Psoas: ‘The’ Core Muscle


This mighty muscle, lying at the very core of your physical body, has a profound influence upon our well-being.

The psoas is the most important muscle in the body for 3 reasons:

  1. It brought us up to stand. The lumbar curve was created when we came to stand upright by the psoas.
  2. The walking muscle.  It is the muscle responsible for propelling you forward.  There are a lot of muscles helping it, but essentially walking is falling, and falling is all about your psoas. A healthy psoas provides a suspension bridge between trunk and legs. The psoas responds to every movement of the spine. Ideally the psoas guides rather than bears the transfer of weight from the one (trunk) into the two (legs).
  3. It’s a muscle of trauma.  This is the muscle in your body wherein you’re storing your emotions. When feeling threatened it is your psoas muscle that propels you into fleeing or fighting or curls you into a protective ball.

Everything from the chairs we sit in to the shoes we wear can curtail the natural movement of the psoas. Having a constricted psoas might be traced back to your first shoe. Wearing a shoe that shapes the foot, stops bones from rolling, limits ankle mobility, drops the heel behind or shifts the weight onto the toes can and does affect skeletal balance. It can stifle the vitality of your psoas.

Premature standing and walking (before the bones are fully formed and weight bearing) teaches a child to rely on their psoas muscle for structural support. Playpens and walkers encourage early standing and limits crawling, which is so important for kinaesthetic maturation. Plastic baby holders restrain and limit natural movement, rhythm and the protective give and take of a mother’s supple body.

The Effects/Symptoms of a Shortened Psoas

  • Pain with prolonged standing, or standing while leaning forward (doing dishes), pain on rising to stand after sitting, especially when you are leaning forward (computer use or bleacher sitting), and lying flat on your back with the legs flat
  • Constricted organs
  • Impinged nerves
  • Impaired diaphragmatic breathing
  • Putting pressure on the uterus, a tense or short psoas can cause cramping
  • Pushing the oesophagus forwards, a tight upper psoas can cause digestive problems
  • A short psoas can interfere with the diaphragm fully descending through the abdominal core

Psoas as ‘The’ Core Muscle

psoas

See the Psoas as a support.  It is the length and vitality of the psoas that helps to maintain volume in the core. Providing a diagonal muscular shelf, the psoas moves through the core supporting the abdominal organs. A major ganglion of nerves is located on top, around and imbedded through the psoas. Together with the diaphragm, the action of the psoas works like a hydraulic pump to massage the organs and viscera while stimulating the flow of fluids throughout the body.

The keystone of skeletal alignment, it is the balanced pelvis that provides a base of support for the spine, ribcage, neck and head. It is the aligned pelvis that transfers weight down through the hip sockets, legs, knees and feet. If the bones do not support and transfer weight properly, it is the psoas muscle that is called upon to provide structural support, making it tight & weak.

In addition to the psoas being tight, it is also typically weak at the same time. This creates dysfunction in the muscle. Our brain has trouble controlling the muscle because it has been in a shortened position for so long, thinking the psoas always needs to be flexed.

True core strength then, depends upon core integrity. Unlike other muscles, the Psoas does not need strengthening, but rather nourishing. The ‘weak’ Psoas muscle is really a dry, exhausted, Psoas; abused, over-used and too often misused.

Test your Psoas

  • constructive-rest-positionConstructive Rest is an easy position for releasing tension in your psoas muscle. After work and before your evening meal take 10 – 20 minutes to rest in constructive rest and feel the benefits.  Begin by resting on your back. Knees bent and feet placed parallel to each other, the width apart of the front of your hip sockets. Place your heels approximately 12-16 inches away from your buttocks. Keep the trunk and head parallel with the floor. If not parallel place a folded, flat towel under your head. DO NOT push your lower back to the floor or tuck your pelvis under in an attempt to flatten the spine. For best results keep the arms below the shoulder height letting them rest over the ribcage, to the sides of your body or on your belly. There is nothing to do; constructive rest is a BEING position. In this simple position gravity releases the psoas and you’ll feel more at peace with your self and the world.
  • Psoas Strength Test  hip-flexor-strength-test-226x300
    (Modified Sahrmann’s Test (3))
    Here is a general way to determine if your psoas is weak:

    1. Standing, grab and pull your knee to your chest as high as you can without leaning backward. You will need to get your thigh well past 90° (in relation to your supporting leg).
    2. Once your knee is close to your chest, release your hands and attempt to keep your leg above 90 degrees for 15 seconds.
    3. Start timing when you release your hands and stop when your thigh drops below 90° (make sure to use a clock on the wall).

    If you fail before 15 seconds then you have a weak psoas muscle. Any major body shifts, leans, cramping, or loss of control in the allotted time also results in a failed test.  Failure far before 15 seconds shows further weakness. For best accuracy have a fitness professional conduct your test.

For more on Psoas muscle & its conditioning, check out:

Thus working with the Psoas challenges the standard precept of core strength. To really achieve core strength you must first regain a supple, responsive and fluid core so that rich bio-intelligent messages from the central nervous system can foster healthy neuromuscular and skeletal relationships.

