Clive Gomez FAQ: Psoas Syndrome (sore lower back)
August 11thPsoas Syndrome
The iliopsoas is a group of muscles that connects your lower back and pelvis to the top of your thigh. Pain or irritation in this area can sometimes be referred to as psoas syndrome.
You use these psoas muscles when you lift your knee, or bring your leg forwards, or steady your body. Because this set of muscles and tendons sit deep inside your body, it’s sometimes hard to locate. The pain may be felt in front of your hip, in your groin or even in your lower back.
These symptoms overlap with other hip and back problems, so pain or tightness in this area does not automatically mean it is a psoas related issue.
Where will I feel iliopsoas pain?
Pain is often felt deep and in the front of the hip or groin. Some people may notice discomfort near the crease where thighs meet the pelvis.
At rest, pain may feel like a dull ache or a deep discomfort. With movements such as lifting your leg, pain can sometimes feel sharper.
Pain is more noticeable after sitting or resting for a long time, such as getting out of bed in the morning, standing up after sitting at a desk, or getting out of the car after a long drive. Some people may even feel a deep tightness that does not seem to ease even after stretching.
It’s hard to pinpoint exactly where the pain is coming from since the psoas lies deep within the hip and is covered by several muscles and tissues.
What movements will I struggle with if I have pain in my iliopsoas?
Movements that involve lifting your knee towards your chest can be uncomfortable. For example, when climbing stairs, pain may be more pronounced especially when stepping up with the affected leg. Other movements like putting on your socks or climbing into a car can also cause discomfort.
When working out, sit-ups, hanging leg raises, or deep lunges are definite struggles. Sitting still can feel fine. As soon as you stand up, tightness becomes obvious. The longer you are in the same position, the deeper the stiffness you may experience.
The movements that aggravate symptoms can vary from person to person
Will I feel pain in any other regions of my body?
Psoas-related pain may be felt in the lower abdomen, lower back or at the front of the hip / groin. You may also feel or hear a click at the front of your hip as your leg moves.
Painless clicking is common and does not necessarily mean there is a problem. However, a click that hurts becomes more frequent or begins to restrict your movement is worth having assessed.
It is important to remember that groin pain and pain in the front of the hip can come from many different structures, including the hip joint, nearby tendons, lower back or other structures within the pelvis. Where you feel the pain gives us useful information, but location alone cannot confirm the cause.
How does Psoas Syndrome happen?
Symptoms often begin when the muscles or tendons are exposed to more load than they are able to tolerate. This can follow a sudden increase in running distance, hills or sprint work.
Repeated hip flexion exercises at the gym may have a similar effect, particularly when you have recently returned to training after time away. Less commonly, pain starts after a slip, an awkward step or a forceful hip stretch.
For other people, the discomfort develops slowly. Long periods of sitting, reduced strength around the hips, changes to training or restricted lower-back movement can alter how much work the iliopsoas is doing. The area may feel tight, but simply stretching a tight muscle does not always address the problem.
It is more helpful to work out why the tissue has become sensitive during your usual movements.
What should I do if I have Psoas Syndrome?
Start by temporarily reducing the activities that clearly aggravate your pain. You might shorten your walks, stay on flatter ground or take a break from sprinting and deep lunges.
You usually do not need complete rest. Gentle, comfortable movement can stop the hip becoming more stiff and guarded. For example, a short walk on level ground may feel better than spending the whole day sitting or lying down.
Gentle and comfortable stretches are better than exercises that aggravate the pain. Short walks can be good options as it’s a gentle enough activity that loosen up tightness.
Heat or ice packs can also be applied as temporary relief. Try both and choose the option that eases the pain better. Talk to your doctor before any pain medication especially if you have existing medications or health conditions.
What things should I try to avoid in the initial stages of iliopsoas muscle pain?
Try to avoid repeatedly testing the painful movements. Lifting your knee every few minutes to see whether it still hurts can keep irritating the already sensitive area.
Strong hip-flexor stretches may also make symptoms worse. When the muscle or tendon is already sensitive, forcing your hip into a deep lunge stretch may add more strain rather than relieve it.
Sharp pain during running, sport or gym work is a sign to change the activity. That does not mean stopping everything. You may be able to reduce the weight, shorten your stride, limit the range of movement or choose another exercise while your symptoms settle.
What type of exercises or movements do I need to learn to rehab the psoas muscle?
During the early stages of rehabilitation, the focus will be on getting the hip working ensuring that exercises do not repeatedly aggravate the pain.
Some exercises that introduce load without the need for large movements include gentle hip-flexor holds, bridges, and controlled sit-to-stands. Your therapist will also help you strengthen your hips, pelvis, and trunks so they can support movement instead of the iliopsoas taking most load on its own.
As your healing progresses, rehabilitation can gradually progress to more demanding exercises such as resisted marching, step-ups, squats, and hip-flexor exercises that demand more from the muscles.
A good programme should reflect your lifestyle and the activities you want to return to. For a runner, that may mean gradually adding jogging, hills and faster sessions. In the gym, it could involve rebuilding confidence with deeper squats, lunges and loaded carries.
What other considerations contribute to a sore psoas muscle?
There are many factors that affect how your psoas area responds. These involve sleep, training load, work habits, and injury history that could have affected the hip or back.
Your physiotherapist will assess the way you move your hip, how strong you can lift your legs, and whether specific positions reproduce pain. Comprehensive assessments also include notes on how you move when you walk, run, or squat. The evaluation will focus on your lower back and pelvis because there are other conditions that overlap similar symptoms.
Sometimes scans may be considered when there’s significant trauma involved. If the pain is worsening and there’s accompanying fever, unexplained weight loss, numbness or tingling, seek prompt medical advice.
What treatments can help relieve iliopsoas pain or fast track my rehabilitation?
Rehabilitation is designed so exercises gradually become more challenging to increase the capacity of the muscle and the surrounding structures. Treatment may also include hands-on to better ease discomfort and allow you to be more confident with the exercises.
The goal is for you to restore strength, confidence and comfortable movements so you can return to your normal activities. A physiotherapist will help you identify changes to manage load while you build capacity to tolerate normal loads again.
Your physiotherapist may also review your running volume, lifting technique, workstation or weekly training schedule. Persistent symptoms occasionally need further medical assessment. Imaging or an injection may be considered in selected cases, although most people do not require either.
How long does it take to recover from Psoas syndrome?
Recovery varies from person to person. It can depend on how long you have had symptoms, how easily are the symptoms aggravated and the demands the muscle needs to handle.
A mild problem that followed a recent increase in activity may begin improving within several weeks. Symptoms that have been recurring for months, or involve an irritated tendon, may require a few months of progressive rehabilitation.
Recovery is not always linear. You may feel more discomfort after increasing your activity. This does not necessarily mean you have caused more damage, it can be a sign that the increase was more than your body was ready to handle.
Consider physiotherapy when your symptoms start affecting your daily life. Book an assessment at Kinematics in our Richmond clinic. Our team can help clarify the pain or discomfort that’s already affecting the quality of your sleep, work, mobility. Then provide a rehabilitation plan that is designed around the activities you want to return to.
This article is for general education and is not a substitute for personalised medical advice.