Back Twinge + Groin Pain =

This is a post for a gym buddy of mine who doesn’t have access to a computer.

Dude is 5’10", close to 325 lbs, and used to be able to deadlift around 600. And he’s mexican, if that helps diagnosis.

He suffers from a sharp pain in his lower right back, right above his glutes, on his waist, about five inches to the right of his spine. It hurts when he lifts (even if he’s only DLing 95 lbs), and it hurts when he’s recovering in between sets whether he’s standing or sitting (Don’t know about laying down, forgot to ask). It gets aggravated when his back and glutes are flexed simultaneously- I don’t know about seperately.

The second ailment is a pain in his right groin, where the leg meets the hip. Turning his leg inward and bending foward increases the pain.

Both pains come and go. A physical therapist friend of his told him he might have pulled a muscle that runs from the outside of his thigh to inside his knee. From what I remember this is the IT band, though I’m not a doctor, so don’t quote me on that. Said therapist did some massage on the outside of the hip that didn’t seem to do a whole lot.

I thought the groin problem might have something to do with poor stabilizers, but he’s had the pain for close to a year now and he used to do walking lunges with a (lightly) loaded barbell about six months ago and that didn’t really help him, he says.

For practically all his lifts (not just lifts over 80-90%, but even warm-ups) he uses a belt. He’s never, except in the last two days, done serious ab-work. I had an ab-rollout and told him to knock himself out, just not to go to failure. He did.

I don’t know if these problems are symptoms of the same problem or different problems. The main focus is getting him back so he can deadlift pain-free again. What’s wrong and what should he do?

Sounds like a psoas (muscle) and a sacro-illiac (joint) problem. Both are closely related, and one usually causes the other eventually.

Go to a massage therapist and get them to manually work on the psoas, also, get them to give him some massages he can do on his own to relax the muscle a bit.

I’m just guessing that he has a job that makes him sit all day?

You are probably right about the stabilizers though, they will need some work. But he needs to address that muscle first.

Once it is relaxed a bit, he is going to need to do some activation, some strengthening, and some lengthening for it.

Get him to sit on a low box where his femurs are at 90 degrees with the floor. Then get him to sit upright and see if he can actively pull his knee up towards his chest and hold for 5 seconds. Then try the other side. Let me know the difference, either in strength or pain.

This is just my 2 cents.

[quote]Im_New_Feed_Me wrote:
Sounds like a psoas (muscle) and a sacro-illiac (joint) problem. Both are closely related, and one usually causes the other eventually.

Go to a massage therapist and get them to manually work on the psoas, also, get them to give him some massages he can do on his own to relax the muscle a bit.

I’m just guessing that he has a job that makes him sit all day?

You are probably right about the stabilizers though, they will need some work. But he needs to address that muscle first.

Once it is relaxed a bit, he is going to need to do some activation, some strengthening, and some lengthening for it.

Get him to sit on a low box where his femurs are at 90 degrees with the floor. Then get him to sit upright and see if he can actively pull his knee up towards his chest and hold for 5 seconds. Then try the other side. Let me know the difference, either in strength or pain.

This is just my 2 cents.[/quote]

This is good advice.

[quote]Im_New_Feed_Me wrote:
Sounds like a psoas (muscle) and a sacro-illiac (joint) problem. Both are closely related, and one usually causes the other eventually.

Go to a massage therapist and get them to manually work on the psoas, also, get them to give him some massages he can do on his own to relax the muscle a bit.

I’m just guessing that he has a job that makes him sit all day?

You are probably right about the stabilizers though, they will need some work. But he needs to address that muscle first.

Once it is relaxed a bit, he is going to need to do some activation, some strengthening, and some lengthening for it.

Get him to sit on a low box where his femurs are at 90 degrees with the floor. Then get him to sit upright and see if he can actively pull his knee up towards his chest and hold for 5 seconds. Then try the other side. Let me know the difference, either in strength or pain.

This is just my 2 cents.[/quote]

I’m actually fairly certain he stacks boxes for a living, and does other warehouse work. He wears his weightlifting belt to hold up his pants during his workout, and I wouldn’t put it past him to do that at his job too.

I can get him to do this test. Just for clarification, this isn’t a box set to parallel, but a little above, to where the femur is parallel, right? And then its okay for one foot to be on the ground keeping him stable, while he tries to pull the other toward his chest? And if he can’t do it, it has to do with psoas weakness? And the cure for that is… more psoas work? Sit ups?

