This Hip Flexor Can Contribute to Lower Back Pain: the Psoas

There is one hip flexor muscle that often contributes to lower back pain: the psoas.

The psoas muscle is hard to find and easy to annoy. It is not just a hip flexor, it is also a spinal muscle and the only muscle to bridge the upper and lower body. You can learn more about the location of the psoas and how it relates to the other muscles of the torso by checking out these posts on core anatomy and hip anatomy.

How the Psoas Hip Flexor Causes Lower Back Pain

Because of its attachment points all along the inside of the lumbar spine, when the psoas muscle isn’t properly supported, strengthened, and lengthened it can pull on the vertebrae of the lower back. If this goes on long enough it creates conditions that are conducive to spasms. When you hear someone say that their “back has gone out” (where did it go?) or if you have had that unpleasant sensation of excruciating lower back pain that causes you to lie on the floor and cry for two days, there is a good chance that your psoas was in rebellion.

Studies have also shown a correlation between weak, underused psoas muscles and degeneration of other spinal muscles.

Chronicly tight hip flexors, in particular the psoas, can contribute to long-term spinal pain and can even pull the vertebrae out of place. The psoas can even affect chronic issues liks spondylolisthesis and spinal stenosis.

Two major factors that can contribute to tight hip flexors and cause the psoas to pull on the lower back are sitting for long periods of time and poor posture. Both of these activities can make the psoas squashed, weak, and tight. You can learn more about posture and hip tightness here, and see a posture tutorial here.

How to Take Care of Your Psoas to Prevent Lower Back Pain

The good news is that there are things that you can do to take care of your hip flexors and psoas to prevent lower back pain and injury. While stretching can play a part in this regimen, sitting in a lunge alone will not usually be enough. Lunges can be a great tool, but you have had the experience of sitting in lunges for hours only to find your hip flexors tighten right up afterwards, you will know that stretching alone is not enough to change the way that your hips work.

Most often there needs to be a combination of elements including improving the cooperation of the core muscles to improve the support of the spine, strengthening for the hip extensors (hamstrings and glutes), and a nice, loving targeted routine to strengthen and mobilize the psoas muscle so that it feels free and empowered. I have a routine that I have used for years and has greatly helped my lower back pain, in tandem with all of the other tools mentioned here, in this post on how to have a strong, flexible psoas.

Even though the psoas hip flexor is a difficult muscle to work with because if its internal position and how many different ways it can move, it is worth the investment since it has a profound effect on lower back pain and your long term spinal health.

Happy Bendings!

Video for you visual learners…

Can Beginner Running Compliment Flexibility Training?

Everyone knows that running and flexibility exist in opposition to each other. Right?

Ask any flexibility coach about cardio cross-training and the vast majority will tell you to stay away from running. Ask any runner about flexibility training and most will groan and treat it as a boring and unpleasant but necessary evil to keep them from turning into one big, gristled tendon.

Convention will tell you that running makes you inflexible and flexibility training and being highly flexible or hypermobile makes you unsuitable for running.

But what if, by focusing on impeccable running technique, proper pre-conditioning, warm-ups, balance, and an almost exclusive application of active over passive flexibility exercises, these two disciplines could complement each other instead of oppose each other?

This is my experiment of one, as I test the capabilities of my own body in the lab of life.

Running with Proper Technique

Fortunately, with running technique I don’t have to invent the tools because someone else has already done it and written the book.

In the process of preparing for and recovering from foot surgery for osteoarthritis in my right foot I started running. I had been working with a client who was a trail runner and he had recommended that I read “Born to Run” by Christopher McDougall. The running technique he describes in the book flipped my preconceptions about running being hard on the joints, positing that with the right technique and preparation running can strengthen and heal our bodies (and be insanely fun at the same time and I’m always down for fun).

