Should you get your psoas treated?

Hip flexor ‘tightness’ is a common complaint amongst athletes and runners.  Psoas is one of the hip flexor muscles and a muscle that receives a lot of attention from athletes and therapists alike.  The psoas muscle should not be the primary focus of treating hip flexor tension though.  There are multiple hip flexor muscles and some contribute to hip flexor tension more than others.

The psoas muscle is a powerful hip flexor muscle.  If we look at the anatomy the psoas is well designed to flex the hip.  It anchors itself on the lumbar spine and attaches to the femur.  It is often grouped with the illiacus muscle (referred to as illiospoas) which shares the attachment on the femur but originates on the anterior surface of the pelvis.  The reason why I believe that the psoas should not be the first hip flexor muscle to look at when treating hip flexor tension is that there are other hip flexor muscles that do more work.  They may not do more work in flexing the hip but they do more work over all.  Muscles like the rectus femoris and the tensor fasciae latae (TFL) cross both the hip and the knee.  This means that every time that the hip moves and every time that the knee moves these muscles are either contracting or relaxing.  It shouldn’t be too hard to get your head around the fact that muscles that cross two joints do more work than muscles that cross one joint and therefore are more likely to be dysfunctional.

There is also a very simple test that can be done to determine if your hip flexor tension is coming from the illiospoas complex or rectus femoris.  The modified Thomas test is a great test that can quickly identify whether the psoas needs treatment or not.  No therapist should be treating the psoas without performing the modified Thomas test.

Treating the psoas has become somewhat ‘fashionable’ but it is a particularly uncomfortable technique for both the client and the therapist.  I think the ‘No pain, no gain’ attitude has contributed to the popularity of treating the psoas.  Because the psoas originates on the lumbar spine when we come to treat it we are trying to touch your lumbar spine through your stomach.  Take a second and look at the distance between your stomach and your back (that distance will be larger on some compared to others) but that is the distance that the therapist needs to achieve to successfully treat the psoas.  On that fact alone I question the effectiveness of traditional psoas treatment.  Not to mention all the organs that we are trying to push through as well to make contact with the psoas.

To summarise all this information, it is possible to have psoas tension that needs to be treated but before you ask for your psoas to be treated or before you let your therapist treat your psoas you should be confident that they have done appropriate testing to ensure that you will benefit from the treatment.  The ‘No pain, no gain’ attitude doesn’t have much clinical reasoning and evidence to support it.  Athletes that have always had their psoas treated will most likely continue to have their psoas treated without considering whether it is necessary or not.  Our attitude at Excelsior Sports Therapy is to educate our clients so they can get the most out of their bodies.  That means ensuring that any treatment we perform is clinically relevant, meaning that is will benefit our client and is determined by the assessments that we do.

To answer the original question ‘Should you get your psoas treated?’ Probably not, but if your therapist wants to treat your psoas make sure that they have performed a modified Thomas test first and that it is clinically relevant for them to treat your psoas.