Hip Flexors
Iliopsoas
Location The iliopsoas muscle is composed of two muscles, the Psoas muscle, and the illiacus. The psoas muscle lies deep in the abdominal wall and attaches to the vertebras of the lumbar spine making it one of the most important muscles in back pain. The illiacus is located in the front part of the pelvis. They both connect together in the groin area and attach through a common tendon in the area of the femur called lesser trochanter.
FunctionThe iliopsoas is classified as a hip flexor because it’s main function is to flex the hip and bring the knee closer to the abdomen. However it also flexes the torso and is one of the main muscles involved in sitting up from laying down position or when doing sit-ups. Sit-ups in particular can overwork this muscle and lead to significant back pain. Iliopsoas and back painThere has been quite a bit of published research connecting the dysfunction of iliopsoas to low back pain. The reason being that if iliopsoas is overused and develops trigger points, it will become shorter and tighter. The shortening and tightening of the muscle lead to increased tension between the attachments in the femur and the spine. Since the attachment at the femur – the thigh bone- is fairly fixed, it is the spine that will be pulled on and bends forward to allow for some slack. This forward bending of the spine is called lumbar lordosis and can be noted by your provider on physical exam as excessive curvature in your lower back. The forward bending of the lumbar spine creates tremendous pressure on the disks in the spine resulting initially in the back pain and eventually possibly in disk bulging or herniation. This phenomenon is frequently seen in athletes who try to develop strong abdominal muscles by doing many sit-ups on daily basis without proper stretching of the iliopsoas. Flutter kicks and leg raises are also frequent causes of significant back pain secondary to this mechanism if they are done in excess without proper stretching.
Most characteristic pain caused by trigger points in the IliopsoasThe trigger points in the iliopsoas refer pain mainly to the low back. Typically the pain is located along the spine on one side, but if the psoas muscle on both sides is involved, you may experience the pain across the low back on both sides. The pain due to iliopsoas can be so severe, that the individual may not be able to stand up at all and can only crawl on their four. This typically happens after several days of strenuous exercises affecting the muscle. In more chronic cases, the individual may complain of having difficulties standing straight and the onset of more back pain with prolonged standing or walking. The upright position causes constant pull on the spine by the shortened iliopsoas. Sitting on the other hand brings at least some relief since the psoas can relax and the pull on the spine is released. Sometimes trigger points in the psoas can refer pain also to the groin area, scrotum and the upper aspect of the thigh. Location of trigger points & Acupressure tipsThe trigger points in the iliopsoas are located deep behind the abdominal wall and in the groin area. They are therefore not easily accessible for acupressure. If you suspect involvement of iliopsoas in your back pain, ask your provider about a referral to an acupuncturist or a physical therapist experienced in dry needling this muscle.
Summary
SymptomsClassic lower back pain (LBP) & sciatica symptomsPain is located mainly along the spinePain worse when standingStanding up from a seated position is quite painfulLBP/sacral pain with getting up after prolonged sittingSit-ups become impossible to doWalking is difficultInability to stand or walkWhen acute, the individual may only crawl on hands & kneesLower back pain & hip/groin stiffness in the morningHard to stand straight in the morningWalking with feet turned outward Pain radiationAlong the spine from the lower ribs to the sacral areaSometimes to the upper medial buttockOften to the front part of the thigh and groin
Causes for development of trigger points & general considerations
Sports activity:Excessive running or climbingAny exercise that overworks the midsectionSit-ups, leg raises, flutter kicksHabitual weight bearing on one side of the bodyCarrying a child on the same hip
Posture:Sitting for long periods of timeHabitually stooped or slouching postureSleeping with knees up in a fetal positionSleeping with a pillow under knees
Special ConsiderationsOne of the key muscles in low back painA highly involved muscle in walking, running & jumpingA frequent cause of ‘adductor problems’ in soccer players (inguinal pain)Not easily accessed for self acupressureFocus on stretching
Stretching Exercises
