. Avoid going up hills and climbing until you're completely healed, and don't increase your activity too fast.
