First published in The American Chiropractor Magazine October 2017 The Psoas – The Missing Link in Pelvic Correction
The psoas is one of the most frequently neglected yet vitally important muscles in the body. Its action is that of the major hip flexor. That seems simple and straight forward enough, but a closer look shows there is more to it than its action as hip flexor would suggest.
A large and powerful pair of muscles, with origins into the transverse processes of T 12 – L5 and the lateral aspects of the discs of L1 – L5, they cross the pubic arches and the sacroiliac joints before inserting into the medial aspect of the lesser trochanters of the femurs.
These powerful hip flexors cross two joints, the sacroiliac and the ileofemural, they are diarticular, and the only muscles joining the axial and appendicular skeleton.
The psoas allows movement mainly in the saggital plane and to a lesser degree in the frontal and horizontal planes.
Another unique feature is that they can become their own antagonist in stabilization between flexion and extension.
Innervation of the psoas is by the L1-L3 nerve roots.
The psoas is a primary fight/flight muscle, reacting to our inner and outer state of consciousness and awareness. It contracts strongly when we are stressed preparing us to fight or run even when such physical action is not appropriate for the situation. It is an important part of the sympathetic nervous system’s stress response designed to be engaged for brief periods, meaning for moments, not days, months and years. Prolonged psoas contraction has negative consequences.
Tight psoas can cause lumbar hyperlordosis as well as lumbar body rotation on the same side or spinous rotation on the contra lateral side. This contributes to the pelvic imbalance that is the root cause of much of the acute and chronic low back pain that chiropractors see in their offices every day.
The question is: What causes the psoas to become hypertonic, sometimes to the point of spastic contraction, causing difficulty in walking, changing position from sitting to standing or turning over in bed?
Because it is such a large and powerful muscle, it is susceptible to multiple stimuli. First is the postural stress of sitting. Sitting has been identified as one of the foremost health liabilities of people living and working in our modern world. There are multiple liabilities imposed on us by the long periods of sitting that most of us do in the course of our work and leisure activities.
The act of sitting places the long axis of the femur at a 90 degree angle to the lower lumbar spine. Sitting causes the psoas to shorten in much the same way as the biceps shorten when the forearm is flexed against the upper arm. Prolonged sitting more than 15 minutes causes a progressive and persistent tightening of the muscle belly and shortening of the tendons. The many hours that most people spend sitting each day cause the psoas to become more or less permanently short and tight unless steps are taken in the course of the day to stand, walk and hopefully do some stretching exercises to elongate it. The goal is to prevent the fibrous degeneration that a muscle will undergo if chronically shortened when not put through its full range of extension and contraction on a regular basis.
The static compressive loading of the spine caused by sitting significantly increases the hydrostatic pressure in the nucleus of the disc. Asymmetric psoas contraction place lateral pull on the disc exerted at its tendon attachments into the lateral portion of the L1-L5 discs. This has the effect of distorting the disc, reducing its ability to resist compression by altering the geometry of the radial fibers of the annulus fibrosis. The ability of the disc to resist the compressive effects of gravity on the upright spine is based on the structural strength of the fibro cartilage of the disc, which is arranged in the form of 30-60-90 degree triangles. When the disc distorts or bulges laterally, the vertical or 90 degree angle of the triangle increases. Each degree beyond 90 reduces the ability of the disc to resist compression and causes it to narrow or loose vertical height.
The psoas is known to be reactive to not only physical and emotional stress, but to deficiency of the B vitamins as well as mineral deficiencies, especially magnesium, calcium and manganese, which should always be considered in cases of chronic psoas contraction.
Most cases of pelvic imbalance will be found to have some degree of unequal psoas contraction. This is especially true of those involving sacroiliac slippage and separation, which in Sacro Occipital Technique is designated as Category II.
In the majority of these cases, the strongest psoas contraction is on the short leg side designated as Category II PSS right or left. Category II can cause severely acute one-sided pelvic pain, sometimes accompanied by lateral antalgic spinal incline. Occasionally there is a combination of lateral and anterior antalgic posture, as a compensatory and protective mechanism designed to transfer weight bearing from the injured to the other side.
