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According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), back pain affects approximately 8 in 10 people. Lack of regular exercise and the presence of other diseases (e.g. arthritis, osteoporosis, disc disease) may contribute to back pain. However, one of the most common factors is often related to poor posture, occupations that require heavy lifting or simply sitting through most of the day at a desk or in a car. Sitting for long periods of time shortens and tightens a muscle called iliopsoas (il-e-o-SO-us).

What is the iliopsoas?

It is composed of three muscles: psoas major, psoas minor, and iliac. Psoas major and psoas minor lie in the back wall of the abdomen; whereas, the iliacus attaches to the inside of the hip bone. These muscles join together to insert in the leg bone called the femur. We rely on this particular muscle for standing, walking, and running. It is a very strong muscle that brings your knee up toward your chest, similar to a sitting position. It also bends the trunk forward and it can raise the trunk like when you are doing a sit-up. Moreover, iliopsoas helps stabilize posture while standing.

How does the iliopsoas lead to back pain?

Iliopsoas has often been clinically implicated in low back pain. As mentioned above, prolonged sitting and heavy lifting overwork the muscle. As a result, it shortens the length of the muscle which may rotate the pelvis forward and downward. This increases the curve in the lower back which bears more weight and stress onto the spine, also known as lumbar lordosis. The shortened muscle may limit hip extension and develop trigger points that may mimic deep and achy pain to the hip, leg and low back. Furthermore, there is a lot of discomforts when you go from sitting to standing position.

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What can I do?

Massage therapy is effective in addressing low back stiffness. On the other hand, if you feel that the relief is short-lived or that there are no improvements with further treatments, then perhaps a massage for the back alone is not enough. Ask your RMT to include the iliopsoas in the treatment. Since it is located deep in the abdomen, it involves putting firm pressure on the muscle which may feel very tender. However, with slow deep breathing, the muscle will loosen up fairly quickly and the end result is usually positive. Regular treatments to this area will remove trigger points and prevent them from returning, which will ultimately minimize pain referring to the lower back. Although massage therapy is beneficial, it is also important to be active in maintaining your own wellbeing. Here are some of the following things you can do to help reduce the stiffness in the low back.

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1) Sleeping posture
Avoid sleeping on your side in a tight fetal position because it shortens the iliopsoas to the point of pain. Instead, on your back with a pillow under your knees to lessen the tension in the muscle.

2) Heat therapy
A heating pack, hot bath, or sauna are a few examples of heat applications that you can use to alleviate pain, decrease muscle tension, and increase blood flow which promotes soft tissue healing. Plus, it is easy, relaxing, and inexpensive to do.

3) Stretching
Stretching is essential to minimizing low back stiffness. It helps increase flexibility and range of motion; as well, it allows the body to move more efficiently. As a reminder, stretches should be pain-free and held for about 30 seconds. Never hold your breath; instead, breathe slowly and regularly. An Iliopsoas stretch may be useful.*

4) Strengthening exercises
In order to provide a strong core to help stabilize the spine, it is important to strengthen the abdominals and lower back. The plank exercise increases the strength of the abdominals and the lower back simultaneously.*

Low back stiffness is a common condition that results in persistent pain that can be disabling. Many of us assume the location of the pain is often the source of the pain and as a result, we tend to overlook the iliopsoas. Next time when you come in for a massage session and fit the description of symptoms mentioned above, be sure to ask our RMTs at the Pacific Wellness Institute to include the iliopsoas in the treatment.

* If you have any history of chronic back pain, it is recommended that you perform this exercise under the supervision of a professional. Please ask your registered massage therapist for detailed instructions.

Monica Yeoh holds a bachelor’s degree in kinesiology from York University and completed the Registered Massage Therapy program at Sutherland Chan massage therapy school. To arrange a therapeutic massage session and iliopsoas exercise demonstration with Monica, call The Pacific Wellness Institute at 416-929-6958.