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Saturday, May 24, 2008

Low back pain, cycling and the iliacus and psoas muscles

Hi Gary. I had a recent recurrence of the lower-back pain that has plagued me on and off over the last 12 years of my life.
Funnily enough it usually turns up when I stop riding my bike so much.
To cut a long story short, my usual physio was on holiday, so I tried an osteopath for the first time.

His diagnosis was pretty swift. He said I had weak hip flexors. A bit of deep massage on the trigger points and instruction on how to do it myself, or get my wife to do it, and I was away.

My improvement was very rapid. Straight away I was able to sleep in past 5am, which is when my back would generally start to ache so much that sleep was difficult.

Googleing on the "psoas" muscle, which he said was in a weakened (contracted state) turned up the kind of exercises I could do to help my rehabilitation when the pathway between my brain and the muscle had been re-established. Funnily enough they were the same exercises I was given way back when my back first failed in 1995.

Can you comment on whether or not you think cyclists have a higher risk of getting weak hip flexors because of the repetitive motion of cycling, and the sitting, or in my case, very extreme aero position I spend a lot of time in?
Gary Moller comments:
I think your osteopath was right on the button when identifying your iliacus and psoas muscles being the source of your back pain. The diagram of this muscle group makes it pretty self evident why these can cause back and hip pain. The other related possibility is your gluteals and piriformis muscles. I do not think the problem is to do with weakness. The problem is probably more to do with the muscles being inflamed, knotted and bunched up.

Exercises to strengthen these muscles are largely a waste of time as long as the muscles are in an unhealthy state. Gentle stretching may give some relief; but anything more may exacerbate the problem because the hard, knotted tissue is not what gives when stretching - it is the softer margins that give. The consequence may be that the area affected may be extended. I have seen one example where the scarring in a calf muscle has been extended the full length of the muscle belly as the result of excessive stretching as commonly prescribed for calf injuries.

Be the problem with the psoas, the gluteals or the piriformis, or all of them, the remedy for all is the same:
  • Attempt to deal with the underlying causes of muscle spasm and toxicity at the biochemical level. Start first with balancing tissue salts with the Active Elements Assessment. I now have over 100 people on this programme which allows me to make a fair assessment of its worth as a therapy and the results have been very good for most participants.
  • Arrange for several vigorous massages of the affected areas, especially the butt muscles. If the psoas and iliacus muscles need to be massaged, this is done via the abdomen and must only be done by an experienced massage therapist for the sake of safety. Your osteopath could do this; but these sessions need to be about an hour long to be of much use and about 1-2 sessions for as many weeks as it takes to be completely pain free.
  • Once the tissue salts therapy and the massage begin to kick in (You will know because the massage will not hurt as much!) you can commence gentle and regular stretching.
  • While you can do special strengthening exercises, I am ambivalent about these. As the muscles restore to good health, they will begin to work properly and the resumption of normal exercise, including cycling, will strengthen the muscles specific to the sport.
And, to answer your question: YES! Cyclists are definitely at risk of these kinds of injuries. Cyclists are my most represented group, next to distance runners!

When you have a complete resolution of your pain, you then need to put in place an ongoing prevention programme such as ongoing tissue salts and a massage every few weeks for as long as you go on doing abnormal activities like competitive cycling.

Do you have a question?
Email Gary: gary at (Replace the "at" with @ and remove spaces). Please include any relevant background information to your question.

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