Gonstead Technique provides another insight into this condition. In that system of spinal analysis and correction, the doctor is advised to adjust the PI ileum on the side of lumbar body rotation. The PI ileum in Gonstead analysis is usually found on the short leg side and corresponds to the Category II PSS side in Sacro Occipital Technique analysis.
Quantum Neurology and Gonzalez Rehabilitation Technique provides yet another set of analytical and corrective tools which allow us to make more comprehensive pelvic corrections.
Most techniques ignore the hips or ileo femoral joints because they are either in place or completely dislocated. Conventional wisdom would indicate that there is nothing of value to be done with them, but Dr. George Gonzalez, the founder of Quantum Neurology® and Gonzalez Rehabilitation Technique, has developed a series of protocols that allow us to identify and correct previously little known mechanisms of dysfunction that commonly occur in the hips.
The hip joints are surrounded by layers of multi-directional bands of ligaments that form the inner and outer joint capsules. Within these capsules are a network of mechanoceptors and neural relays which carry afferent and efferent proprioceptive information regarding the lower extremity, pelvis and lumbar spine.
In his Lumbar and Hip Fix instructional DVD, Dr Gonzalez demonstrates how easy it is to identify the usually overlooked anterior and posterior femur head dysfunction using specific muscle testing. Once identified, fast, easy and effective correction is done by resetting the mechanoceptors using the ArthroStim electronic adjusting instrument manufactured by Impac Inc. These Quantum Neurology protocols are important because they free the flexion, extension, abduction and adduction of the hip joints.
When the hip joints are fixated they disrupt the synchronous action of the other five pelvic joints. Because of their important role in weight bearing and not only mobility but agility, failure of the hips to move freely causes rapid onset of inflammation of the joint capsules. Because of the network of mechanoceptors and neural network contained in them, many people experience extreme hip and leg pain which is often mistakenly diagnosed as discogenic disease and sciatic neuropathy.
Dr. Gonzalez has also developed the best analysis and correction I have seen for the symphysis pubis. Pubic joint correction is key to the overall correction of the pelvis.
The symphysis pubis functions in much the same way as the keystone of an architectural arch does in construction. Removal of the keystone of an arch causes it to collapse. Fixation or even slight malposition of the pubic joint destabilizes pelvic motion and weight bearing balance. Quantum Neurology gives us an easy way to identify this joint dysfunction. The ArthroStim instrument gives us the perfect tool to correct this sensitive and important component of the pelvic joint complex.
Good chiropractic techniques complement each other and often serve to cross reference the findings and conclusions of one another.
The observation of lumbar body rotation on the same side as a PI ileum is consistent with unilateral psoas contraction. Given the attachments into the lateral aspect of the lumbar vertebrae, it is natural for strong psoas contractions to rotate the bodies of the lumbar vertebrae to that same side.
Contraction of the psoas can cause excessive lumbar extension and rotation disturbing the normal lumbo-pelvic balance. When this happens, the lumbar discs, facet joints, sacroiliac joints, symphysis pubis and hip joints are all potentially affected.
That makes release of psoas contraction a key element and should be considered a prerequisite procedure to be performed before other lumbar or pelvic corrective protocols are employed.
I do not remember where I first learned of the technique I use to release the psoas, I only know that I have made it a standard part of my lumbar and pelvic corrections for more than thirty years.
It is safe to assume that almost everyone who walks into your office will have some degree of psoas tightness. The very act of sitting in a car to get to your office followed by a few minutes of sitting in your reception room almost guarantees the psoas will be tight.
You will find that when you do a psoas release before proceeding with lower back corrections, you will have reduced the resistance to your correction, making it much easier on you and your patient.
The effort or work necessary to correct the spine can be reduced to the simple physics work formula: W= D x R (the degree of displacement or misalignment times the resistance holding it).
Integrated Advanced Chiropractic Techniques is the methodology I use that has evolved over the course of my fifty years of practice, study and experience. I now offer a series of seminars in which I share my methodology and protocols with other chiropractors. I offer it to the young chiropractors, knowing that it will shorten their learning curve and path to success. I also offer it to the senior members of the profession who are feeling the toll that many years of “full contact” practice has taken on their bodies. My technique can add many enjoyable and productive years to your career as it has for me.