My feet and ankles have always been a weak point. As a dancer I struggled with a perfect relevé, always wobbling like a faun. I’ve sprained both ankles more times than I can remember, over-stretched my feet and toes in pursuit of perfect lines, danced for years in high heels, and suffered bouts of tendonitis in my ankles. Now, with osteoarthritis limiting the flexion in my right big toe, it seemed so easy to follow the doctor’s advice and resign myself to a life of supportive shoes, cushy insoles, and a strict avoidance of impact training.

But everything I know about bodies in general, and my body in particular, told me that this medically recommended course of action would cause me nothing but misery. Because I’m hypermobile, constant strengthening and stability work is essential to keep me out of pain. If I’m not working out, everything falls apart very quickly. If I stop challenging my feet and ankles I’ll soon be walking around on a couple of melted marshmallows. What will that do to my knees, hips, back, and psyche? Nothing good.

So McDougall’s book spoke to me. He had also defied countless medical opinions to become an ultramarathoner and running devotee. His book chronicles his training with coach Eric Orton who rebuilt his running technique based on the timeless, tried and true form used by all the world’s best runners like the Tarahumara people of Mexico’s Copper Canyons. The way we ran before our obsession with over-engineered sneakers robbed our feet of their agency and power—what is now called minimalist running because you don’t need much more than your own body to do it.

Learning Beginner Running When Flexible

I started running about one year prior to my scheduled surgery date. I bought myself some minimalist running shoes (the Xero HFS) and hopped on the treadmill a few days a week. I quickly found that the only kind of running that didn’t make my knees and ankles scream at me was sprinting. A steady jog hurt, but sprinting felt great. I couldn’t do it for very long, so my running sessions were all done as interval training, alternating between uphill walks, 1-2 minute sprints, and recovery walks. These training sessions, as well as the extensive foot and ankle strengthening I did every morning, sent me into surgery with the strongest feet I had had since ballet training and certainly aided in my fast recovery.

A few weeks ago, three months post surgery, I started running again as part of my rehab. My cardio was utter crap after three months of inactivity, but as usual I found that a slow jog was painful so I was gasping through 30-60 second sprints with 4 minute recovery walks in between.

It was then that I had the good fortune to find myself on a Zoom call with Chris McDougall and Eric Orton themselves! It was exciting to have the opportunity to chat about fitness in general and beginner running in particular, and share my story.

I described how running had been part of my pre- and re-hab from the osteotomy surgery but that I was really only comfortable with sprinting, and Eric asked me about my cadence.

Cadence? What is cadence?

Eric explained that extensive observation of effective running technique has shown that everyone, regardless of leg length or the speed they are running, has optimal form when their feet hit the ground at 180 beats per minute.

If you aren’t a musician or dancer, I’ll tell you that 180 bpm is a pretty fast clip. Think of The Ramones’ Judy is a Punk or, Eric and Chris’ favorite, the B52s’ Rock Lobster. Eric explained that even if you are chugging along at a stately pace of 4.5 mph you want to keep that quick cadence. At 180 bpm your feet are boinging back up off the ground like the spring-loaded shock absorbers they are designed to be, and there is no time to sink into your joints. Most of your time is spent in the air where gravity can’t hurt you.

At the earliest available opportunity I was back on the treadmill, ready to try out this new approach. I loaded up the B52s in my headphones, momentarily transported back to my efforts to create a mosh pit at the 7th grade dance, and started trotting.

The effects were just as Chris and Eric describe in their new running technique book Born to Run 2, immediately effective and delightful. From 1 minute run/4 minutes walk I was instantly able to do an effortless 2 minutes run/3 minutes walk. A few days later 2.5/2.5. With no joint pain at all. I had been relying on sprinting to protect my joints because, at 7.5mph I had no choice but to spring back up off my feet.

Most people without squishy joints can get away with jogging at a lower bpm without pain, at least for a while, until something starts to feel worn or overworked and then that 70% injury rate for runners kicks in. For better or for worse I don’t have the ability to run slow and heavy at all. Hypermobile folks don’t have any of that desirable stiffness in our connective tissue that many runners rely on to protect their joints and help their muscles work more efficiently. Thumping along I was relying solely on muscles to hold me together, and with the slower cadence my feet were spending long enough on the ground with every stride that the muscles couldn’t hold on and I was sinking down into every joint. Pain appeared almost immediately.

