The Psoas Major: A Major Player In Back Pain

Have you ever had back pain or know someone who has? If so, this post is for you, my friends!

There are many muscles that could cause back issues, but today I’m going to focus on just one, that being the psoas major; mainly because I’ve come across too many new clients whom never had them treated before… And this surprises me. Another reason is because I’ve noticed that many people think that only back muscles should treated because it’s their “back that hurts”. Believe it or not though, there are muscles in the front of our body that have an effect on back pain as well. Before I go on though, let’s go over the anatomy…

THE ANATOMY (per Tortora & Derrickson, 11th edition)
Origin: Transverse processes and bodies of lumbar vertebrae.
Insertion: With iliacus into lesser trochanter of femur.
Action: Psoas major and iliacus, acting together, flex thigh at hip joint, rotate thigh laterally, and flex trunk on the hip.
Innervation: Lumbar spinal nerves L2-L3.

NOTE: Some people refer to this muscle as the “iliopsoas” because the psoas major and iliacus share a common tendon and end-point, but they are in-fact two separate muscles, which is why I’m only going to refer to the psoas; however, they do work in-conjunction, in some circumstances.

The function of the psoas is to increase flexion of the thigh at the hip. It can either bring the femur towards the spine or the spine towards the femur; just depends on what movement is taking place. An example of when it would be active—or contracting—is when you swing your leg forward during walking or running. The psoas is also a strong lateral flexor and stabilizer of the vertebral column (ipsilaterally—same side); as in when you bend to one side or the other.

How do you know when the psoas could be influencing back pain? Well, let me share a few examples—which also happen to be indicators for treatment—with you…

  • You have back pain when lying on your back; without a pillow under your knees
  • You have back pain that is vertical, but is relieved when in the reclining position
  • You have difficulty straightening after prolonged sitting

Taking it one step further, let me share some additional indicators for treatment with you…

  • An increase—or possible decrease—in your lordotic curve
  • You stand with your weight off the affected psoas side
  • You have unexplained pelvic floor pain (neural entrapment issues)
  • You have rotational distortions of the spine (Scoliosis)
  • You have groin pain

Please keep in mind that muscles have synergists and antagonists, so even though you have this information at your fingertips, there are other muscles not mentioned in this post that can cause a person pain and dysfunction in the back; anywhere in the body, really.

As always, I hope you find this information to be informative!

IMPORTANT NOTE: The psoas is a deep muscle in the abdominal area and great caution should be of utmost concern when treating this muscle. I mention this because of the possible presence of an AAA—Abdominal Aortic Aneurysm—which would be a serious contraindication for treatment, due to the fact that it could have potentially disastrous consequences.

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Massage And Contraindications

I have found in my practice that many people are not familiar with the word contraindication, and it is an important word to know; not just when referring to massage, but when referring to any medically-related condition as well. So, taking that into account, here is some information that I would like to share.

When referring to massage, a contraindication—”contra” meaning against—is any physical, emotional, or mental condition that may cause a particular massage treatment to be unsafe or detrimental to the client’s well-being. It means that the expected treatment is inadvisable; conditions may exist in which it would not be beneficial to apply any form of massage to part of or all of the body. There are absolute contraindications and regional (or partial) contraindications; absolute meaning that massage is absolutely not appropriate and regional (or partial) meaning that massage is not appropriate in certain areas of the body.

Some examples of absolute contraindications would be:

  • Severe, uncontrolled hypertension (high blood pressure)
  • Acute pneumonia
  • Toxemia during pregnancy
  • A fever over 101°

Some examples of regional or partial contraindications would be:

  • Local contagious conditions
  • Open wounds
  • Acute neuritis or arthritis
  • Local inflamed areas

Some of those may have been obvious, but keep in mind there are many more. At the end of the day, it is the responsibility of the therapist to fully understand contraindications for massage; however, it’s a good idea for the client to have a good idea as well.

A good book that I have on-hand is Pathology A to Z: Handbook For Massage Therapists. Not only has this book helped me with conditions I’m not familiar with, but it also helped me to understand and realize that some pharmaceutical drugs can affect the outcome of massage treatments as well.

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

TMD: Temporomandibular Disorder

The arrow is intended to point at the general area.

Since I am trained to treat TMJ pain and dysfunction related to the temporomandibular joint—which also happens to be something that many people suffer from; yours truly included—I decided this would be a great topic for today’s post.

Temporomandibular disorder (TMD) rears it’s ugly head when there are problems with the jaw, jaw joint(s), and/or when surrounding facial muscles are imbalanced. This disorder is often incorrectly called TMJ, which stands for temporomandibular joint… And every single one of us has two.

What is the Temporomandibular Joint (TMJ)? The TMJ is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull, which is immediately in front of the ear on both sides of our head. (You can feel them move by placing your fingers where I just mentioned while opening and closing your mouth.)

The joints are flexible, which allows us to move our jaw smoothly; up-and-down, side-by-side. The joints make it possible for us to talk, chew, and yawn. The muscles connected to the joints make it possible for us to control the position and movement of our jaw.

