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HOW A TIGHT PSOAS MUSCLE

CAN CONTRIBUTE TO DISC BULGES

IN THE LUMBAR SPINE

Elizabeth Ruffell

CCTC BASI Course

January 2014

The Pilates Clinic, Wimbledon, UK

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TABLE OF CONTENTS

Page No.

Table of Contents 2

Introduction 3

Anatomical Description & diagrams 4 - 7

Case Study 8 - 9

Conditioning Program 10

Conclusion 11

Bibliography 12

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INTRODUCTION

Lower Back Pain (LBP) is a collection of symptoms that affects all age groups.

Millions of people will suffer with LBP at some point in their lives and the

majority of it can be avoided by changing everyday bad habits. It can vary

from a minor twinge lasting a few days to acute long term debilitating pain

resulting in serious conditions, which potentially requires surgical procedures.

LBP is usually caused by repetitive stresses on vertebral discs and joints plus

a lack of core muscle stabilization. This case study will look at the link

between LBP, the role of the Psoas muscle and disc bulges in the lumber

spine and how using Pilates is an effective form of rehabilitation.

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ANATOMICAL DESCRIPTION & DIAGRAMS

What is Lower Back Pain?

Lower back pain (LBP) is a common disorder involving the muscles and bones

of the lumbar region of the spine. It is defined as the area between the

bottom of the ribcage and the top of the legs. It usually feels like an ache,

tension or stiffness of the joints and muscles. The pain can be triggered by

bad posture while sitting or standing, bending awkwardly or lifting incorrectly.

LBP is usually caused by repetitive stresses on vertebral discs and joints plus

a lack of core muscle stabilization.

There are three forms of therapy available to the client to treat LBP and they

are:

Passive therapy = little or no involvement from the client, can

include bed rest, pain management with drugs, ultrasound and

chiropractic treatments.

Active therapy = engaging the client in physical exercise which

includes strengthening, stretching, balance and stabilization.

Biomechanical therapy = posture correction which will educate the

client to move in a safer way during everyday activities such as sitting,

standing, lifting and carrying.

Pilates is a combination of Active and Biomechanical exercise designed to

improve physical strength, flexibility, and posture, and enhance mental

awareness.

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What is a disc bulge?

A disc bulge looks like this:

The back is made up of a spinal column of bones called vertebrae, which

house and protect the spinal cord; the delicate nervous system that controls

the body’s movements and sensations. The spine runs from the neck to the

pelvis. Between the vertebrae are discs; these are round spongy pads of

mucoprotein gel with a tougher exterior, these discs act like shock absorbers

that cushion the body’s movements. Discs can haemorrhage between the

vertebrae, commonly known as a disc bulge, due to repetitive strain without

proper core muscle support, poor posture or a sudden unexpected load.

What is the psoas muscle?

The psoas has many diverse functions and is widely recognized as being one

of the most important muscles in the body. It enables your hip and thigh to

flex, which makes it the major walking muscle. It also stablises and balances

the trunk, and the iliopsoas (lower psoas), tilts the lumbar spine forward and

   Diagram A

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creates the beginning of the pelvic curl (i.e. pelvic tilt). It is also a primary

muscle in flight, fight, freeze or fear responses to danger/stress/anxiety. In

our modern society we have a tendency to always be ‘on guard’ because of

our stressful lifestyles and the psoas muscle tends to stay contracted and

repetitive behavior leads to further shortening or muscle spasms.

The psoas muscle is situated on the side of the lumbar region of the vertebral

column and brim of the lesser pelvis.

The link between LBP, disc bulges and the psoas muscle

Many of my clients have complained about the same problem with the same

symptoms and I believe there is a link between LBP, a shortened psoas

muscle and disc bulges. What these clients have in common is the following:

• Bad posture

• Sedentary job – many hours sitting hunched over a laptop

• Very little or no exercise with most choosing to drive rather than walk, even for short distances

• Sleep on their fronts

 Diagram B

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The bad posture and lack of exercise can cause the disc to bulge with any

sudden and unexpected load. This load could be lifting heavy shopping,

getting up awkwardly out of a chair, or even from an aggressive sneeze, for

example. As these can be regarded as common events, disc bulges can

happen easily and can cause excessive pain. Most clients suffering from disc

bulges find the smallest tasks, such as getting dressed (spinal flexion, rotation

and extension) to be an exceptionally painful and frustrating experience.