After 30 minutes of high cadence running intervals, never going faster than 5mph, I had no joint pain. The muscles in my feet and calves were singing, but it was a song of new challenge and strength-building, not the lament of damaged connective tissue. To my surprise I woke up the next morning ready to do it again and felt even better the second day. My challenge was to not get so excited that I over-trained, and remember that I’m still in rehab and I need to take it slow.

After two weeks I felt brave enough to try running around the Silverlake Reservoir, away from the safety of the treadmill. Running on uneven surfaces makes me exceedingly nervous. Every pebble and sidewalk crack is a chance for my foot to land funny and my ankle to stage a repeat performance of it’s spectacular 90 degree lateral collapse, which has landed me on my back countless times since I was a kid. But I took it slow, trotted to the sound of the Ramones in my head, and trusted the strength I was building.

The idea of a real, up and down, rocky, trail run still feels impossible in my body. But I know what it’s like to achieve things I once felt were impossible. I didn’t think that I could ever sit on my own head either, but I learned to do that, a little at a time.

Tightness vs. Stiffness for Running and Flexibility Training

In my flexibility coaching I often talk about cultivating stiffness without tightness. Stiffness comes from stability in the joints that results from both healthy connective tissue and neurological control of the full range of motion. Flexibility without stiffness, often found in hypermobile, over-stretched people, is dangerous and debilitating. Tightness is an absence of flexibility. It means that a muscle is in a locked state, unable to either fully contract, fully relax, or both. Tightness has a variety of root causes, but most often it comes from stressed-out muscles that don’t trust each other and lock up to prevent you from moving into a position that your nervous system has deemed unsafe. Tight muscles are no longer working together as a team.

What I have learned from Chris and Eric is that running with proper preparation and form can be a vehicle to cultivate stiffness, even in people like me for whom stiffness is not an innate trait. If running is making you tight it’s because something is going on to foment mistrust and poor cooperation in the muscles and joints. Your form is off or you aren’t prepared.

With this new understanding, I am deeply curious and even optimistic that I could be both a runner and flexible, and that these two skills could actually compliment each other. Goals like running a marathon and being able to do a comfortable standing split and waterfall backbend seem less like pipe dreams and more like a compelling puzzle challenge. I just have to figure out the right pieces and put them in place.

This is my experiment for the next year or two. To take these two historical enemies and cultivate a romance between them, using the theater of my rather worn-in 48-year-old body as a setting. Let’s see what happens!

What is your “Core Muscle” Group and How Does it Work?

What is your core muscle group and how does it work? Practically every fitness program known to humanity talks at some point about “core muscles” and how to strengthen them. But what are your core muscles? Meet the team of muscles that works together to create mobility and stability throughout your body.

A lot of programs focus on the rectus abdominus muscles (known as the six-pack) but the six-pack is really just a supporting player.

The core muscles aren’t just on the front of your body. They make up a shape like a soup can with a top, sides, and bottom. The core muscles are constantly in dynamic interaction to provide both support and movement to your torso and internal organs and control how you breath, use the bathroom, have sex, digest food, and much more. They need to be trained together so that they can coordinate for both strength and flexibility.

Core Muscle group is like a soup can in the middle of the body

What is Your “Core Muscle” Group?

The Diaphragm

The diaphragm is the top of the soup can, a big dome of muscle at the bottom of the rib cage. It attaches to our spine, rib cage, and the muscles all around our midsection, with holes in it where the aorta, vena cava, and esophagus pass through on their way to the lower body.

The primary job of the diaphragm is breathing. When it contracts, the dome drops down pulling air into the lungs. When it relaxes it lifts back up into its original dome shape as the lungs empty out. Having the ability to fully relax and contract the diaphragm is very important for taking full, deep breaths. This is called diaphragmatic breathing, not because it only uses the diaphragm (other muscles also play important roles) but because it makes full use of the diaphragm.

