What is Psoas syndrome?

The psoas refers to a pair of muscles that start in the lower back, travel along the groin, and finish on the inside aspect of the hip bones of the legs.¹ Psoas syndrome is when the psoas muscle becomes injured or painful and occurs commonly in athletes and very active people. The psoas can be strained, stretched or torn, resulting in pain and inflammation that make everyday tasks and exercise challenging.²

Psoas injuries are treatable, uncommon injuries. Exercises that focus on strengthening the muscles of the hip and core are the main treatment options for physiotherapists, and many of these exercises can be performed at home.²

To find out more about psoas syndrome, what it is, and when to seek help, please click here to be directed to an article from Klarity’s own Health Library. 

Anatomy of the psoas

The psoas muscle originates in the lower back and inserts into the hip where it connects to another muscle the iliacus muscle, becoming the iliopsoas muscle. In some literature, psoas syndrome will be referred to as iliopsoas syndrome. 

The psoas comprises of the psoas major and psoas minor. The psoas major sits as a ‘front-to-back’ muscle, originating in the lumber spine at the back of the body, and inserted onto the upper thigh bone towards the front of the body. When seated, the psoas major helps to stabilise the lower back. It also helps with movements, such as moving from lying down to a sitting or standing position.

As it attaches to the hip, it functions as a hip flexor (bringing your knee closer to your chest or bending at the hip), a rotator (turning the leg outwards, away from the body), and an adductor (bringing the thighs together). 

The psoas minor is also involved in flexing the hip and spine, but not everyone has this muscle and its presence can vary in different populations.⁴

Exercises for the psoas

In addition to managing the pain experienced in psoas syndrome with the use of painkillers or applying ice packs to the painful areas⁵, strengthening and stretching exercises can be highly effective.^2,6

Exercising gently and mindfully can offer pain relief, as well as improved mobility and stronger, more stable hips. As with all exercise, form, technique, and consistency are key to success.⁶

Strengthening exercises 

Internal rotation to strengthen the hip:

• In a seated position, take a resistance band and place it around your ankles. Keeping one foot firmly on the floor, slowly move the lower leg out to the side and carry out. Repeat on the other leg^6,7

External rotation to strengthen the hip: 

• Place a chair next to a table. In a seated position take a resistance band and secure one end around the leg of the nearby table, and the other around one ankle. Keep the free leg firmly rooted to the floor and move the lower leg in the band towards the stationary leg Repeat on the other leg^6,7
• Alternatively, you can perform a side-lying abduction (abduction is a movement away from the midline of the body). This movement is also known as a clam shell. Lie on your side, with the resistance band just above your knees. Pull your knees towards your chest to about a 45-degree angle. Lift your top knee while keeping your feet and ankles together and on the floor. Repeat on the other side^6,7

Weightbearing to strengthen the hip:

• Stand next to a wall for stability if needed. Balance on the affected leg, holding the other leg behind you. Perform a gentle, mini-squat and ensure the knee tracks over the outer edge of the foot. Repeat on the other leg⁷

Core stabilisation 

As part of your recovery from psoas syndrome, you may be prescribed a routine to help strengthen and stabilise your core muscles.⁸ The core muscles comprise of deep muscles of the abdomen, hip, and back, and are involved in stabilising and supporting the spine and pelvis. 

Eccentric exercise

Eccentric contractions are characterised by a force applied to the muscles which is greater than that produced by the muscle, causing the muscle to lengthen under the contraction. 

Eccentric exercises have been widely researched in treating similar injuries like tendinopathy (overuse or injury of the tendon which attaches muscle to bone).⁹ In one case report, an individual was offered a 12-week exercise training program which included an eccentric hip flexion exercise that markedly decreased pain and enabled rehabilitation.⁹

Psoas stretches

Stretching daily is an essential component of recovery and management, and should be continued until the pain has subsided.⁶ The key stretches suggested by research target a number of key muscles, including the psoas and hip flexor muscles, the quadriceps on the front of the upper leg, the hamstrings at the back of the upper leg, and the outside of the hip (particularly a muscle called the piriformis).

Summary

The psoas is a major muscle that attaches the upper and lower body. Psoas syndrome is a rare but painful condition that affects this major muscle group and causes pain in the lower back, groin, and hips. Physical therapy and exercises can help alleviate some of these symptoms, particularly a regular routine of strengthening and stretching the hips and core. Although many exercises can be performed at home, always seek professional advice before starting a new exercise or routine.