What Causes TMD? Injury to the jaw, temporomandibular joint, or muscles of the head and neck—such as from a heavy blow, a fall, or whiplash—can cause TMD. Repetitive movements can adaptively shorten the surrounding muscles causing it as well. Other possible causes include:

  • Grinding or clenching the teeth, which puts a lot of pressure on the joints
  • Dislocation of the disc between the ball and socket
  • Presence of osteoarthritis or rheumatoid arthritis in the joints
  • Stress, which can cause a person to tighten facial and jaw muscles or clench the teeth

What Are The Symptoms of TMD? People with TMD can experience severe pain and discomfort that may be temporary or last for many years. Common symptoms of TMD include:

  • Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide
  • Limited ability to open the mouth very wide
  • Jaws that get “stuck” or “lock” in the open- or closed-mouth position
  • Clicking, popping, or grating sounds in the jaw joint, which may or may not be accompanied by pain, when opening/closing the mouth or chewing
  • A tired feeling in the face
  • Difficulty chewing or a sudden uncomfortable bite—as if the upper and lower teeth are not fitting together properly
  • Swelling on the side of the face
  • Headaches
  • Dizziness
  • Pain and paresthesia in the upper extremities
  • Difficulty swallowing
  • Toothaches
  • May occur on one or both sides of the face
  • Ear symptoms

Ear symptoms associated with TMD include:

  • Fullness in the ears
  • Tinnitis (ringing in the ears)
  • Ear pain
  • Hearing problems such as ubjective hearing loss
  • The sensation of itching in the ears

About 75% of the population has a least one sign, and 33% has at least one symptom. The age range at presentation is normally in the region of 16-30 years, but often persists for two or more decades.
Gender bias = 4:1 female.
AAOP TMD Guidelines: 1990, ’93, ’96

On another note, it is VERY important that I mention this… A sudden onset of severe pain within the jaw could indicate a heart attack. This is more common with females. Please keep this in mind for yourself and your loved ones as it could potentially save a life!

As always, I hope you find this information informative!

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Referred Pain At-A-Glance

Before I go on with my post, I would like to first state that I have inserted Wikipedia’s links for the following conditions in case some of you are unfamiliar; however, please keep in mind that they do not mention PNMT—or any specific modality of massage—as an option for pain-relief, aside from the brief-mention of “massage” in the carpal tunnel and piriformis syndrome links under Treatment. Traditional medicine is basically the main focus, which is one of the reasons why I felt it was important to start this blog. At the end of the day, PNMT is extremely beneficial for pain and dysfunction caused by muscular imbalances within the muscular-skeletal system. What’s even better is that it is non-invasive!

Referred pain is a phenomenon used to describe pain perceived at an area, adjacent to or at a distance from, the site of an injury’s origin. For example, carpal tunnel symptoms can be caused by muscular imbalances in the shoulder and/or upper arm. These imbalances can throw off the alignment of muscles and tendons down the arm. The result is not necessarily pain in the shoulder, but instead, pain that is similar to carpal tunnel. Interesting, huh?

Assuming you would agree, I’ll go ahead and get a little more specific, using sciatica as another great example. In my experience, it appears that many people aren’t aware of specific muscles in and around the buttocks that can mimic true sciatica. The piriformis, gluteus minimus, and hamstrings being perfect culprits. Most people are told that sciatica is directly related to the sciatic nerve; generally caused by compression of the lumbar nerves L4 or L5; sacral nerves S1, S2, or S3; or by compression of the sciatic nerve itself. There is also another diagnosis called piriformis syndrome. This is when the sciatic nerve is compressed or irritated by the piriformis muscle due to it being in the shortened position or from spasming. (Please read the portion on Davis’ Law in this post if you are unfamiliar with “shortened” muscles and how they occur.) Not only can muscles in the shortened position entrap or compress nerves, but they may also contain TrP’s that replicate nerve-related pain, such as the carpal tunnel and sciatic-type symptoms I mentioned, among others. (Please read this post for more detailed information on TrP’s.)

I know it may sound crazy that muscles could actually be the root cause of the above mentioned problems, but I promise you it is indeed very possible. If you have tried other options out there, up to and including surgery, but have had no relief or it was short-lived, I encourage you to look into this form of medical massage. If you live in the Cincinnati, OH area and are interested in reading some testimonials from my clients, please click here.

As always, I hope you find this information informative!

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Just A Couple Shoulder Pathologies

There are so many things I want to write about, but since I mentioned a muscle related to the shoulder joint in a previous post (The Infraspinatus), I figured I might as well continue with the same theme.

To start, pathology is the precise study and diagnosis of disease, which I obviously do not specialize in. Pathologies can cause individuals a lot of distress and here are just a couple linked to the shoulder that I have come across with clients in my own practice…

Impingement Syndrome – Also known as rotator cuff tendonitis. This syndrome is one of the most common causes of shoulder pain and dysfunction. Repetitive movements of the arm in over-the-head positions (i.e. baseball, tennis, lifting weights, swimming, painting, carpentry work, etc.)—or holding the arm in the same position for a long period of time or a direct blow or stretch injury—can cause continuous pinching of the rotator cuff tendons (supraspinatus, infraspinatus, subscapularis, teres minor). This can then cause inflammation and result in pain. If movement is continued despite the pain, a tendon may degenerate near the attachment and ultimately tear away from the bone resulting in a not-so-welcome rotator cuff tear.

Torn Rotator Cuff – This injury is pretty self-explanatory, but nevertheless, is diagnosed when one or more of the rotator cuff tendons tear away from the head of the humerus. OUCH, not so funny if you ask me—pun intended! Most tears of this nature occur in the supraspinatus muscle and tendon, but other muscles and tendons can be involved as well.

Do you have shoulder problems? Have you been diagnosed with one of the above mentioned ailments? If so, PNMT can help! It won’t mend an actual tear, but it will lengthen shortened muscles, thus relieving tension on the tendons and increasing range of motion.

All in all, before taking the surgery route followed by lots and lots of post-op rehabilitation—unless of course it’s absolutely 100% without-a-doubt necessary per a medical professional—I highly recommend giving this non-invasive option a whirl.

NOTE: Due to a much anticipated upcoming vacation, I may not be posting on here for 2-3 weeks.

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“Neutral balance alignment is key to becoming pain free!”™ ~ Me