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A few months ago I hurt my psoas muscle and a couple of ligaments around it. I've been off of it since then and it's been healing and I'd like to get back into the things that I had to quit.

I'd like to know, how can I lower the chances or re-injuring it?

  • How can I stretch it out? (I'm not sure of the right stretch to accomplish this)
  • How can I safely strengthen the muscle?
  • Can I protect it by strengthening muscles around it, and what exercises should I do for this?

And anything else that'd help.

Additional Information: I hurt it by overworking it over time, slowly injuring it playing ultimate frisbee - lots of spriting and changing directions hard, so plenty of small yanks on the muscle without having warmed it up enough (that's my best guess). Now I'm not going back into frisbee but instead have started to do less strenuous activities. I started learning windmills (breakdancing move) and I think the psoas is being worked because I have to swing my legs to create momentum for the movement.

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How did you hurt it and what kind of exercise do you normally do? PS: Your psoas is also used a lot when leaning backwards, like when you look up and such ;-) –  Ivo Flipse Apr 6 '11 at 22:21
    
I hurt it by overworking it over time, slowly injuring it playing ultimate frisbee - lots of spriting and changing directions hard, so plenty of small yanks on the muscle without having warmed it up enough (that's my best guess). Now I'm not going back into frisbee but instead have started to do less strenuous activities. I started learning windmills (breakdancing move) and I think the psoas is being worked because I have to swing my legs to create momentum for the movement. –  JustcallmeDrago Apr 6 '11 at 22:50
    
please edit this into your question, but thanks for following up on the comment! –  Ivo Flipse Apr 6 '11 at 22:52
    
@Ivo: Thanks, I did –  JustcallmeDrago Apr 6 '11 at 22:54

3 Answers 3

I pulled out my copy of of Arnheim's Principles of Athletic Training to see what it had to say. I'm only going to give you the stuff related to strengthening/stretching, but it also lists a bunch of other therapy stuff you should be going through concurrently--if you want to give yourself the best chances of recovery, you should see a physiotherapist for rehabilitation.

First of all, it says that after a groin strain (which includes a psoas strain) exercise should be delayed until the groin is pain free, so make sure you don't get started up again too soon. Once you're ready for exercise, your program should focus on gradual restoration of the normal range of motion. It also says that until normal strength and flexibility are regained, you should wear a protective brace like one of these.

Here are a couple stretches for the hip flexors.The lunge and assisted stretch will target the iliopsoas. The stretch with the ankle held will target the quads (the rectus femoris works with the iliopsoas as a hip flexor). When doing the lunge, try to keep your pelvis neutral; if you tilt it anteriorly (forward), it takes away from the stretch. If your other hip muscles have become tight due to lack of use, you should probably stretch those too. Exrx has quite a comprehensive set of stretches for the hip muscles (right column).

The book has a sample injury management plan for a basketball player--not exactly the same as ultimate frisbee, but the running and direction changes are similar. Two to three weeks after the injury, they recommend doing resistance training once a day (10 reps, 3 sets). When doing normal weight training you're supposed to leave at least 48 hours between workouts, so once you become stronger and start increasing resistance, I would stop doing this daily. Always remember that it shouldn't hurt. A cable standing leg raise would work the iliopsoas (See ExRx for more options). Just like with stretching, you should target the other hip muscles as well--you probably haven't been using them as much due to the injury, and training the iliopsoas alone would create imbalances (same ExRx link as immediately above, just scroll). Other muscles that help the iliopsoas are the quads and abs, so you may want to focus on them as well.

To get back into running, the book suggests you start in the pool:

Jogging in chest-level water (10 to 20 min) 1 or 2 times daily for first exercise rehabilitation week [2-3 weeks after injury] followed by flutter kick swimming (pain free) once daily during subsequent weeks.

Water provides quite a bit of resistance, so it helps you build strength. Three to six weeks after the injury, you may be able to get back into jogging:

Begin a program of jogging on flat course, slowly progressing to a 3-mile run once daily and then progressing to figure eights, start with obstacles 10 feet apart and gradually shortening distance to 5 feet, from one-half speed to full speed. (link added for your reference)

The figure eights will prepare your muscles for the direction changes in your sport. Applying cold to the area after exercise can also help prevent inflammation (excess inflammation slows down recovery).

It sounds like you're outside the time window for this specific recovery time line, but most of this stuff is still probably worth trying, especially if you didn't do it within the first 6 weeks after your injury.

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Here's the strengthening pose we use in our yoga practice.

Stand with feet about hip-width apart. We're going to work the left psoas. Slightly bend your left knee and shift your weight to the right and stand firm on the right leg, feeling the four corners of your right foot pressing into the ground, especially the big toe. Keep the right leg straight, but don't lock the knee out. Your weight should be ever-so-slightly forward on your toes.

Place your left palm on the top of your left thigh. Continue pressing that right leg strongly into the floor as you lift and bend your left knee trying to bring the left thigh parallel to the floor. With the left hand, simply resist your left thigh as it raises. Don't use more than 20% effort, anything else and you're working other muscles. Very slight resistance is enough. You aren't pressing down with the hand so much as you are simply acting as a barrier to moving your knee higher.

Continue to the left leg.

This can also be done lying down if necessary.

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This is definitely a challenge for the psoas muscle! The one problem I see with using it as your primary rehab strengthening exercise is that it only strengthens the psoas at one joint angle, which isn't that practical considering the range of joint angles you hit during sports. –  Barbie Apr 8 '11 at 17:39
    
@Barbie, of course you are right about only strengthening one angle here. The psoas is a difficult muscle to target, and I'm offering one way to do it. The same exercise with the knee turned out to the side (captain morgans) helps to hit from another angle. I find this exercise is only a challenge if you put too much effort into it, which brings in bigger muscles and shifts the focus off the psoas, negating the targeted benefit. –  Jay Apr 8 '11 at 19:01

I pulled my psoas a few months ago and saw a doctor. He recommended doing the following stretch:

Lie down inside a doorway, with your hips even with the doorframe. Lift your left leg and place it against the wall on the right side of the door, keeping your back flat against the floor. You can scoot forward or backwards on the floor to increase or decrease the stretch. Repeat on the other side.

It seemed to work for really focusing on that tendon and stretching it out gently.

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I don't understand. It feels like I'm stretching out my hamstrings. I tried putting my leg straight on the wall, and also bending it so that my shin was parallel to the floor (kind of like your legs are when you're cross-legged). Neither felt like it was hitting the psoas. The closest thing I could get to a stretch was something like the "upward facing dog" yoga position. –  JustcallmeDrago Apr 7 '11 at 0:16

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