The diaphragm also works with the rest of the core muscle team to stabilize the upper body. When other core muscles aren’t working well the diaphragm ends up needing to work overtime as a stabilizer, making it hard to relax. This can have a big effect on important stuff like your breathing patterns and neck and back flexibility.

The Transversus Abdominus

While the six-pack muscle is the showboater of the core muscle group, the transversus abdominus is the real power behind the throne. This is the deepest of the three muscles I like to call the “meat corset” because they wrap around our waist and, when they contract, they squeeze in to stabilize us from all sides. The meat corset makes up the sides of the soup can.

The TA attaches in back near your spine and wraps all the way around your waist where it comes together at a thin line of connective tissue in the middle of your belly. A happy TA works together with the other meat corset muscles as a primary stabilizer for the spine and entire upper body.

The Internal and External Obliques

The obliques are the second and third layer of the famous meat corset. They wrap around your waist over the TA at slight angles, providing even more stability and adding a dynamic side-bending and twisting ability that gives our spine it’s famous mobility.

The meat corset muscles work in constant coordination with the diaphragm so that when the diaphragm relaxes and you exhale the meat corset ramps up to take over most of the job of holding you up. If the meat corset is sleepy and uncoordinated then the diaphragm doesn’t get to relax and you can end up with breathing issues, back and neck pain, poor posture, stiff spine, and a long list of additional issues.

Check out the work of the Postural Restoration Institute if you want to do a deep dive here.

The Pelvic Floor

The pelvic floor muscles are a basket of interwoven muscle fibers that sits at the base of your pelvis. They are the bottom of the soup can.

The two main muscles are the levator ani and the coccygeus, that support your internal organs and have little holes in them to control your poop and pee, and the opening of the vaginal canal if you are AFAB (assigned female at birth).

The pelvic floor muscles are part of the intricate choreography of the soup can. When the choreography is off the pelvic floor can become sleepy and under-working, or stressed out and over-working, which can have unpleasant repercussions for digestion, pooping and peeing, and sex.

The Erector Spinae

The erector spinae are a bunch of small muscles that stick out all along your spine like little pine tree branches, connecting the vertebrae together. They are the solid seam in the side of the soup can that provides extra stability and helps to keep your body upright but mobile. If the rest of the soup can gets sleepy and squishy the erector spinae can end up very over-worked and tight. Unpleasant outcomes include tight back muscles, back spasms, and even displacement of the vertebrae.

The Rectus Abdominus

Here we have arrived at the six-pack, all the way down at the bottom of the list. The rectus abdominus attaches to the bottom front of the rib cage and the top front of the pelvis. It’s sole job is to forward flex the spine (like in a sit-up) but it isn’t really awesome at stabilization. It’s a bit of a one-trick pony: very good at an important job but not good at anything else.

When the soup can is squashy the rec abs can end up over-working. You can tell if you have too much rec ab in your life if, when you try to do a sit-up, your abs push out instead of in. This ultimately robs you of a lot of your strength and stability.

Honorable mention goes to the Iliopsoas

Even though it isn’t technically part of the soup can, you can’t talk about core muscles without mentioning the iliopsoas. This is a loving union of two muscles, the iliacus and the psoas, that attach to the spine at the same place as the diaphragm and swoop down inside your body, through the pelvic floor, to attach to your upper inner thigh. I have a lot of content on the iliopsoas and how to fall in love with yours, so I wont get into too much detail here.

Key Takeaway about the Core Muscle Group and How it Works

The most important thing to remember about the core muscle group and how it works, is that these muscles all work together and what affects one of them, affects all of them.

The core muscles are always moving because you are always breathing and breath is the first and most accessible way to start to feel how they work and interact. Coming soon is a series of workouts and tutorials on how to coordinate and strengthen your core muscle group so that they work together as one happy team!

