Low Back Pain — The Three-Dimensional Picture

I would estimate that seventy percent of the clients who seek me out for massage have low back pain as either a main or secondary complaint. Maybe they’ve injured themselves or maybe they’re just getting older and experiencing their bodies breaking down slowly. If I just work on their low backs and hips, I’m not getting at the whole picture. You see, we live in a three-dimensional body. The low back has a front, two sides, and a back to it. Most massage therapists work on the back of the low back and hope for the best. But let’s look at the front of the low back.

The Iliopsoas

Meet the iliopsoas – a two-part muscle made up of the psoas major and iliacus muscles. It lives in the front of the back on both the right and left sides of the body. The psoas major originates between the last thoracic vertebra and every single lumbar vertebra. The iliacus begins in the front of your pelvic bone. Both of them weave together at your hip and attach to the front inside of your upper leg. The iliopsoas is a powerful hip flexor, meaning that it helps you bend over to tie your shoes or bring your knee up to your chest. However, when it’s tight, it pulls down and forward on your low back vertebrae, making them feel tighter and tighter, until you’re walking around with a chronic low back ache and a feeling like you’re wearing a belt of tightness and pain around your waist. How does it get tight? Oh, the usual things that we do way too much of: sitting in front of a computer, sitting and watching tv, and more sitting in the car. The iliopsoas hates couch (and desk) potatoes.

Massage Techniques for the Psoas

Psoas massage is an advanced technique. If you’re looking for this for yourself, seek out an orthopedic massage therapist or a physical therapist. I sink right down into the abdomen when I massage the psoas. The intestines and mesentery move reflexively out of the way, so I don’t worry about compressing them. There are some serious endangerment points, like the aorta, the vena cava, the colon and the ovaries, so you shouldn’t do this on yourself. I’ll do a combination of cross fiber friction and pin and stretch technique along the length of the right and left psoas, as well as trigger point massage and pin and stretch technique on the right and left iliacus. Then I ask my client to straighten their legs fully on the table and tell me how their low back feels. Iliopsoas massage done well should make the low back feel like it has relaxed. The low back curve will be straighter and you will actually get the feeling that your low back has dropped down and is contacting the massage table more. For clients with chronic low back pain, the lengthening and straightening of their lumbar spine can feel like a miracle and give incredible pain relief. Results can be long-lasting, but unless you stop your sedentary lifestyle, the iliopsoas will generally tighten right back up again.

A Visual Description of the Psoas

Here is a great descriptive video of the iliopsoas from Kenhub:

For more information on the iliopsoas, here is another helpful link from Dr. Christiane Northrup’s website:

Why Your Psoas Muscle Is The Most Vital Muscle in Your Body, by Christiane Northrup, M.D.