{"id":5777,"date":"2026-10-19T14:24:07","date_gmt":"2026-10-19T14:24:07","guid":{"rendered":"https:\/\/aliantis.es\/?p=5777"},"modified":"2026-10-19T15:23:40","modified_gmt":"2026-10-19T15:23:40","slug":"the-psoas-the-perfect-culprit","status":"publish","type":"post","link":"https:\/\/aliantis.es\/en\/2026\/10\/19\/the-psoas-the-perfect-culprit\/","title":{"rendered":"The psoas: the perfect culprit?"},"content":{"rendered":"\t\t
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The psoas: the perfect culprit?<\/h1>\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\tMyths and facts about psoas pain, low back pain, and evidence-based treatment.\t\t\t\t\t\t\t\t<\/div>\n\t\t
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If you search for information about the psoas online, you may quickly get the impression that this muscle can explain almost any type of pain.<\/p>

That it is tight.<\/p>

That it is blocked.<\/p>

That it needs to be stretched every day.<\/p>

That it needs to be strengthened.<\/p>

That it stores toxins because it sits just behind the kidney.<\/p>

That it stores emotions.<\/p>

That it is responsible for most low back pain.<\/p>

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Over time, the psoas has gone from being a muscle that most people had barely heard of to becoming the star of countless explanations about pain. Today, it seems to get blamed for almost everything. <\/p>

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But when one single structure appears to explain so many different problems, it is worth stopping for a moment and asking a question.<\/p>

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Is the psoas really the culprit\u2026 or has it simply become an overly simple explanation for a body that is far more complex?<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\"psoas\"\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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What is the psoas, really?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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The psoas major is a deep muscle that originates from the lumbar vertebrae and runs down to the inner part of the femur. Together with the iliacus muscle, it forms the iliopsoas, the main flexor of the hip. <\/p>

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It helps us lift the leg to walk, run, climb stairs, or get in and out of a car. It also contributes to the stability of the pelvis and lumbar spine, working in coordination with the abdominal muscles, the diaphragm, the glutes, and many other muscles of the trunk and lower limbs. <\/p>

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In other words, it is an important muscle.<\/p>

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But important does not mean indispensable. And it certainly does not mean responsible for every pain. <\/p>

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Its location helps explain why it has become so well known. The psoas passes through one of the most anatomically complex regions of the body. It lies close to the lumbar spine, the hip joint, numerous blood vessels and nerves, the intestines, and the kidneys. When pain appears in this area, it is therefore tempting to assume that the psoas must be the problem. <\/p>

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However, being close to the painful area does not mean being the cause of the pain.<\/p>

Imagine a busy town square. If an accident happens there, everyone present was close to the scene, but that does not automatically make them responsible. The same applies to the psoas: it is part of the \u201cneighbourhood\u201d where many symptoms can occur, but that does not mean it is always to blame. <\/p>

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The iliopsoas also never works alone. Every movement we make is the result of coordination between dozens of muscles, joints, tendons, and structures of the nervous system. The human body works like an orchestra: every instrument has an important role, but none performs the whole piece on its own. <\/p>

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That is why, when pain appears, there is rarely an explanation as simple as pointing to a single muscle.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t

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\ud83d\udca1 Did you know?<\/b><\/span><\/p>

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The psoas is the only muscle that directly connects the lumbar spine to the lower limbs. This strategic position means that it is involved in many everyday movements. However, its anatomical importance does not mean that it is responsible for most cases of low back or hip pain. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

\n\t\t\t\t\t\t\t\t\tSo, if the psoas is simply one muscle within such a complex system\u2026\n\nHow did it become responsible for almost everything?\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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Why has the psoas become so famous?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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The popularity of the psoas did not happen by chance.<\/p>

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In fact, it reflects something that often happens in healthcare: when we find a simple explanation for a complex problem, we tend to accept it easily.<\/p>

If someone tells us that our low back pain is caused by one single muscle and that there is a technique to \u201crelease\u201d it or an exercise to fix it, it is understandable that this explanation sounds appealing. It is easy to understand, reassuring, and seems to offer a quick solution. <\/p>

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However, the human body rarely works in such a simple way.<\/p>

For a long time, medicine also looked for \u201cthe culprit\u201d. It was assumed that behind every pain there had to be one specific structure responsible for the problem: a blocked vertebra, a damaged disc, a misaligned pelvis, or an excessively tight muscle. <\/p>

Over the years, research has changed the way we understand pain.<\/p>

Today we know that, especially when pain persists for weeks or months, it rarely depends on a single structure. In most cases, several factors interact at the same time<\/a>: the condition of the tissues, the way the nervous system processes information, physical activity levels, sleep quality, stress, previous experiences, and even the beliefs we hold about our own body. <\/p>