 

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Core Muscles of Neck and Exercises


Everyone talks about strengthening of “CORE MUSCLES” to prevent back pain but, we rarely hear or talk about the core muscles of neck.
Research shows that 70% people experience neck pain at some point in their life.The cause of injury may range from accident to use of wrong pillow causing strain in their neck. Any injury has shown to inhibit recruitment and strength of muscles in neck. And these muscles are your DEEP NECK FLEXORS or Core muscles.
Similar to lumbar spine, cervical spine uses these deep muscles to ensure the intersegmental spinal control.

DEEP FLEXOR MUSCLES

Small stabilizing muscles are located in anterior and antero-lateral part of cervical spine. They are located deep to sternocleidomastoid.

LONGUS COLLI
ORIGIN and INSERTION
Superior oblique arises from anterior tubercle of transverse process of third fourth and fifth cervical vertebra and inserted into narrow arch of the tubercle of atlas.
Inferior fibres originate from first 2 or 3 bodies of thoracic vertebrae and is inserted intoanterior tubercle of the transverse process of 5th and 6th cervical vertebra.
It is the most common muscle injured during whiplash injuries.
Longus colli with other muscles forms a sleeve to stabilize the neck in antigravity positions.

LONGUS CAPITIS
ORIGIN and INSERTION
It arises from four tendinous slips from the transverse processes of third, fourth, fifth and sixth cervical vertebra and is inserted into inferior surface of basilar part of occipital bone.

Both the muscles together perform following role:

  • Responsible for initiating or starting neck flexion movement.
  • reduce shearing force across cervical facet joint and disc.
  • maintain neck posture.

Patients with neck pain exibit an increased EMG amplitude of superficial sternocleidomastoid and scalene muscles and decreased activation of deep flexors which causes a decrease in range of motion.
A low load program for craniocervical flexion exercise focusing especially on motor control of deep neck flexors have shown to reduce neck pain and headaches.

chin tuck in

EXERCISES TO ACTIVATE CORE MUSCLES


1) CHIN TUCK IN EXERCISE:
Lie on the floor with neck supported.Tuck your chin in or push your head on the floor without bending your neck. Repeat the exercise for 12 counts for 2 sets. Gradually try to hold each count for 5sec.

2)HEAD LIFT EXERCISE
Lie on the floor. Tuck your chin in and lift the head just 3-4 inches above the floor and return.

3)NECK FLEXION
Ask the patient to lie on the floor with knees bent and feet on floor. Put finger at base of the skull and lift about 1/8th inch off the floor. Make sure the neck is not liftitng off the floor. Remember core exercises are slow movements. Feel down  for a bony bump (7th cervical vertebra). Now ask patient to lift the neck till this bump and the skull but not the rest of the neck. Now gradually ask to release it.

4)BIOFEEDBACK
You can also keep a pressure sensor or pressure cuff beneath patients neck and ask him to slowly nod as if saying yes.Ask him to hold the position 2mmHg above the baseline and gradually increase the baseline to 4,6,8 10 mm Hg and 10 Sec hold. Highest level acheived in 10 repetitions 10 seconds hold.

PERFORMANCE INDEX MEASURE
Number of times patient can hold pressure level, multiply  it by pressure increment. For example: if patient can achieve 4mmHg and could do 6 repetitions of 10 sec hold without breaking the form then the performance is 24. The highest is 100 that is 10 mmHg and 10repetitions.

5) CRANIOCERVICAL FLEXION WITH CERVICAL FLEXION
It works on deep as well as superficial muscles.
Tuck in the chin and lift the head off  so that chin touches the chest.

PROGRESSION
a) Using resistance with help of theraband or manually applied resistance.
Patient is supine. The resistance is applied manually  and the patient is asked to do 12 repetitions of craniocervical and cervical flexion.
 Perform 3 sets of 12 repetitions for 2 weeks then by 4th week perform 15 repetitions.

 b) In quadruped position
Ask patient to assume quadruped (on all four) position and perform chin tuck in or nods without bending the neck.

EXERCISE IN FUNCTIONAL POSITION


a) Sit with feet flat n buttock supported.Gently roll the pelvis forward on ischial tuberosity.
Instruct the patient to move thorax slightly up and forward for slight lift.Gently and minimally lift the occiput to position the head in neutral position away from cervical extension.

b) Also, Patient must be taught to maintain optimal neck position while performing upper extremity task.

Shoulder blade stabilization is integral part of stabilization of neck and hence shoulder blade exercises should also be performed.

Also a heat pad can help to relax the muscles and the perform the exercises, make sure that mild stretches are done after the exercises are over.
While performing all exercises breathing is very very important. Make sure during the course of exercise you donot hold your breath and perform the exercise.

Thus, training these muscles along with the treatment commonly practiced by the physiotherapists will serve to prevent the later complications or recurrence of any chronic dysfunction.

 DISCLAIMER: The above given program is a general guideline to introduce the importance of the concept of core muscles of neck. Do thoroughly assess your patient before attempting any of the exercises.