To address the stabilizer issue, my guess would be bodyweight lunges in the extra-high rep range, like 50-100, so the muscle can get a lot of work without doing any spinal loading, which causes pain. Good idea?

He’ll probably dig the massage advice. Not only because massages are awesome, but because they’re cheaper than an MRI.

Assuming it is Psoas weakness (isn’t this usually the opposite problem for people with Low Back Pain? strong psoas and weak glutes + abs which leads to pelvic tilt?), where should I go for activation and flexibility exercises? I saw Robertson recommends some serious time spent on stretching in a recent article. Is that the way to go?

Thanks for the response.

[quote]Otep wrote:

[quote]Im_New_Feed_Me wrote:
Sounds like a psoas (muscle) and a sacro-illiac (joint) problem. Both are closely related, and one usually causes the other eventually.

Go to a massage therapist and get them to manually work on the psoas, also, get them to give him some massages he can do on his own to relax the muscle a bit.

I’m just guessing that he has a job that makes him sit all day?

You are probably right about the stabilizers though, they will need some work. But he needs to address that muscle first.

Once it is relaxed a bit, he is going to need to do some activation, some strengthening, and some lengthening for it.

Get him to sit on a low box where his femurs are at 90 degrees with the floor. Then get him to sit upright and see if he can actively pull his knee up towards his chest and hold for 5 seconds. Then try the other side. Let me know the difference, either in strength or pain.

This is just my 2 cents.[/quote]

I’m actually fairly certain he stacks boxes for a living, and does other warehouse work. He wears his weightlifting belt to hold up his pants during his workout, and I wouldn’t put it past him to do that at his job too.

I can get him to do this test. Just for clarification, this isn’t a box set to parallel, but a little above, to where the femur is parallel, right? And then its okay for one foot to be on the ground keeping him stable, while he tries to pull the other toward his chest? And if he can’t do it, it has to do with psoas weakness? And the cure for that is… more psoas work? Sit ups?

To address the stabilizer issue, my guess would be bodyweight lunges in the extra-high rep range, like 50-100, so the muscle can get a lot of work without doing any spinal loading, which causes pain. Good idea?

He’ll probably dig the massage advice. Not only because massages are awesome, but because they’re cheaper than an MRI.

Assuming it is Psoas weakness (isn’t this usually the opposite problem for people with Low Back Pain? strong psoas and weak glutes + abs which leads to pelvic tilt?), where should I go for activation and flexibility exercises? I saw Robertson recommends some serious time spent on stretching in a recent article. Is that the way to go?

Thanks for the response.[/quote]

As for your first question about the test, yea to everything you said.

As for the stabilization exercises, I’d like to see him on one leg for a bit. (Anterior reach, upgrade to ant. reach on cable machine, one legged squats, x-band walks - for glute med, things like that)

Now, a few years ago, I assumed that tight hip flexors meant they were too active and strong. But after more reading and studying, I’ve come to the realization that just because a muscle is tight, does not make it strong. Same idea as a kyphotic person. Just because they have tight pecs and lats, doesn’t mean they can crack out push ups and pull ups like a motherfucker.

What we need to do is get in there and decrease the muscle density a little bit with some art, or massage. Then once, it’s relaxed, we can work on activating it and strengthening it.

In doing that, we3 should (somewhat) take care of the SI joint problem as well.

If anyone else has any ideas, feel free to chip in help me out. This is just what has worked with more than a few of my clients.

Let me know how he does on that test, and we can go from there.

Thanks!

Edit - Robertson is a genius, but save the stretching until he gets the soft tissue work done, we have no idea if the fibers are all stuck on one another (not so technically speaking) so it might not have much of a benefit until he gets it looked at.

In my own research, I’ve found tight muscles are most likely weak muscles. They tighten up because they are too weak to properly support the body.

This post was flagged by the community and is temporarily hidden.

[quote]bushidobadboy wrote:

[quote]BackInAction wrote:
In my own research, I’ve found tight muscles are most likely weak muscles. [/quote]

You are correct; a tight muscle is weak - because it is incapable of optimum function. So is a lengthened muscle. This is because only a muscle that has the correct resting length/tension relationship can effectively generate optimal force.

Also, a chronically tight muscle is likely to have scar tissue infiltration which replaces myofibrils with inelastic, non-contractile collagen fibres.

Add in the fact that adhesions may be present. Since adhesions are often intermuscular (sticking one muscle to a different muscle) and/or intramuscular (sticking different fasicles of the same muscle to itself), we can see that adhesions rob a muscle of its power and force generation capacity.

