People with this pain run their hand up and down along one side of their low back and say that it hurts there. They often say that it hurts when they get up from sleep, after a drive or some other activity where the hip is flexed for extended periods. When this trigger point becomes more active, they complain of the pain when walking.
Sitting may offer them relief for short periods but they often complain when they are driving for long periods. They are stiff and slow to rise after long periods of sitting.
They often seek relief by “moving around.” One client complained about this to get out of jury duty. They may also get relief by putting a pillow under their legs when sleeping on their back.
They may also complain of a “twisted hip” or that their “back is crooked” or they have “scoliosis in their low back.” One side of their low back is often notably flatter than the affected side.
They may also complain of disturbed sleep and digestive disturbances.
This is the standard stretch that most therapists give for psoas major. Because it is a hip flexor, extending the hip stretches the psoas. If you want to make this faster and more efficient, use ice-and-stretch. Ice along the abdomen, through the fold of the hip and onto the top of the thigh.
Yoga postures that stretch psoas include cobra, which stretches both psoas muscles, while also lengthening the superficial abdominals and pigeon, which offers a more intense stretch of psoas on one side and piriformis on the other. A tight psoas will make it difficult to stop the thigh and knee on the back leg from turning out. I discuss the common trigger point patterns of the pigeon pose in this post.
Restoring proper function to any part of the psoas major is highly debated. In this case, the trigger point is near L3 and usually palpable. Normalizing function of the mid-lumbar vertebrae is critical. Balancing the pelvis and restoring tone to the superficial abdominals is also key to lasting results. Palpate the TP before and after working the lumbar vertebrae and pelvis. Treatment is more effective and longer when it has some release before direct treatment.
Tony Preston has a practice in Atlanta, Georgia where he sees clients.
He has written and taught about anatomy, trigger points and cranial therapies since the mid-90s.
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