Introduction 

Psoas syndrome is a condition characterised by pain, discomfort, and dysfunction of the psoas muscle. It typically arises when the psoas muscle becomes tight, inflamed, or irritated due to overuse, injury, or emotional stress.¹ The condition of the psoas is closely connected to emotional status and well-being. Understanding this condition and how stress can affect it, is essential for recognising the condition’s symptoms and implementing effective management strategies.

The psoas muscle and stress

Importance of the psoas muscle

The psoas muscle is one of the most important muscles in the human body due to its central role in spinal and core stability, posture, stress disorders, and lower back pain. This long, deep-seated muscle originates at your lower back (lumbar vertebrae), extends downwards past the abdomen and pelvis, and attaches to the hip and upper leg. It is the only muscle that connects the lower vertebrae to the legs, facilitating movement of the hips and lower body, such as walking, running and bending. 

Beyond its mechanical functions, the psoas muscle is closely linked to emotional well-being. Some believe it stores tension and stress, reflecting emotional states through physical tightness or discomfort. Due to its deep location and role in core stability, maintaining a healthy and well-conditioned psoas muscle is crucial to overall physical health, posture, and emotional balance.¹

Physiological responses of stress

Stress is a natural response to challenging or threatening situations. While acute stress can be beneficial in certain situations where enhanced performance, improved memory, heightened awareness and cognitive function are required, chronic stress can have profound negative effects on health.

The psoas is often referred to as the “fight-or-flight” muscle and is one of the primary muscles involved in the body’s stress response. When stimuli are perceived as threatening or dangerous, the body instinctively activates the hypothalamic-pituitary-adrenal (HPA) axis, the main stress response system linking perceived stress to the physiological responses. Activation of HPA axis triggers the release of the stress hormones, cortisol and adrenaline, from the adrenal gland. Increased adrenaline levels activate the sympathetic nervous system, triggering the ‘fight-or-flight’ response. This response causes signals from the psychophysical system to be conveyed to the somatomotor system, leading to a reflexive contraction of the skeletal muscles, particularly the psoas. This prepares the body to either fight the threat, flee from it, or curl into a foetal position for protection.² 

Ideally, the stress response subsides when the threat is removed. However, when perceived stress becomes chronic and the HPA axis cannot be deactivated completely, the sympathetic nervous system will be activated for extended periods which leads to continuous reflexive contraction of the psoas. The continuous reflexive contraction of the psoas results in chronic muscle tension that leads to psoas syndrome and overall detrimental effects on well-being. 

While cortisol is essential for normal body functioning, enhancing brain activity, regulating metabolism and the immune system, modulating inflammation, and maintaining blood pressure, chronically elevated cortisol levels can cause various health issues. These issues include digestive problems, pain, sleep disturbances, and mood disorders. Additionally, muscle tension can occur, particularly in the psoas leading to inflammation and reduced flexibility.

Psoas muscle as a stress indicator

Due to its inherent connection with the physiological stress response, the condition of the psoas muscle serves as a valuable indicator of an individual’s inner sense of security. Research has shown a clear connection between stress levels and tension in the psoas muscle. A study has found that individuals with higher perceived stress levels exhibited greater psoas muscle tension.¹

Acute or chronic trauma, stress, anxiety, or emotional distress can directly affect the mobility of the psoas muscle, influencing whether the muscle remains relaxed and flexible, or becomes tense and rigid. High levels of ongoing stress, such as those seen in post-traumatic stress disorders, can lead to chronic tension in the psoas, causing it to remain in a constant state of contraction. This persistent tension can result in symptoms of psoas syndrome, including pain, tightness, and discomfort. The body may store unresolved trauma and emotional stress in the psoas muscle, regardless of the conscious mind, even when there is no immediate physical threat.³ 

Understanding the impact of stress on the body is crucial for recognising its role in conditions like psoas syndrome. By addressing stress through various techniques and lifestyle modifications, individuals can often improve their overall well-being and manage conditions related to muscle dysfunction and pain.

Understanding psoas syndrome 

Psoas syndrome is a condition that occurs when the psoas muscle becomes tight, inflamed or irritated. It is characterised by pain and dysfunction in the lower back, hips and groin area, and it can affect individuals of all ages and activity levels, from athletes to those with sedentary lifestyles.^4,5

Symptoms

• Lower back pain, which is often felt deep within the lumbar region. The pain may be dull, achy or sharp, worsening with movement or prolonged sitting. It may also radiate from the lower back into the hips, groin or thighs, following the path of the psoas muscle
• Hip pain or discomfort, particularly in the front of the hip joint. The pain may feel like a deep ache or sharp sensation when moving the hip. Activities, like walking, climbing stairs, or bending forward may exacerbate the discomfort
• Abdominal discomfort, since the psoas muscle runs through the abdomen, tightness or inflammation can lead to abdominal discomfort, often experienced as fullness, bloating, or cramping
• Postural changes, the dysfunction of the psoas muscle, can cause postural imbalances, such as an anterior pelvic tilt, where the pelvis tilts forward, causing excessive arching in the lower back. A shortened stride or difficulty standing up straight due to pain and tightness in the hip flexors can also occur

It is important to note that symptoms of psoas syndrome can vary in severity and presentation from person to person. Some individuals may experience mild discomfort, while others may have significant pain and limitations in movement. Prompt diagnosis and appropriate treatment are essential for managing the symptoms and preventing further complications.