Happy Bendings!
Kristina

How to Have a Strong Flexible Psoas for Healthy Hips

A strong flexible psoas muscle is fundamental to a healthy back and mobile, balanced hips. The psoas attaches all along the lumbar spine in the lower back then swoops down under your internal organs to attach to the top inside of the femur. It is the only muscle connecting the upper and lower body, and it has multiple jobs including spinal support and movement, hip stabilization, and internal rotation and flexion of the thigh.

The Iliopsoas

Despite its extremely important role in our mobility (the psoas plays a part in anything we do from the waist down) it is often neglected. Part of this is because the psoas runs deep under other muscles and guts, so it’s hard to touch it or have a strong awareness of what it’s up to. It’s also because sitting too much, as most of us do, makes the psoas squashed, weak, and tight.

The Consequences of a Tight, Weak Psoas

Many people have issues strengthening and stretching their psoas and experience some kind of sub-optimal consequences. If you experience back spasms (“throwing your back out”), snapping hip syndrome, SI joint pain, sciatica, or myriad other issues, it’s good to take a close look at your psaos health.

My own psoas was very unhealthy during my years as a dancer and contortionist. It was chronically tight, which I found extremely frustrating. I over-stretched it and it spasmed on a regular basis. It wasn’t until I learned how to feel my psoas, which took some concerted work over a period of months, and strengthened it, that I was able to finally get it to relax and my hip flexibility and back health improved.

How to Have a Strong Flexible Psoas

The routine in this video is basically the format that I used to create a strong flexible psoas. I progressed slowly. It took me many months to be able to move through the exercises that I show in half an hour. In the beginning I kept offloading the work to the other hip flexors (see this post on hip flexor anatomy if you want to know who they are).

So you may want to just start with the first exercise, the foot slide on an elevated surface, and stick with that until you have a sensation of where the psoas is and how to use it, then progress slowly at the pace that works best for you.

This is not the most glamorous, social media-worthy work but it has changed my life to have a better relationship with my psoas, and I hope it changes yours too.

Viva el psoas! Hail the psoas! Psoas forever!

How “Fixing Your Posture” Could be Causing Your Back Pain and What to Do About It

Earlier this year I made a post called 4 Tips to Get More Flexible Without Stretching, and the #1 item on the list was to improve your posture. This post offers a deeper dive into posture, how some “fixes” can actually create back pain, and a checklist with alternatives.

We all know that hunching over like a buzzard is not good for us. The “tech neck”, rounded back, forward-thrusted head, and drooping shoulders characteristic of our modern lifestyle is obviously problematic. But how do you fix it? What should you do instead?

The most common “fix” that I see is to thrust the chest forward, lift the chin, and pull the shoulders “down and back” like a proud peacock. While this posture may work for peacocks, it isn’t so great for human anatomy and can actually cause more chronic pain, especially in the mid and upper back.

This tutorial is a little step-by-step bottom-up checklist for getting your bones stacked up and your muscles gently but firmly engaged for relaxed, healthy, mobile posture.

It is important to note that “perfect” posture is not a requirement for health or the same for all bodies. There is tremendous variety in the way our bodies are formed so this might not be what is optimal for you. This is just a set of guidelines you can use to check in with your body if you are having back pain or if you notice that your posture is feeling weird.

Posture Checklist to Align Your Spine

1. Notice How your Posture is Now

The textbooks have some guidelines for correct posture that I take as a loose jumping-off point, understanding that all bodies are different. Look for the landmarks of your ear, your shoulder bone, bone on the outside of your hip (the greater trochantur of the femur), the middle of the knee, and the ankle bone and get them all lined up one on top of the other.

Noticing where you deviate from this vertical line can help you identify some postural corrections that might help with chronic pain or tightness.

2. Check Your Pelvic Bones

All of us have different sizes and shapes for our hips, butt and bellies that make our posture look different, and that is part of what keeps the world interesting! Instead, I like to assess pelvic position using the bones, since those tend to be more (but by no means completely) consistent.