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This does not mean that anatomy no longer matters. It means that anatomy is only one part of the story. <\/p>

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The psoas itself has several characteristics that make it easy to give it a starring role. It is a deep muscle, difficult to palpate, located in a region where the lumbar spine, pelvis, and hip all come together, and it is involved in many everyday movements. All of this makes it easy to turn it into the explanation for almost any discomfort in this area. <\/p>

Over time, all kinds of theories began to appear. Some suggested that the psoas became shortened from spending too many hours sitting. Others claimed that it needed to be \u201creleased\u201d through deep massage. Later came the idea that it stored toxins because it lies behind the kidney, followed by the belief that it stores emotions or stress. <\/p>

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Many of these theories are based on real observations. Others combine anatomical, physiological, and therapeutic concepts to create explanations that sound coherent. <\/p>

But just because an explanation sounds logical does not necessarily mean it is true.<\/p>

Science progresses precisely by testing these hypotheses. Some are confirmed. Others are modified. And others are eventually discarded when higher-quality studies become available. <\/p>

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That is exactly what has happened with the psoas.<\/p>

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Today, we have far more information than we did twenty years ago, and we are better able to distinguish between what we know with reasonable certainty and what still remains only a hypothesis or belief.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t

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\ud83d\udca1 Common myth<\/b><\/p>

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\u201cIf we can identify the muscle responsible for the pain, we will also find the solution.\u201d<\/b><\/p>

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In reality, musculoskeletal pain rarely depends on a single structure. Understanding why someone is in pain is usually far more useful than trying to find one single culprit. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Of all the ideas that have developed around the psoas, perhaps none has spread as widely as this one: that the psoas is the body\u2019s \u201cdumping ground muscle\u201d because it stores toxins and emotions.<\/p>

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But\u2026 is there actually any scientific evidence to support this claim?<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Does the psoas really store toxins or emotions?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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This is probably one of the claims that has contributed most to the popularity of the psoas.<\/p>

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It is common to hear that the psoas is the body\u2019s \u201cdumping ground muscle\u201d because it sits just behind the kidney and therefore stores toxins that supposedly need to be removed through massage, stretching, or certain manual techniques. It is also sometimes described as the \u201cmuscle of emotions\u201d, where stress, anxiety, or even traumatic experiences are said to become stored. <\/p>

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These are striking ideas and easy to remember. However, when we look at them from an anatomical and physiological point of view, they do not hold up very well. <\/p>

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It is true that the psoas lies very close to the kidneys. If we look at an anatomy atlas, we can see that both structures occupy the same region of the body. But proximity between two organs or tissues does not mean that one transfers substances to the other. <\/p>

The kidneys continuously filter the blood. Waste products become part of the urine and are then eliminated through the urinary system. This entire process takes place within a highly organised physiological pathway. <\/p>

To date, there is no scientific evidence showing that toxins leave the kidney and become stored in the psoas or in any other muscle in the body.<\/p>

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Likewise, there is no evidence that emotions are physically \u201cstored\u201d inside the psoas.<\/p>

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So why do so many people feel more tension in this area during periods of stress?<\/p>

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Because stress does affect the body.<\/p>

When we experience stress, the nervous system can alter breathing, increase muscle tone, change the way we perceive pain, and make certain movements feel more uncomfortable. All of this can create a sense of stiffness or increased sensitivity in different areas of the body, including the region where the psoas is located. <\/p>

But this does not mean that the muscle is storing emotions. It means that the whole body is responding to a stressful situation. <\/p>

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Understanding this difference matters because it completely changes how we approach the problem. If we believe the psoas is full of toxins or trapped emotions, we will try to \u201cempty\u201d or \u201crelease\u201d it. But if we understand that pain depends on multiple factors \u2014 including movement, the nervous system, rest, and stress \u2014 we can focus on the things that genuinely support recovery. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t

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\ud83d\udca1 Did you know?<\/b><\/span><\/p>

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Every day, the kidneys filter around 180 litres of blood to produce approximately 1 to 2 litres of urine. The entire process of removing waste products takes place within the urinary system. There is no known mechanism by which these substances pass into the psoas and remain stored there. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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\ud83c\udfc3 In practice<\/b><\/span><\/p>

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If your back or hip feels tighter during a stressful period, this does not mean your psoas is \u201cstoring emotions\u201d. Sleeping better<\/a>, staying active, managing stress, and gradually returning to movement will usually have a much greater impact than trying to \u201crelease\u201d one single muscle.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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So\u2026 can the psoas actually hurt?<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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The answer is yes.<\/p>

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After discussing so many myths, it might seem as though the aim of this article is to prove that the psoas never causes problems. But that would not be true either. <\/p>

