When most people get that familiar back pain or “tweak [their] back,” what is the first thing they do, besides applying ice/heat or popping an Ibuprofen? They usually start stretching their hamstrings or glutes. This can certainly help at times, if their hamstrings are tight, as it can pull the pelvis into a posterior pelvic tilt; however, if your hamstrings, glutes, gastrocnemius, and soleus (calves) — aka the muscles of the posterior chain — are not hypertonic (tight), then you may be wasting your time.
For most people, who are leading sedentary lives and working from home at a desk (or on the couch), it is the anterior chain that needs to be lengthened rather than the posterior chain. As we sit or slouch for hours on end at home (due to the pandemic), we are passively and unintentionally lengthening the posterior chain musculature while tightening and shortening the opposing anterior chain musculature. In the mainstream media, the focus is usually placed on the posterior chain muscles that we recognize — namely, the hamstrings, glutes, calves, etc. Lesser known but equally or even more important are the muscles that make up the anterior chain, especially the illiopsoas (psoas) muscle and the hip flexors.
Why is the psoas so important when it comes to low back pain? The psoas attaches to the vertebrae of your lumbar spine, so when it shortens or contracts, it can exert tension on your low back and cause pain. This is especially true if the psoas muscles (which are a pair) are imbalanced and exerting uneven tension on the lumbar attachments.
Iliopsoas muscle in situ
Now that you know the problem, what can you do to address it? One of the simplest measures is to reduce your time sitting by taking periodic breaks while working. I often tell my patients to set an alarm on their phone for every hour on the hour, while they are working (ideally it would be every 30 minutes but that would be too distracting). However, while this is a good preventative measure, it doesn’t fix the already shortened iliopsoas muscles, so the muscles need to be directly stretched to reduce the tension placed on the lumbar spine. Since this is a muscle located deep in the abdominal region, it cannot be superficially massaged like most muscles. A manual therapist/LMT can certainly address it with direct massage but this is quite uncomfortable and difficult to do on one’s own. If you would like to stretch the psoas on your own, there are a number of ways to do so. If they are extremely short, then a simple lunge will start to stretch it, but for most people, a deeper stretch will be needed.
This is one way to do a deeper psoas stretch; however, I like to deepen it even more by keeping the torso upright (chest up), and then reaching with the ipsilateral arm (same side as the psoas being stretched) upwards and then towards the opposite side. If that isn’t enough, then I look up into the palm of the raised arm. It is also key to try to maintain a neutral pelvis. You can attempt to do this by trying to tuck in your tailbone (posterior pelvic tilt) during the stretch as the maneuver naturally will cause your pelvis to anteriorly tilt if you are not opposing it.
If you have done this several times over several consecutive days and are still having the same intensity level of low back pain, you may need direct pressure to release the psoas contracture and you should see a chiropractor or LMT for that. You may also not even have a tight iliopsoas muscle; the way to assess if you have a tight or imbalanced psoas is with an orthopedic test called the Patrick FABERE test and this can be done properly by a chiropractor or physical therapist. There are many factors that come into play with low back pain and a shortened psoas muscle is just one of them. If you would rather take out the guesswork and trial and error on your own, you can always schedule an appointment for an initial chiropractic exam and get an assessment at Chiropractic Solutions in the Fremont neighborhood of Seattle, WA.