[quote]

This is how I want my hands to type… . instead of my “muscles sticking to one another” comment… haha, thanks for clearing up what I can’t explain, but am pretty sure is happening.

Didn’t see my buddy at the gym today, but I will definitely give him the information. I’ll post results of the test when I have them, and thank you all so much for your advice.

This post was flagged by the community and is temporarily hidden.

Okay, did the test. Sitting pretty much at parallel, he can pull his right knee up to maybe a 70 degree angle made between his torso and his leg. This is his injured side. At this point, it causes pain, though the reason he can’t pull it up anymore isn’t because of the pain- that’s just as far as he can pull it up. His left leg (for comparison) can be pulled up to about a 40 degree angle- much higher- and causes him no discomfort.

I’ve advised him to incorporate ab work and walking lunges, with relatively high volume as opposed to intensity or endurance. I haven’t seen him follow this advice, but figure he could be doing stuff at the end of his workout when I’m not there.

Curious event- after spending about 20 minutes on the stair-stepper yesterday, and making an effort to hit full extension on his right leg AND pull his leg back (/push his hip forward, like how you close out a deadlift… basically, once he started involving a fuller contraction of his glutes with a straight leg) the pain in his right leg went away. That was only yesterday, and my guess is he hasn’t put it under a great deal of stress, so I doubt the problem is ‘fixed’, but I figured its definitely information to use during diagnostics.

So… it looks like it has to do with that psoas. How do we activate/strengthen/stretch it?

[quote]Otep wrote:
Okay, did the test. Sitting pretty much at parallel, he can pull his right knee up to maybe a 70 degree angle made between his torso and his leg. This is his injured side. At this point, it causes pain, though the reason he can’t pull it up anymore isn’t because of the pain- that’s just as far as he can pull it up. His left leg (for comparison) can be pulled up to about a 40 degree angle- much higher- and causes him no discomfort.

I’ve advised him to incorporate ab work and walking lunges, with relatively high volume as opposed to intensity or endurance. I haven’t seen him follow this advice, but figure he could be doing stuff at the end of his workout when I’m not there.

Curious event- after spending about 20 minutes on the stair-stepper yesterday, and making an effort to hit full extension on his right leg AND pull his leg back (/push his hip forward, like how you close out a deadlift… basically, once he started involving a fuller contraction of his glutes with a straight leg) the pain in his right leg went away. That was only yesterday, and my guess is he hasn’t put it under a great deal of stress, so I doubt the problem is ‘fixed’, but I figured its definitely information to use during diagnostics.

So… it looks like it has to do with that psoas. How do we activate/strengthen/stretch it?[/quote]

I find it hard to stretch my psoas alone. Anything in the lunge position with a hand held overhead up in the area will stretch the area. As for working it directly, I would assume leg raises. But this should come after he lengthens and stretches that area out.

[quote]BackInAction wrote:

[quote]Otep wrote:
Okay, did the test. Sitting pretty much at parallel, he can pull his right knee up to maybe a 70 degree angle made between his torso and his leg. This is his injured side. At this point, it causes pain, though the reason he can’t pull it up anymore isn’t because of the pain- that’s just as far as he can pull it up. His left leg (for comparison) can be pulled up to about a 40 degree angle- much higher- and causes him no discomfort.

I’ve advised him to incorporate ab work and walking lunges, with relatively high volume as opposed to intensity or endurance. I haven’t seen him follow this advice, but figure he could be doing stuff at the end of his workout when I’m not there.

Curious event- after spending about 20 minutes on the stair-stepper yesterday, and making an effort to hit full extension on his right leg AND pull his leg back (/push his hip forward, like how you close out a deadlift… basically, once he started involving a fuller contraction of his glutes with a straight leg) the pain in his right leg went away. That was only yesterday, and my guess is he hasn’t put it under a great deal of stress, so I doubt the problem is ‘fixed’, but I figured its definitely information to use during diagnostics.

So… it looks like it has to do with that psoas. How do we activate/strengthen/stretch it?[/quote]

I find it hard to stretch my psoas alone. Anything in the lunge position with a hand held overhead up in the area will stretch the area. As for working it directly, I would assume leg raises. But this should come after he lengthens and stretches that area out.
[/quote]

^^ All of these things.

If his psoas is that messed up, just stick to the basic kneeling hip flexor stretch for now, just make sure not to hyper extend the lumbar spine, as that will shorten your hip flexor. Think “tall”. Also, while in this stretched position, contract and hold your core, and the glute on the same leg of the hip flexor you are stretching.

