The quadratus lumborum, psoas, iliacus and piriformis – connection of back and hips and the battle to be the superhero?

By Becci Grant, Wed 24th Apr 2019

Do you suffer with back pain?

So many of us struggle with tightness and lower back pain in

 the lumbar region or hips so let’s look at 4 super hero muscles and how we can give them some loving.

Is your Psoas the cause of back pain?

It could be an imbalance or it could be that it is being over dominated by your Quadratus lumborum?

But apparently the psoas is never a problem in the realm of musculoskeletal injuries. Right?

But I rode a Unicorn today to the end of a rainbow, I found a pot of gold and I hung out with a leprechaun… 

Ridiculous right?

Because It’s a key player in everything and it is underrated. It is a super hero in its own right but its number one enemy is a chair. Sitting down in chairs for long periods of time weakens this little superhero.

The psoas is a chaotic mess for most people. It’s the ‘crazy’ muscle of the body. Most often the psoas is tight and weak. Not always, but most of the time. If your lower back hurts the psoas is involved. If your sports performance is suffering then the psoas is probably going to be involved.

What’s the role of the psoas and why is it so important?

More commonly shortened and referred to as the psoas, iliopsoas refers to the joined psoas and iliacus muscles. It is the strongest muscle of the hip flexor group, originating in the upper vertebra of the lumbar spine and attaching to the lesser trochanter of the femur (a tiny prominence near the head of the thigh bone).

It is the only muscle that connects three zones of the body, the lumbar spine, pelvis and hip, so I think it is now safe to say it is quite important in stabilisation not just in asanas but our bodies in general. We use our backs for so much, our hips, we move, we are always flexing so let’s keep this strong so it can do its job.

Its primary role though is lumbar spine stabilisation, but it’s also involved with hip flexion, hip external rotation, lateral lumbar flexion, trunk flexion and anterior pelvic tilt with the insertion fixed or drawing the thigh and the spine towards each other. Postures like Navasana and Bakasana where deep hip flexion is required, will also activate the psoas.

So try:

Standing on your right foot and raise your left leg up in the air bending at the knee. You’re coming into hip flexion on the left. But you’re also having to elevate your left pelvis. If the psoas is weak you over hike your left hip in the air to compensate or extend your lumbar spine to absorb force. You cheat to make it easier. Extending the lumbar spine and hiking the hip is the quadratus lumborum working overtime.

One of the biggest reasons for a weakened quadratus lumborum muscle is a weakness of the psoas on one or both sides

What to do about it?

  1. Foam roll or release the quadratus lumborum. Don’t dig in there too long or you may upset and irritate it
  2. Lie on the ground with legs straight. Bring one knee toward the chest until the knee breaks the waistline. On the downward straight leg slowly squeeze your glute on that side and hold. On the flexed knee try to press back down to the ground with your hands on top of the thigh and resist. Hold for 4 seconds. Repeat 4 times. Switch sides and repeat.
  3. Don’t hold your breath

What’s the connection between the lower back and hips?

One of the major reasons for these issues in the lower back and hips (other than from accidents, trauma or structural design from birth) is that most people live their lives in the forward flexion portion of the saggital plane sitting, driving, walking, running, cycling, anything and everything.

Because of this constant state of forward flexion, muscles that hinge the body forward at the hips get tight, shortened and weak and muscles that want to take the body back into a neutral position of upright extension become tight and weak from overworking, overtrying and essentially, failing at their job. 

Tight hip flexors and twinging backs

When we talk about tight hip flexors, tight or weak or twinging lower back muscles and weak lower back-hip integration (Sacrum-Iliac joint pain and instability) it’s helpful to consider the relationship between the four deep muscles that connect the spine to the pelvis and femur (the Psoas, Iliacus, Quadratus Lumborum & Piriformis)

The relationship between these four can be an interesting one like do they even get along? Or is there a bully mentality, each one wanting to be stronger and more favoured and to be the ultimate super hero? 

Like a relationship between two people that may need a bit of counselling to regain balance, the dilemma that occurs here is that the iliacus and psoas (known together due to their combined insertion on the femur as iliopsoas) are tight and weak from overflexing and the quadratus lumborum (which extends, stabilises and laterally flexes the lumbar spine, lifts the hip and aids breathing so it’s a pretty busy one) are tight and weak from trying so hard to bring the body back upright to neutral.

But then we throw the piriformis in which is responsible for the external rotation of the femur (thigh) stabilising the sacroiliac joint and abducting the femur when the hip is flexed such as in tree pose and it all gets a little complicated because When the psoas is tight it pulls the lumbar vertebrae into a deeper lordotic curve which then lifts up the sacrum and ilium into an anterior tilt 

lordotic curve

which can lead to tightness in the quadratus lumborum and strain on the piriformis which attaches from the sacrum (lower fused part of the spine) to the femur (thigh bone) and is responsible for external rotation of the hip which then has the nock on effect as when the piriformis is tightit pulls on the sacrum where the usual SI joint issues can arise and pinch on the sciatic nerve causing potential iliotibial band tightness, due to the increase workload that the tensor fascia lata is having to do to bring the femur back to neutral with internal rotation.

When the iliacus is tight andconsistently over time, it pulls the ilium (hip bones) forward and away from the sacrum, which leads to either SI joint pain and instability and/or opposite side piriformis tightness. This then leads to IT Band tightness due to tensor fascia lata trying to bring the femur back to neutral again with internal rotation. 

The struggle Is real

The constant struggle between these four muscles can lead to a permanent deformity in bones and the connective tissues that hold them together. This can result in compressed vertebrae and discs, twisted ilium, separated sacrum-ilium, knee, lower leg, ankle collapse) as well as compression, manipulation and pain to reproductive organs, intestines and the diaphragm (the major muscle of breathing). That’s a whole lot of trouble that we can get ourselves into if we don’t look after this super hero group.

To help prevent and correct these muscles, we need to stretchstrengthen with various asanas and constructive poses with weights and resistance bands but  slight back bends, quadricep stretches, triangle pose, low lunge, boat pose, twisted lizard, one legged planks are all good but more importantly are the constructive rest postures laid on your back letting gravity do the work, softening your body to the ground supine twists on the floor always maintaining a deep breath

Otherwise fascia ( a continuous sheath of connective tissue that weaves around everything ) starts to pull and tug in the direction of the tight fibres of ilipsoas, quadratus lumborum and piriformis, causing even more discomfort, deformity and pain so prevention is better than cure by any measures. Look after this super hero group of muscles.

And again the most effective way to support a healthy relationship between all four of these muscles is with the Constructive Rest Posture.

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