If you’re reading this I’m assuming you’ve been experiencing pain in the lower left abdomen and back, but have no idea what it is or what to do about it. I’m sure googling your symptoms, you’ve come across a handful of possible diagnoses, but before you get yourself all worked up, let’s discuss the most likely, but ignored, cause of your pain and more importantly the treatment for it! This blog has to do with the muscle-skeletal issues related to pain in the lower left abdomen and back.

What Is Pain In the Lower Left Abdomen and Back?

There can be a number of things causing your pain in the lower left back, but the combination of the lower back and left lower abdomen points to a more specific culprit! For instance, if pain occurs with walking, bending forward, going from bending to the upright position, going from seated to standing up, or standing up but rotating the torso while keeping the pelvis stationary, then we are talking musculoskeletal malfunction.

Most people point to the lower ab. portion close to the groin when complaining of pain in the lower abdomen and back. To understand what’s going on requires a little knowledge of some anatomy, but easy to understand, especially with pictures, so let’s dive in.

The very likely source of your pain is coming from a muscle called psoas (hint: the p is silent). The psoas, seen in the image below, begins at the bottom of your thoracic spine (T12) through the entire lower back spine (L1-L5), runs down the inside of the pelvic bones and over the pubic bone portion of the pelvis, then finally ends at the femur (thigh bone). 

In translation, this is a very long muscle that runs from your lower back, down the front (lower abdomen) area to your thigh bone. See where I’m going? The psoas is involved in hip flexion, such as the part in walking where the thigh gets closer to the torso when you bend the knee to take a step. When the legs are in a fixed position the psoas muscle will also flex the torso (bringing the torso closer to the thighs). 

Any activity or lifestyle involving the lower back, hip, and pelvis positioning will directly impact this big muscle which is one of your so-called, hip flexor muscles.

There are many reasons why this muscle is the likely cause of your pain, which I happen to see in a majority of my patients who work behind a desk and I’ll tell you why in the sections below. 

What Causes Pain in the Lower Left Abdomen and Back?

Now that you know how the psoas works, we can talk about what makes your psoas become painful and what you need to avoid. Muscles in general start giving you issues when they are overused or underused. With overuse, the muscle in question becomes too short and contracted, tired of not taking a break and therefore weak. With underuse, the same muscle hardly gets a chance to perform and as a result, becomes weak. Two different sources with a similar end result. The question then should be, why would that even happen?

Our lifestyle and activities dictate how our body moves. We are all designed to move the same way! We know that because all babies throughout the world, regardless of any differences move the same way. That is because we are programmed to move that way; we are born with a movement blueprint that dictates the progression in the development of muscles, the nerves that initiate muscle use, and the patterns of movement. The problem arises when we, for whatever reason, deviate from the ‘factory designed’ methods.

The psoas is no exception. This muscle does hip flexion and torso flexion which are both done in sitting, walking, and the in-between (going from sitting to standing and vice versa). When you sit for longer periods of time, the psoas becomes shortened and tight, therefore weak. If it is short and your feet are now planted on the ground because you are standing up and/or walking, one end of this muscle becomes more stationary so the other end has to give in because the muscle is stuck in its shortened state. Guess what the other end will have to do? Correct, bend forward. So you are standing up, the thigh end of the muscle is straight (you are standing) so the other end, the torso attachment (see the picture above) will bend forward with a slight twist.

You are walking with a bent forward, twisted torso which is 100% not what it is supposed to be like, with every step you take, and every time you sit. You have managed to re-design the patterns of movement and positioning. You are now, re-programming how the brain commands the body parts to get involved in movement and in general. You are negatively impacting everything.

The Missing Link

You have pain so you stretch the tight muscle but at this juncture, how does this problem stay in isolation? Movement is a collection of muscles contracting, letting go, coming in and out of their role in a specific, per blue-print progression. If movement was a concert, all musicians (body parts) play their part, sometimes chiming in or out, sometimes being in the background, sometimes being in the spotlight. Do you see where I am going?

It all started with an innocent activity, sitting, sitting for a long time of course but still sitting. Sitting not because you are wasting time, but doing work. It was an innocent lifestyle contributing to major pain and limitation. Now you decide to go play basketball, tennis, run, cycle, go to the gym to work out your legs, or who knows what else. How can an exhausted, weak muscle perform optimally? 

Now you have an even weaker, more exhausted muscle that needs to go sit more. Are you kidding me? Is it a surprise that you are in pain? You take meds to numb the pain, but is it going to do ANYTHING about what caused this to begin with?

You go get physical therapy sessions; they focus on the area and you feel better but the pain comes back, you know why? The immediate area was addressed but how about the other parts of the body that had to pick up the load, the reprogramming of the brain to use whatever could be used to pick up the ‘load’ all this time? It is the brain that tells your body the what, when, and hows of everything. Just because you strengthen the psoas and work on the lower back does not mean your movement patterns are now functional.

If you are wondering if there is even a right treatment for these types of problems out there, thankfully the answer is yes.

The Most Effective Treatment for the Lower Left Abdomen and Back Pain? 

The first step in treating any musculoskeletal issue is always to stop or correct anything that is feeding the issue, which is why you NEED to use this Free Ergonomic Checklist. What good is treating the issue when you continue to make the same mistakes that got you into trouble in the first place, right? Read my Ergonomic Fix Blog for details.

Next is a Postural Neurology Exam to find out what parts of your brain, with regards to movement, sensation, and posture have been modified as a result of what is going on. We are not talking about pain, but function.

Now that you’ve addressed the ergonomics, we cannot pretend the damage is not done. Depending on the condition of the psoas and surrounding soft tissue, you may require some functional rehab. work such as Active Release Technique (ART) to ‘clean up’ some of the restrictions that exist in the joints involved and to ‘wake up’ some of those muscles that are overworked and exhausted, or underworked and weak.

To correct the dysfunction in your movement that has resulted, will require some additional work you won’t typically find at other offices and that is Dynamic Neuromuscular Stabilization (DNS) or Developmental Kinesiology. There’s a great example of this shown in the video below.

The concepts of DNS are based on the knowledge of babies moving and developing the same way throughout the world. That is the blueprint; if we see how you compare to that, we see what gets highlighted and work on that. Why something as simple and obvious as this notion, is not widely used for treatments of movement, posture, and musculoskeletal conditions is beyond me.

Check out how a baby strengthens the hips, lower back, lower abs, obliques, and all associated muscles, joints, and connective tissues without using a band, weight, or gym! This is what we all have used and done but have deviated from. To fix a problem, we have to go to the ‘manual’ to see how to troubleshoot.

If you want to learn more about functional movement, how Postural Neurology and DNS can help and all other services we utilize in treating our patients, make sure to visit my website and contact the office if you need help.