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Like any other muscle, tendon, or joint, the iliopsoas can become injured, irritated, or overloaded. There are well-known conditions in which this muscle plays an important role and that are part of the usual clinical assessment by doctors, physiotherapists<\/a>, and osteopaths<\/a>. <\/p>

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One of the most common is iliopsoas tendinopathy, which often causes pain at the front of the hip or in the groin, especially when lifting the knee, climbing stairs, running, or performing certain sporting movements. Iliopsoas bursitiscan also occur, although it is less common, as can snapping hip syndrome, where the tendon produces a clicking or snapping sensation as it moves over certain bony structures. <\/p>

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These conditions do exist, and it is important to recognise them because their treatment may differ from that of non-specific low back pain.<\/p>

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However, it is equally important to put them into context.<\/p>

Most people who consult for low back pain do not have a psoas injury. Likewise, many cases of groin pain come from other structures, such as the hip joint itself, the adductor muscles, the abdominal wall, or even the lumbar spine. <\/p>

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That is why, during a clinical assessment, the question should never simply be: \u201cIs it the psoas?\u201d<\/p>

The better question is: \u201cAre this person\u2019s symptoms compatible with an iliopsoas problem?\u201d<\/p>

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Answering this question requires listening to the patient\u2019s history, understanding how the symptoms began, identifying which movements increase or reduce the pain, and carrying out a full physical examination.<\/p>

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We sometimes use different clinical tests, such as the Thomas Test or resisted hip flexion tests. These can provide useful information, but none of them can confirm on their own that the psoas is responsible for the pain. <\/p>

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The same applies to imaging tests.<\/p>

Finding small changes in a tendon or muscle does not necessarily mean that those changes explain the symptoms. Likewise, an apparently normal examination does not completely rule out involvement of the iliopsoas. <\/p>

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Diagnosis is always the result of putting all the pieces of the puzzle together.<\/p>

And that is precisely what separates a high-quality clinical assessment from an overly simplistic explanation.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t

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\ud83d\udca1 Did you know?<\/b><\/span><\/p>

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Snapping hip syndrome is relatively common, especially in younger people and athletes. Many people experience this snapping sensation for years without pain or any functional limitation, so hearing or feeling a \u201cclick\u201d in the hip does not necessarily mean there is an injury. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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\ud83c\udfc3 In practice<\/b><\/span><\/p>

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If the pain mainly appears when lifting the knee, getting in or out of the car, climbing stairs, or running uphill, the iliopsoas may be part of the problem. But before reaching that conclusion, it is important to assess the hip, lumbar spine, pelvis, and the way you move as a whole. Treating only the psoas without understanding the origin of the pain may mean missing the real cause of the symptoms. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Si tengo dolor lumbar\u2026 \u00bfes culpa del psoas?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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This is probably the question that gives the whole article its meaning. And the answer is simple: <\/p>

In most cases, no.<\/p>

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Today we know that around 90% of low back pain is classified as non-specific low back pain. This term may sound a little counterintuitive, but it does not mean that the pain is imaginary or that healthcare professionals do not know what is going on. It simply means that we cannot confidently attribute the pain to one single anatomical structure. <\/p>

In other words, we cannot say with certainty that the cause is a disc, a joint, a ligament\u2026 or the psoas.<\/p>

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This can feel frustrating at first. We are used to thinking that every symptom must have one single cause and that, if we find it, we will also find the solution. <\/p>

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However, the human body does not work that way.<\/p>

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Imagine someone who starts running again after several years without exercising. After a few weeks, they begin to notice low back pain. <\/p>

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Was it the psoas?<\/p>

Maybe.<\/p>

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Was it the lumbar muscles?<\/p>

That is also possible.<\/p>

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Could weak gluteal muscles, a training load that increased too quickly, work-related stress, poor sleep, or spending ten hours sitting every day have played a role?<\/p>

Most likely, several of these factors contributed.<\/p>

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That is precisely the shift in thinking that has taken place in musculoskeletal pain care over the last few decades.<\/p>

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Today, we understand that pain often results from the interaction between the tissues, the nervous system, and each person\u2019s individual context.<\/p>

That is why we talk about a biopsychosocial model of pain<\/a>.<\/p>

This does not mean that \u201cit is all in your head\u201d. It means that the body functions as a system in which biology, movement, lifestyle habits<\/a>, and psychological factors all influence one another. <\/p>

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A muscle can be perfectly healthy and still become painful for a period of time. Likewise, an MRI can show significant changes in the spine of someone who feels absolutely no pain<\/a>. <\/p>

The relationship between imaging findings, tissues, and symptoms is not always straightforward.<\/p>

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That is why, when someone comes to see us with low back pain, our goal is not to desperately search for one structure to blame.<\/p>

What really matters is answering other questions:<\/p>