Psoas Pain: Symptoms, Causes and How to Treat It

01Anatomy

Where is the psoas?

The psoas major attaches to the sides of the lower spine, from the last thoracic vertebra (T12) to the fifth lumbar vertebra (L5). It runs down through the pelvis, joins the iliacus muscle and attaches to the lesser trochanter on the inner thigh bone. Together, the iliopsoas flexes the hip, lifting the knee towards the chest, and helps stabilise the lower spine and pelvis. Because it lies deep behind the abdominal organs, it cannot be touched easily, and pain can be difficult to locate.

02Symptoms

Symptoms of psoas pain

• Deep pain in the groin or front of the hip.
• Pain in the lower back on one side.
• Pain lifting the knee, climbing stairs or getting in and out of a car.
• Pain when sitting up from lying down.
• Stiffness after sitting for long periods.
• A clicking or snapping sensation at the front of the hip (snapping hip).
• Difficulty standing fully upright after sitting.

03Causes

Causes

• Overuse: running, sprinting, kicking, dancing, cycling or repeated sit-ups.
• Iliopsoas strain: a sudden injury during sprinting or kicking; see hip flexor strain.
• Iliopsoas tendinopathy or bursitis.
• Internal snapping hip: the tendon flicking over bone.
• Prolonged sitting: often blamed for tight hip flexors, though evidence is limited.
• Referred pain from the hip joint or lower spine.
• Rarely: psoas abscess or bleeding.

04Similar

Conditions that can feel similar

• Hip joint problems such as arthritis or labral tears.
• Groin strains of the adductor muscles.
• Hernias.
• Lower back problems with referred pain.
• Abdominal or pelvic conditions, such as appendicitis, kidney problems or gynaecological conditions.
• Stress fractures of the hip in runners.

05Diagnosis

How psoas problems are diagnosed

A physiotherapist or doctor will ask about the pain and examine the hip and spine, testing strength and flexibility. Pain when lifting the leg against resistance, and tightness on the Thomas test, in which you lie on your back with one knee pulled to the chest, suggest a hip flexor problem. Ultrasound or MRI may be used if the diagnosis is unclear. A review of iliopsoas abscesses noted that the classic signs of fever, back or flank pain and limp are not always present, so blood tests and imaging are important if infection is suspected.

06Stretches

Psoas stretches

• Half-kneeling hip flexor stretch: kneel on one knee, tuck the pelvis under and shift forward gently, 30 seconds each side.
• Standing lunge stretch: similar position standing, with the back knee slightly bent.
• Bridge with hold: lift the hips and hold, gently opening the front of the hips.
• Thomas stretch: lie on the edge of a bed, hug one knee and let the other leg hang.
• Tight hip flexors are discussed in tight hip flexors.

07Strength

Strengthening exercises

• Seated knee lifts: lift one knee a few centimetres, hold 5 seconds, 10 each side.
• Standing marching: slowly lift each knee to hip height, 10 each side.
• Banded hip flexion: with a band around the ankle, lift the leg forward.
• Lying psoas hold: lying on your back, lift the knee towards the chest against light hand pressure.
• Dead bug for core control.
• More exercises in hip mobility exercises.

08Recovery

Recovery and return to sport

Mild psoas strains and overuse pain often improve within two to six weeks. Reduce activities that cause pain, such as sprinting, kicking and hill running, while maintaining general fitness with swimming or walking. Progress strengthening gradually, then add running, change of direction and kicking. Pain that keeps returning, or does not improve after several weeks, should be assessed to rule out hip joint or spine problems.

09Myths

Myths about the psoas

The psoas is sometimes described as the “muscle of the soul” or said to “store trauma”. These claims are not supported by scientific evidence. The psoas does respond to stress like other muscles, and relaxation techniques may reduce general muscle tension, but there is no evidence that releasing the psoas treats emotional problems. Evidence-based treatment focuses on movement, strength and load management.

10Cases

Three common situations

• Footballer with groin pain after kicking practice: reduce kicking, stretch and strengthen the hip flexors.
• Office worker with stiff hips when standing up: regular breaks, hip flexor stretches and strengthening.
• Hip pain with fever and limping: seek urgent medical assessment.

11Summary

Key points to remember

• The psoas is a deep hip flexor connecting the spine to the thigh.
• Pain is usually felt in the groin, front of the hip or lower back.
• Stretching and progressive strengthening help most cases.
• Fever, severe pain or unexplained limp need urgent care.