The Psoas Syndrome

Happy new year to all. I hope you all had a wonderful holiday season.

I wanted to start the new year off with one of the most common sites of injuries for dancers. I am talking about the most powerful hip flexor in the body as well as a powerful trunk flexor, the ILIOPSOAS.
Injury, shortening and contracture of this muscle can cause lowback pain, hip pain, sacroiliac pain, mid back pain, clicking hip and pain down the leg. It is commonly misdiagnosed as a low back strain or a disc bulge or herniation.
It kind of makes you feel that you are off. You seem to walk unbalanced. Common causes of injury are repetitive hip flexion. sleeping in the fetal position, lifting incorrectly, and in a dancers case the constant hip flexion and external rotation seen in a grand plie and a demi-plie.
A brief anatomy lesson of the iliopsoas. The Iliopsoas is made up of the iliacus muscle and the psoas muscle. It attatches from the the lumbar spine and iliac fossa to the lesser trochanter of the hip. It actually connects to your lumbar spine. If this muscle is contracted and is pulling on your spine you can develop a low back pain syndrome.

One way which I check for psoas shortening is the following: You need 2 people for this. Have the patient lie on there back. Have them bring there hands above their head fingers touching. Usually the problematic side will show that one of your arms is shorter than the other. Your fingers won’t meet at the tips. The short side is the dysfunctional one. There are other orthopedic tests for the psoas but that is for the doctors office.

A common release stretch for psoas shortening.

This is a stretch I recommend to my patients for psoas dysfunction (this is not medical advice, please see your doctor before doing any of this)

What is the best treatment for a psoas problem?

The muscle is not outwardly palpable such as the hamstring or biceps muscle. You really need to dig deep to get to the psoas. Stretching helps but rarely eliminates the problem. I have found Active Release Technique to be the most successful treatment in the case of Psoas dysfunction. ART allows you to fully stretch the muscle while breaking down scar tissue and adhesions that develop from repetitive use.


Situps- Make sure to isolate your abs. Many times you recruit the hip flexor or psoas and it takes away from the Abs. This improper situp can cause injury to the psoas. How do I do that?
Place both feet on a wall and do a crunch. Feel the difference.

In cases of LOW BACK PAIN, MAKE SURE YOU GET YOUR PSOAS CHECKED. If you are being treated for Low back pain with adjustments, electric stim, ultrasound, pt, stretching, etc and you are not feeling better after 4 or 5 visits, LOOK TO THE GREAT PRETENDER, THE PSOAS.


  1. megan

    Interesting post! I have scoliosis and when I don’t stretch my psoas enough, the tightness exacerbates it. Then it’s time for a trip to my chiropractor! Thanks for the nice illustrations and clear description!

    Jan 08, 2008 @ 02:00

  2. emma rocco

    thank you sooooo much for posting this!!!!!!!! I’ve had this problem for a while and never really understood what happened or why, or what i should do. (I mostly just ignored it) Thank you again!!!!!!!

    Jan 08, 2008 @ 02:26

  3. GraciaMichelle

    Wow, this is really interesting and useful information!!!
    Thank you so much!!!

    Jan 08, 2008 @ 02:51

  4. doug

    i think my psoas is tight on my left side but my right side usually hurts and often has a click, is this typical?

    Jan 08, 2008 @ 11:40

  5. Liz

    Dr. Rosenthal, I always look forward to your thorough explanations of common dancer ailments, treatment recommendations, and “brief anatomical lessons”. Your posts are right on the money and incredibly helpful! Thank you for being so generous with your impressive knowledge of dancer bodies and injuries. Please keep posting!!!

    Jan 08, 2008 @ 20:34

  6. Justin

    Thanks for this post.

    I’m not clear on the function of the stretch above. “This is the Psosas stretch..” and the image provided could be elaborated upon with instructions for those without access to the apparatus depicted.