The two hip bones in the front (the anterior superior illiac spine or ASIS for those who care) and the pubic bone make a downwards-facing triangle in the front of the hips. With some variation for anatomy, you want to make these boney landmarks flat and symmetrical with each other so that the pelvis isn’t tilted side-to-side or front-to-back.

This generally involves a gentle engagement of the muscles of the pelvic floor and the illiopsoas. I have a number of workouts on pelvic stability if this feels mysterious and inaccessible for you and you can see how this looks in the video below at 2:00 minutes.

3. Engage Your Meat Corset

The meat corset is my fond nickname for a triple-layered band of muscles that wraps around your waist like a corset made of you. The transverse abdominus, internal obliques, and external obliques are a vital set of postural muscles, and like all postural muscles they are ideally awake and responsive almost all the time.

You can feel your meat corset by putting your hands on your waist and coughing or laughing. For postural work these muscles only need to be awake and lightly engaged. The “suck in your gut” cue that I loathe does not encourage sustainable posture, and endless crunches aren’t going to help either. I find that breathwork can be a good entrée to building that healthy meat corset structure.

Again, check out some of my workouts for some meat corset strengthening ideas and see the visual at 2:50 in the video below.

3. Open The Shoulders Without Squishing the Shoulder Blades

Forward rounded shoulders are the scourge of modernity, with so many of us sitting hunched over keyboards, phones, steering wheels, gaming consoles, textbooks, food preparation, sewing machines, antique scrolls, you name it. As previously stated, the common “fix” of thrusting the chest forward, squeezing the shoulder blades together, and lifting the chin is suboptimal. It strains and compresses the muscles of the upper back in a way they will not enjoy long-term and can create ongoing back pain if you try to maintain it.

Those gimmicky postural aides that encourage squeezing your shoulder blades together are just going to create a host of new issues for you.

The trick with shoulder blades is actually to pull them apart, while externally rotating the shoulder socket. This will get your upper back engaged sustainably while opening up the front of the chest and shoulder, and stacking that shoulder joint over your hip.

For an exercise to help you find this tricky position, please check out the video embedded below. For this specific tutorial skip to 4:00.

4. Stack that Ear

The head and neck come last, stacking them comfortably over the nice foundation you just built along the rest of your spine.

Many of us have a forward thrust to our head, so that the ear habitually sits in front of the shoulder instead of over it (see previous list of reasons). This position makes the neck muscles have to work much, much harder to hold up that heavy coconut of a head.

My favorite quick exercise to start to bring that head back in line is to interlace the finger into a basket cupping the back of the head, elbows wide, and gently press the head and hands together, feeling the inspiration of the muscles in both the upper back and the front of the neck. The chin should not be lifted or dropped, but remain parallel to the floor.

For that tutorial, skip to 6:30 in the video below.

Now What? Why is Good Posture so Awkward?

The first time I ran through this checklist and tried to align my posture correctly I got mad. How the hell was I supposed to walk around like this? It felt foreign, difficult, and uncomfortable.

The good news is that perfect posture is not a requirement for a rich, full, happy life or even for pain-free mobility. Like so many other things in life it is pretty much always a work in progress, something you chip away at, check in on, and use as a tool when you need it. If your current posture doesn’t cause you problems and is working for you, you may not need to change it. If you start to have pain, then running this checklist may provide relief.

When I was really dedicated to improving my posture to address my hypermobile back and a lower back pain I set an alarm on my phone to go off every hour on the hour to remind me to run through the check list. After a while I didn’t need the checklist, my body just started to remember to do it.

My posture now definitely isn’t perfect, but it’s good enough that I don’t have back pain any more and I still run through the check list if I’m on my feet for a long time or feel like I need it. It’s change the way that I walk and run, and vastly improved my forward bending which was always pretty crappy.

I hope this checklist is useful for you too!

Happy Bendings,
Kristina

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