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CASE STUDY

Name : Chris Howard

Age : 45

Job : Film Producer / Agent

Build : Slim 5’ 8” slight kyphosis

Lifestyle : Very sedentary, travels between London and LA

Doesn’t walk short distances, always drives.

Prognosis : Disc bulge on L4

What happened : Weeks of working on film script, long gym session,

followed by a night of dancing, and a vigorous sex act.

Initial treatment: Bed rest and painkillers.

Physio and chiropractor sessions

Initial symptoms : Acute pain on RHS, sitting very painful, could only stand

or lie on one side with cushions for support. Getting

dressed, moving around, sitting to work on laptop or in

film studio all exceptionally difficult.

I have known Chris for a couple of years and have always been aware of the

long hours he spends working. He came to me because he wanted to be

taught by someone he was familiar with as he can be self-aware and shy. He

was alarmed at his limited movement patterns associated with basic tasks

such as tying his shoelaces and carrying shopping.

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MY CHOSEN COURSE OF ACTION

The postural assessment showed the following:

• Natural head position is slightly tilted and dropped back to left

• Left shoulder sits higher than the right, slight kyphosis

• Hips level

• Weak glutes and tight hamstrings

• Right foot turns in slightly

Standing Chris in front of the mirror, I made him aware of his natural stance.

While in this position I showed him how standing this way was putting

uneven stresses on the intervertebral joints and discs and was highly likely to

have contributed to his disc bulge. My goal is to help improve his posture

and prevent any unnecessary pressure on his spine by strengthening and

stabilizing his core.

Working with Chris would be a commitment and I encouraged him to

embrace the message that Pilates is not just what you learn in the studio, it’s

what you take away and use in everyday life. This will help undo all the bad

habits and rehabilitate himself to a better quality of life.

I recommended he undertook two 50 min sessions a week to help with his

rehabilitation. He chose to have a one-to-one session on the equipment and

a group mat class for the other. I would expect an improvement in his

comfort levels and pain reduction within a month. In 3-6 months I expect a

vast improvement in his movement capabilities and core strength.

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CLASS PROGRAMME USING BLOCK SYSTEM

Based on 30 sessions

**I chose not to start Chris on the Wunda Chair as I wanted to get him moving on the

equipment, I thought this would encourage him to move more rather than exercising sitting

down.

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CONCLUSION

The aim of my programme was to straighten Chris’s posture and help his daily

quality of life by encouraging him to move more. I stayed away from acute

spinal flexion and encouraged strengthening of the abdominals, glutes and

back extensors along with stretching and lengthening of the hamstrings.

The feedback from Chris was positive. Within 3 weeks Chris reported being in

less pain and had also started walking short distances. This not only helped

his body but enabled him to focus and concentrate more.

By week 10 he reported feeling stronger in many of his daily activities and

less fearful of exaggerating the disc bulge by simple tasks such as carrying

shopping, bending over to tie up his shoes.

By week 25 Chris started to report days without any pain at all, which

inspired him to take up tennis lessons; something he had not done since his

early twenties. I am pleased with his overall progress and encouraged him to

practice and walk as much as he can.

Disc bulges resulting from poor posture, weak core strength and tight psoas

muscles seem common in modern society and my case study suffered from

this problem. After following my recommendations and using the Pilates

method, Chris has enjoyed the physical improvements from his training but

also his quality of life for day-to-day tasks has brought his confidence back.

As a teacher observing these changes, it only enforces how wonderful the

Pilates method can be.

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BIBLIOGRAPHY

Diagram A -

http://backcaretreatment.com

Diagram B -

http://www.strongfirst.com/psoas-so-what/

Other reference books used:

• Study Guide (2013): Comprehensive course. Body Arts and Science

International. Costa Mesa, CA.

• Pilates Anatomy, Rael Isacowitz and Karen Clippinger

• Pilates for Men. Fit for Sport Fit for Life by Alan Herdman.

• Wikipedia

Conversations with:

Physiotherapist - Susanne Riggs

Chiropractor – Ajit Patel

Masseuse – Jess Floyd