    Jan 08, 2008 @ 23:12

  7. jennifer

    this is an amazing post; I’ve had an old hip injury after going back onto pointe after a 3 year break (yeah, not good) which my orthopedic surgeon (not a dance specialist) couldn’t diagnose my problem, saying “It’s probably a muscle thing, take a few Advil…” I still have pain now and then, now I wonder if it’s my iliopsoas…

    Jan 08, 2008 @ 23:14

  8. Ed Hara

    I think this is what I have for the past 2 weeks. But I wonder, if Psoas Syndrome also causes numbness of my thigh and inner side of my leg… Better find myself a good chiropractor. Thanks for the info!!

    Jul 22, 2008 @ 04:41

  9. misty

    I have just complete a round of decompression therapy at my chiropractors office. through x rays we have determined the herniated disk is back in place.

    I have been left with the most unbelievable hip pain. one of my leg continually gets longer than the other and we adjust for this. I have been away for about 3 weeks and my hip is no better. I went yesterday for a upper decompression treatment from the previous one and now my hip is worse.

    I have old scar tissue t8 and t12 from compression fractures. this seems to be causing my other vert to be compensating for the stiffness.

    I now sleep on my back with a pillow under my left leg. The same left hip is the one killing me. I have Rx from doctor for pain but I can tell no difference between hydrocodiene or Advil.

    The pain is a burning pain if I lay on my side. it starts off slow and intensifies. If I sit for long periods I have difficulty standing and walking. My balance seems affected until I get lossened up.

    Any help I can tell my wonderful chiropractor would be helpful. This has been going on for 3 months. It was so bad at one point I had to walk with a cane.

    Jul 23, 2008 @ 00:54

  10. Barbara

    It’s a long time, but I do have what is called edema in the hip joint with tightness and pain. At first it was thought this was due to stress fracture. I speed walk and do other weight bearing exercises, along with stretching. After 4 MRI’s which show NO change, it is now thought that i have psoas syndrome, which is causing this edema. The pain has been in the groin. There has been hip clicking for a long time on that side. There is also some localized pain in the lower back. Also, please explain the psoas stretch in your article. I see that the leg is bent and held up by a cube. But what is being done?

    Sep 22, 2008 @ 18:23

  11. david

    Thanks for this post.

    I have been suffering from extremely tight hip flexors for some time. I Have been doing lots of stretching, and PT. After some research I have found that sleeping in the fetal positions can be cause, which I do. How does sleeping in the fetal position exasperate this disorder? Should I rather sleep on my back?

    Thanks again!

    Mar 23, 2009 @ 02:22

  12. Tori

    Omg! I have the same issue!I am a dancer and are dancing 24/7 my hips click and when I am holding my leg up at 90 degrees it pulls at my hip and it hurts. When i do a battament, when I bring my leg down it pull and it hurts or it will click constanly. I went to the physical theropist and she ssaid I have psoad syndrome, how do I fix it?

    Aug 04, 2009 @ 01:51

  13. Jelle Schaegen

    Straight to the bone Advanced Myofascial Release. I can free your total musculoskeletal system within 4/5, two hour sessions and all in a very safe way.

    Too many pretend to be able to create a genuine Psoas-, Piriformis-, or any other release with exerting hardly any pressure; which is not true. And that’s why my method beats any other method.

    If you (still) think yourself a strong person, than you’ll experience my work not going to be more strenuous than like walking up a rather steep hill.

    After a couple of sessions your body will feel more open, new, like many years younger and it will have gone through many mechanical, as well as physiological transformations. Meanwhile you will experience emotional and/or mental and/or spiritual elation.

    Depending on your overall health and better understanding of the causes that brought you to the unfortunate position in the first place, you will be more free of complaints for a very long time or can even leave them behind you.

    If you want to do any kind of stretch in search of a release (relieve), never hold your breath at any moment! Breath through your mouth; in and out. Inhale the ‘pain’ and relieve on the outgoing breath coming from your belly.

    The emphasis is on inhaling and you will have to release from the inside out. Do not forget to surrender yourself! Use feminine (yin, magnetic) energy to heal. Doeltreffende hulp bij Nek en Rugklachten; prof sport, dans en yoga, Amsterdam, Maastricht, Nederland. Thanks a lot!

    Oct 03, 2010 @ 19:38

  14. amy raichert

    I have a question about the “stretch ,which may seem funny but just to be clear.The leg on the foot stool is the one with the shortened psoas?

    Feb 05, 2011 @ 16:45



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