Hold this intially for about 20-30 seconds. Build yourself up to 1 minute holds.

As for strengthening, let’s start laying down, progress to prone, then to standing once we see some strength.

I want him to lay on his back and get a piece of resistance tubing, or even a cable machine will work for now - with light weights. I want him to concentrate on the lowering portion of this movement the most, that will hopefully yeild some better results initially.

It’s essentially this movement. The psoas usually gets the most activation above 90 degrees of flexion, so what I want him to do is hug his knee into his chest, then slowly resist the resistance on the other end trying to pull his leg back down. You can do the full ROM until his leg is fully extended, but what I really want it to concentrate on that portion until he hits 90 degrees, or until his knee is perpendicular to the floor.

Start with a light weight, or light tubing, and get him to do these for a couple of weeks and let me know how his hip feels. There will be quite a bit of weakness initially, but it should improve once we “wake it up”.

This is all a little sloppy, so if BBB or BIA want to clean it up a little bit, do your thing. I can see what I mean in my head, but sometimes my explanations need a bit of work… that’s why I like working face to face!

Good luck to your friend, this has worked many times over for my clients.

[quote]Im_New_Feed_Me wrote:

[quote]BackInAction wrote:

[quote]Otep wrote:
Okay, did the test. Sitting pretty much at parallel, he can pull his right knee up to maybe a 70 degree angle made between his torso and his leg. This is his injured side. At this point, it causes pain, though the reason he can’t pull it up anymore isn’t because of the pain- that’s just as far as he can pull it up. His left leg (for comparison) can be pulled up to about a 40 degree angle- much higher- and causes him no discomfort.

I’ve advised him to incorporate ab work and walking lunges, with relatively high volume as opposed to intensity or endurance. I haven’t seen him follow this advice, but figure he could be doing stuff at the end of his workout when I’m not there.

Curious event- after spending about 20 minutes on the stair-stepper yesterday, and making an effort to hit full extension on his right leg AND pull his leg back (/push his hip forward, like how you close out a deadlift… basically, once he started involving a fuller contraction of his glutes with a straight leg) the pain in his right leg went away. That was only yesterday, and my guess is he hasn’t put it under a great deal of stress, so I doubt the problem is ‘fixed’, but I figured its definitely information to use during diagnostics.

So… it looks like it has to do with that psoas. How do we activate/strengthen/stretch it?[/quote]

I find it hard to stretch my psoas alone. Anything in the lunge position with a hand held overhead up in the area will stretch the area. As for working it directly, I would assume leg raises. But this should come after he lengthens and stretches that area out.
[/quote]

^^ All of these things.

If his psoas is that messed up, just stick to the basic kneeling hip flexor stretch for now, just make sure not to hyper extend the lumbar spine, as that will shorten your hip flexor. Think “tall”. Also, while in this stretched position, contract and hold your core, and the glute on the same leg of the hip flexor you are stretching.

Hold this intially for about 20-30 seconds. Build yourself up to 1 minute holds.

As for strengthening, let’s start laying down, progress to prone, then to standing once we see some strength.

I want him to lay on his back and get a piece of resistance tubing, or even a cable machine will work for now - with light weights. I want him to concentrate on the lowering portion of this movement the most, that will hopefully yeild some better results initially.

It’s essentially this movement. The psoas usually gets the most activation above 90 degrees of flexion, so what I want him to do is hug his knee into his chest, then slowly resist the resistance on the other end trying to pull his leg back down. You can do the full ROM until his leg is fully extended, but what I really want it to concentrate on that portion until he hits 90 degrees, or until his knee is perpendicular to the floor.

Start with a light weight, or light tubing, and get him to do these for a couple of weeks and let me know how his hip feels. There will be quite a bit of weakness initially, but it should improve once we “wake it up”.

This is all a little sloppy, so if BBB or BIA want to clean it up a little bit, do your thing. I can see what I mean in my head, but sometimes my explanations need a bit of work… that’s why I like working face to face!

Good luck to your friend, this has worked many times over for my clients.

[/quote]

Nope, I think you did a great job of explaining this! The exercise described is similar to a leg raise progressive I’ve used (without the band though). Very effective. A good progressive is the exercise you describe with the resistance.

Thanks for the info!

Thanks guys! I’ll post back in a couple of weeks once I give him the news and get him started on the program. Any exercise he should avoid in the meantime?