The iliopsoas (also known as the hip flexor) is a muscle with important functions, but is hard to access and often harbors painful trigger points. It is located in the front of your body, but often causes low back pain (as well as pain in other areas, discussed shortly.)
This is often the cause of misguided self-treatment, because it would seem logical that if you are feeling an ache in your low back, you should place a heating pad on the low back. This might help relax some trigger points in the no doubt taxed muscles in that area, but if your problem is also iliopsoas trigger points, you need to heat the abdomen and inner thigh area to relax this prankster’s tissues.
The iliopsoas muscle is made up of the psoas major and iliacus muscles (and sometimes the psoas minor). The psoas major attaches to the sides of the lumbar vertebrae and intervertebral discs, and runs down into your inner thigh, attaching to the inner surface of the femur (thigh bone). The iliacus runs from the inside of the iliac crest down to join with the tendon of psoas major. Some of its fibers also attach directly to the femur (upper inner surface).
The main function of these muscles is to flex the thigh at the hip (thus the name hip flexor), and they are important in helping maintain upright posture. They are active during sitting, standing, and walking. The iliacus portion is active when the thigh is flexed during running, and during the last 60 degrees of a sit-up.
Trigger points can flare due to prolonged sitting, especially if sitting with your legs flexed more than 90 degrees (knees higher than hips). Lying on your side with hips flexed up in fetal position also exacerbates iliopsoas trigger points, and can cause pain upon rising out of bed. Trigger points are also commonly flared in these muscles secondarily to trigger points in other surrounding muscles.
Symptoms of iliopsoas trigger points include pain running vertically along the spine from as high as the shoulder blade (but not necessarily that high) down to the sacroiliac region, and sometimes into the sacrum and medial buttock. The iliacus can also refer pain to the groin and front of the thigh.
Pain is worsened with weight-bearing and relieved/reduced by lying with hip flexed slightly. It can often be difficult to get out of a deep chair with iliopsoas trigger points, and sit ups become difficult.
There are many other muscles that refer pain into the back, thigh and groin, so it isn’t a guarantee that your back pain is coming from the iliopsoas (wouldn’t it be nice if it were that simple!)
It should also be noted that iliopsoas trigger points are rarely present on their own. Weak abdominal muscles can lead to overworked iliopsoas muscles as they compensate for the lack of abdominal strength. The quadratus lumborum (QL) muscles in the low back act with the iliopsoas to support the torso, and are often involved with iliopsoas trigger point syndrome. Tight quadriceps can pull and shorten iliopsoas muscles, and tight hamstrings can overload them as they fight to deal with the pull of the hamstrings on the pelvis.
Tight and trigger point laden iliopsoas muscles can also affect posture, as you position yourself to ease tension on them. This leads to overloading and trigger point formation in back and neck muscles.
It is absolutely fascinating just how interconnected the muscles in our body are. It is like pulling a thread at the bottom of a sweater, and watching the fibers tighten and scrunch up at the top.
Home care then, should include not only treatment for the iliopsoas, but also muscles in the thigh, back and even neck! Roll out thigh muscles with a rolling pin, foam roller, tennis ball or other hand held massage tool. Use the tennis ball trick (tennis ball in a long sock), to treat back and neck muscles by leaning on the ball against a wall. (Hold tennis ball behind your back by holding the sock, and lean back so that the ball applies direct pressure to tight spots.)
Self massage for the iliopsoas itself isn’t easy, and I recommend having it worked on by a professional. You can perform gentle stretching yourself by lying on your back on a surface high enough to let the leg to be stretched dangle off the end of the surface. (Bed or countertop) Position yourself so that you are sitting on the very edge of the platform. Hug the unaffected leg up to your chest, and lie back so that the stretch leg is hanging freely off the platform. Hang out and relax, letting gravity take the leg into a stretch. If this is too intense, move up on the platform so that your thigh rests on it. This will lessen the extension at the hip and therefore decrease the stretch.
Heat application to the abdomen, down along the front of the iliac crest and into the upper thigh area can help relax iliopsoas muscles also.
Avoid sitting or lying with your hips flexed beyond 90 degrees, or sitting for excessively long periods of time. If you find it difficult to get out of bed in the morning due to back pain, try rolling out onto the floor on all fours, and crawl for a minute. This will slowly stretch the hip flexors before you stand upright.
Runners should use caution when increasing mileage, or doing hill work. Increase distance and intensity slowly to allow your muscles time to adapt.
With a little precaution and care, you will avoid feeling this pranksters tricks!