Psoas injury that will not go away

Hi,
I have been sidelined with injury for the last 3 months after over doing it on a A team group ride that turned into more of a hammer fest then I was ready for. This is something that tends to happened to me multiple times each year over the last 8 years. Sometimes it is from over doing it like I did this time but other times the flare up happens with no direct cause, or life stress apart from biking. I seem to flare up my left psoas muscle that then locks up my lower back, left hip and rest of my left leg that compensates. I have to stop biking for months before I can slowly work back into training. I have worked with multiple doctors, physical therapists, nutritional coaches, chiropractors, arpwave muscle retraining, dry needling, deep tissue massage, and the list goes on and on. I have gotten multiple bike fits, and do foam rolling, trigger point, and the normal stretching and core strengthening that they have recommended. All of that helps, but it takes months to finally get back to normal and allow me to very slowly start training again. Trainer Road has been great to allow me to control my intensity level and ramp up smartly, but even doing that I end up having to skip weeks at a time. I sit all day at work, and that aggregates my issues. I have worked with my work’s ergonomics team and have a sit stand desk, and stability ball to switch things up but it can be rough some days. Has anyone else had similar issues and any ideas of other stuff I can be doing? I am about ready to give up on ever getting back to having more than a handful of fun rides a year between flare ups.
thanks,
Mike

Have you tried using flat pedals?
Sometimes pulling up with cleats can lead to injuries in that area.

no i have not tried flat pedals, I can try doing that and seeing if that helps.

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Definitely let us know if it helps or not.
It stinks to get hurt and not know why or what to do so that it won’t happen again. I have a good feeling about this!

Why do you think your psoas is at fault and not your back or your hip referring the pain? Joint pain is far more likely. Treating musculature seems myopic especially when onset can be insidious.

my current physical therapist is not sure what is the cause. He currently has me doing a lot of stability work as my left side tests out weaker. My psoas is crazy tight and painful when trying to trigger point and stretch, and i feel confident that it is crazy tight as i have had a few different people work on releasing it and said it was the tightest they have ever felt. i have no idea if that is the root cause or if its just compensating from other issues as i also have itb pain and piriformis tightness/pain too. The weird thing is that other movements i can do fine. for example i can do lunges, and i can squat 1x my weight and dead lift 2x my weight and have full range of motion while doing it. And when i am not flared up things work well on the bike and can take KOM on hill climbs, so it is just weird how everything gets flared up. i would think if its a joint that i would not have such big swings in things working and then things not working. but i have not idea and cant get a clear answer/test that tells me what is the problem.

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I’ve had psoas issues for years, since roughly 2010. Chances are it has more to do with pelvic instability than the psoas. Since it connects to the femur and runs through the hip, either a torn labrum or instable SI join can cause issues.

Sitting isn’t good, you should be stretching and doing ART or Graston (it could be scar tissue) and Myofacial Release.

I don’t want to go into more details because tbh, I’m not a a hip expert, and most doctors and physios aren’t either. Go to a specialist. I know Jerry Hesch in Colorado and the FAIFix guys may be able to help.

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thanks for the info, seems like you have had similar issues. FAIFix looks like a good system. I am currently working through the supple leopard book to see if that can help, but FAIFix looks more specific to my issues. I had ART early in my injury process and have Myofacial Release along with Craniosacral therapy work done, i find that it helps, but i need it every 1-2 months.
thanks,
Mike

The truth is that manual therapy like massages and ART have not proven to cure injuries because it does not treat the source of the issue. It is a way to release tension and give you the opportunity to work on your weakness trought streching, strenght training and moving in general.

I had a psoas tendinitis in the past due to an increased volume (3 hockey games a week + GYM + high volume trad base). My tendons were not ready for that load. I had a minor strain and developped a psoas tendinitis. I followed my physio program: Specific mild stretches + core work + Squats, lunges and deadlift. You really have to ease into it because tendons take a long time to heal. They do not get the same blood volume as muscles so it can take up to a full year before the completly recover.

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This is hard to hear because it is true and we wish it wasn’t. It is easy to set yourself back if you forget this.

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were you able to resolve your psoas issue?

curious as I feel I have the same issue.
it gradually builds and the an innocuous movement triggers debilitating muscle tension in the deep lower back.

I’ve had many different diagnoises; sciatica, hamstring insertion tendinosis, piriformis strain, facet joint inflammation (which is the closest to the source of the discomfort) etc

always occurring at peak or near peak fitness.

Yes and no. For the most part, its moved down in to the groin. and hamstrings. My left pelvis was out of place (nutated) which was the main culprit but everything is still tight. That’s either from a torn labrum or just the muscles being too tight.

I have not yet, still working with a physical therapist, but have not been able to start training again. I have not been able to get the muscles to relax enough to build any strength/stability without flaring back up. Dry needling and massage gun help some when i do flare up.

If you’ve been working for 5 months without improvement, you’ve been misdiagnosed. Have your back examined regardless of muscle tightness.

Hi Mike,

Sorry to read you are still dealing with these issues.
With all that you have been given in terms of strength, stretching, dry needling etc, I am curious if anyone has anyone looked at your breathing.
I am in no way trying to pedal a miracle cure here, and obviously each one of us is different but I had a lot of success with lower back pain with a therapist who focused on my breathing. It may be an avenue to consider if it hasnt been looked at / addressed?
Not 100% a fix for me but helped improved things so as I could focus on other areas.

Hope this helps and wishing you a speedy recovery.

thanks, I have done the melt method that does a ton of breathing work and felt that helped some. I recently had new x-rays and nerve scans, showed some issues in my lower back and hip socket, but not as bad as I was afraid of. Changed up my treatment plan based on those results, so hopefully will see some improvement.

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Good to hear! Here is hoping the new plan will get you back ridding strong.

I have tremendous sympathy, I hurt my hip in 2017 (tore the labrum and was diagnosed with FAI). I saw numerous Dr, physios, surgeons etc.

I used the FAI fix together with my own trial and error of exercises and although it took me some time to figure it out, I eliminated the pain. I narrowed it down to super tight adductor and lack of hip strength which meant the hip wasn’t functioning correctly. I now maintain my hips with 2x per week 20’ routine of single leg work and work on the adductor whenever it feels tight.

The upright health Youtube channel is also a good source of information (from same people as FAI fix) but it covers other areas of the body. I’ve no affiliation with them just found their common sense approach struck a cord with me.

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