Causes and risk factors: 

• Sedentary lifestyle

Prolonged sitting or inactivity causes the psoas muscle to remain in a shortened position for extended periods. This can lead to tightness and weakness, resulting in dysfunction and pain. Those who spend many hours sitting at a desk, driving, or leading sedentary lifestyles are at higher risk.⁶

• Overuse or repetitive motion

Repetitive engagement of the psoas muscle without adequate rest can lead to psoas syndrome. This is common in athletes, dancers, or those who participate in activities like running or cycling. Incorrect form or technique during exercise can also contribute to overuse injuries of the psoas muscle. 

• Trauma or injury

Direct trauma or injury to the lower back or pelvis can result in psoas syndrome. This includes falls, car accidents, sports injuries, surgeries, or any event that causes sudden impact or strain on the muscle. 

• Emotional stress

Chronic stress and unresolved emotional issues can cause prolonged contraction and chronic tension in the psoas, causing tightness, pain and discomfort in the muscle, leading to psoas syndrome.

Managing psoas syndrome in the context of stress

Medical treatments

Physical therapy

Physical therapy is a crucial component in psoas syndrome treatment. A tailored exercise program designed to strengthen and stretch the psoas muscle can improve its flexibility and function. Techniques such as myofascial release, massage, and manual therapy may be used to release tension in the psoas muscle and surrounding tissues. Proper body mechanics and posture can also be taught to prevent further strain on the psoas muscle.

Medications for pain and inflammation

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help to reduce pain and swelling. Muscle relaxants may also be prescribed to alleviate muscle spasms and promote muscle relaxation. However, they are typically used for short-term relief due to potential side effects.

Lifestyle changes

Stress management techniques 

• Mindfulness and meditation: Meditation and breathwork can help reduce stress levels and promote relaxation. Mindfulness-based stress reduction (MBSR) programs can effectively manage chronic pain conditions
• Yoga and stretching: Yoga and stretch poses like lunges and hip openers relieve tightness and improve the flexibility of the psoas. Regular yoga practice also helps stress management and overall well-being

Ergonomic adjustments

Modifications to workstations, chairs, and sleeping positions can reduce strain on the psoas muscle and enhance posture. For example, using a lumbar support pillow while sitting or adjusting the height of a desk chair can improve pelvic alignment. Employing proper lifting techniques and avoiding prolonged sitting or standing in one position can also prevent the worsening of Psoas Syndrome.

Holistic approaches

Massage therapy

Regular massage therapy can improve blood flow to the muscle, reduce inflammation, and relieve pain. Techniques such as myofascial release and deep tissue massage can target tension in the psoas muscle and promote relaxation.

Acupuncture

Acupuncture sessions can stimulate healing, relieve pain, reduce muscle tension, and improve mobility. Acupuncture may also calm the nervous system, helping in stress management and reducing its impact on the psoas muscle.

Preventative measures

• Regular exercise, including cardiovascular activities, strength training, and flexibility exercises, can maintain muscle health and prevent psoas syndrome. Exercises that strengthen the psoas, core, and hip flexor muscles can prevent the risk of future psoas injury and dysfunction
• Stress-reducing lifestyle is crucial for managing psoas syndrome. Incorporating hobbies, relaxation techniques, and time spent in nature can help calm the nervous system
• Mental health practices such as seeking therapy, maintaining a healthy work-life balance, setting boundaries, and prioritising self-care can also reduce chronic stress attributed to psoas tension and pain

It is essential to work closely with healthcare professionals to develop a comprehensive treatment plan tailored to individual needs and goals. Combining the strategies listed above can effectively manage chronic pain and stress associated with psoas syndrome. 

Conclusion

• Psoas syndrome is a complex condition influenced by both physical and emotional factors, with stress playing a significant role
• Understanding the intricate relationship between stress and psoas syndrome is crucial for effective management 
• Adopting a multifaceted approach that includes physical therapy, stress management and reduction techniques, strengthening exercises, and other holistic methods can improve alignment, reduce pain and tightness, and enhance overall well-being
• Regular exercise, a stress-reducing lifestyle, and mental health practices all contribute to preventing psoas syndrome