Trigger Points – Sharp pain in the center of the low back when rising

Client Description

These people complain of sharp pain across the low back when getting out of bed, out of a car, or standing from a chair. They may also be slow to rise from a seated position. This happens when psoas major is tight on both sides and compresses the L5-S1 joint.

You can see from this illustration of psoas major how it crooks across the front of the hip, thrusting the hips back and compressing the lumbar vertebrae.

People with this condition also tend to walk and stand with their hips thrust back and their shoulders forward to accommodate the tight psoas major muscles. This teetering posture usually leads to other musculoskeletal problems that create a sharp, unstable low back, especially in the morning.


This presents itself in a couple of different ways. The may have a chronic anterior rotation, like the woman in this photo.  She’s good at keeping her shoulders back. They are over her hips but notice how her spine is flat with winged scapula but curves sharply at the base of her spine. This is indicative of a tight psoas that is pulling the spine forward and down to counter shortened abdominals.

This pain pattern indicates that the psoas major is tight on both sides but, as you can tell from the flexed hip and knee, hers is even tighter on the right. She may be having this pain pattern instead.

By the way, people are built asymmetrically. The left hip is bigger and more anteriorly rotated in almost all of us. If you watch, you’ll see that people are much more likely to lock the left knee and flex the right hip when standing.

Self Care

Gentle stretching can help to release the hip flexors and the resistance to unfolding. Gentler yoga poses like cobra and pigeon work better than backbends, which are usually too aggressive for this condition and really hurt.

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Therapy Notes

The iliopsoas is complicated, and there are volumes written on how to approach it. That being said, balancing the abdominals and addressing problems in the local joints seems key for lasting work. Direct work on the psoas lasts longer when the local joints, especially the sacrum, are mobilized beforehand.

The pain in this pattern is clearly from the posterior portion of the psoas major, and not the iliacus portion of the iliopsoas. I find that opening of the spinal and hip joints in a side lying position before addressing the psoas major from a supine or prone position prevents a lot of the discomfort involved in treatment and creates longer lasting results.
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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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The Body

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