The Psoas

The idea that "sitting is the new smoking" should more likely be phrased as a sedentary lifestyle kills, but that's certainly not as catchy. Sitting doesn't do damage like smoking does, but the cumulative effect of sitting for the majority of the day instead of moving has widespread effects on calories burned, cardiovascular health, etc. I actually love the phrase because it reminds me to get off my butt and stand or walk.

Tell me if this sounds familiar...

You've had a long day at work, sitting in front of a computer, so you decide to get some exercise before going home (to sit down for dinner and then sit to watch TV). You get to the gym and every treadmill is taken, blast! How could you possibly "run" without the ground moving beneath your feet, music blasting through headphones, and moving pictures on a screen to stare at??? Outside? Are you crazy? You'll have to just ride the stationary bike...Great 20 min done and the machine gave you a bunch of meaningless numbers like "calories per hour" that make you feel good. Now, you look down at that belly. Time to "burn" some of that fat off. Crank up the Brittany Spears, let's do some crunches!!! 50 sit-ups later and some weird foam rolling thing the person next to you was doing...AND YOU'RE DONE. 

You're so glad you saw on Pinterest that "Sitting is the New Smoking." You nailed that workout and undid all that "damage" from sitting, right????

Wrong!!!

Props for getting off your butt and moving, but I won't go so far as to say you undid the damage of sitting all day long. Yes, adding some calories burned to your day helps balance the times you were sitting (burning close to zero), but our bodies are made to move. In the example above, you barely got out of the sitting position. Biking is great but your hips are still flexed and your back hunched over. Sit-ups are good, but hips and knees are usually flexed, essentially horizontal sitting. If you want to think about undoing the damage to your body from sitting all day, you need to think of doing the opposite of just that. Stop practicing hip and knee flexed movements with your lumbar spine hunched. After studying today’s muscle group, I am now convinced that prolonged sitting can cause more damage than just adding to your calorie excess and thus making you fat. I think the actual posture can lead to muscle damage, but I want to look at this, as usual, from an anatomy perspective before we get too carried away with the latest fitness fad (like foam rolling your hamstrings to add that "extra stretch" when you can't even touch your toes).

ANATOMY OF THE ILIOPSOAS

Without further ado, today's topic is the iliopsoas muscle group, particularly 1/3 of that troop, the Psoas Major. These are muscles that are located very deep within the abdomen, all the way back to the lumbar spine. In fact, they make up the posterior wall of the intra-abdominal cavity. Thus, pain in these muscles is often felt deep within the belly.

As you can see in the first diagram to the right, there are 3 muscle that we will adresss: the psoas minor and major, as well as the iliacus muscle. The psoas minor is a paltry thin little muscle that attaches at the lumbar spine to the pelvis. It is a weak spine flexor and that's all we'll say about that. The iliacus muscle, is a broad muscle within the inner iliac wing of the pelvis (hence the name) and reaches down to the femur to flex the leg. The biggest of the three, the psoas major, however, does both movements, flexion of the spina and flexion of the hip, therefore summing up the actions of all of the muscles combined so it is the focus of today's discussion.

THE MIGHTY PSOAS MAJOR MUSCLE

This muscle (pronounced with a silent 'P") originates at the last thoracic vertebrae and all of the lumbar vertebra before diving through the abdomen and pelvis to its insertion on the inner upper part of the femur at the lesser trochanter. This means that it can perform a variety of movements of the spine and hips. Check out the video to the left to see all these. Highlights, of course, include flexion of the hip as well as flexion of the spine, but as you look closer you can see all types of spinal flexion and side bending movement usually attributed to the abdominal muscles we all love to spend time "working" in the gym. Perhaps we should rename them psoas mats???

Looking at the diagrams flipping by above as well, you can also see these iliopsoas muscles spend much of the day shortened when you are in the sitting position, and looking way back at the exercise routine example above, every single one from bicycling to sit-ups all caused the psoas major to contract by flexing the hips and spine. You're basically sitting all day with the psoas in a contracted position and then exercising this same muscle when you get to the gym. My point being not to stop exercising to avoid the dangers of prolonged sitting, but rather to think about the stress that chronic sitting places on the skeletal and muscular system and perform movements that bring balance into the way your body moves overall.

EXERCISE???

I think this is a muscular area, in particular, that is prone to overuse with an inordinate amount of attention paid to the abdominal core muscles that flex the lumbar spine and will give you six-pack abs only if you happen to have very low body fat to start, while little to attention is paid to the hip and lumbar spine extensors. No wonder there are so many people out there with "bad backs" and a million "ab machines" that, again, will only show those rectus abdominus muscles if you are <10% body fat to begin with!!!

But I digress, we're talking today about the psoas major and its contribution to your daily movement. First point, it spends most of the day in a shortened position if you spend most of the day in a chair. Second point, many "ab exercises" that involve flexing the hips and lumbar spine are also strongly relying on this muscle as well. So what's the opposite of sitting??? As far as the psoas muscle group is concerned, it's the "runner stretch" seen below in these two videos, but before you watch I want to make another suggestion on how you consume "expert advice" and instruction on physical fitness.

Could someone please call me when Dr. Greger dies???

Make sure to turn on your brain when you are given advice. All sorts of people can be called "experts," and many videos and commercials include phrases like "scientifically proven." I think the videos below give pretty good instruction, but in no way do they show themselves to be "scientifically proven." Just consider that phrase as the same as "we're pretty sure." What does scientifically proven mean??? Double-blind placebo controlled randomized prospective trials have been conducted? I doubt it. I imagine it means that the looked in "science book" or asked someone with a "science degree" if said fact was true. I actually consider it a warning sign if someone says this because they usually leave out what exactly the science was. It was "scientifically proven" the earth was the center of the universe for a long time, but that didn't make it true.

I think the mysterious psoas mucles, a muscle that you can't see or feel, is particularly prone to this bad science where someone who knows a little projects a lot and extrapolates incorrect information. If you're searching around the interweb looking for more information on the psoas major (like a nerd such as myself does), and you come across the title "End back pain forever by releasing the psoas" maybe you should put on your thinking cap.

I absolutely LOVE these two videos below to show you some absolutely ridiculous claims of "opening the psoas muscle" (like a can of tomato soup maybe???) and how a little anatomical knowledge can be dangerous. In these videos, two self-proclaimed experts show you how to mash a tennis ball and a metal weight through your abdominal cavity with all its critical organs into your psoas major muscle. AMAZING. By just compressing everything in front of the psoas muscle group like intestines, the ocassional ovary, huge iliac arteries, nerves, and veins, you too can potentially damage not only these organs, but falsely believe that pressure on a contracting muscle somehow causes it to "open" or "release" as if this is a good thing. From a medical standpoint, I prefer my patients don't traumatize their muscles and "open" them so that they bleed internally. Anatomically, muscles should be contained within fascia and to "release" them from this fascial layer is to break down the muscle's integrity as a unit. PLEASE, do not try this at home.

In the ER, the psoas muscle is famous for the "psoas sign" that can occur when a patient has an appendicitis. Inflammation from a nearby appendix can irritate the psoas muscles so that when I ask the patient to flex the muscle or I put it on stretch, it causes pain. This illustrates how the psoas muscles are located within the abdominal cavity and how trying to reach them through your abd wall is a bad idea!!