The Psoas Iliopsoas Muscles
The psoas muscle is a deep muscle, a very deep muscle that lies within your abdomen and pelvis. It is attached to the side of your lumbar spine and the intervertebral discs in-between. It then travels down through the pelvis and inserts onto a bony projection on the femur called the lesser trochanter. It also blends with another muscle called the iliacus within the pelvis and so is sometimes referred to as the iliopsoas.
It can be painful and uncomfortable.
It is one of the more sensitive areas a Massage Therapist can treat.
Getting in and working on the psoas is a skill in itself. It takes practice and some clear communication with your patient.
Over the years I have had some great success with it and even have some people who request specifically to have it treated.
The psoas has spinal attachments and is more than just a hip flexor. Some studies think it functions as a stabilizer. Since it attaches to the spine, the only way to release it manually is to go DEEP.
This technique will help:
- Female runners with SI problems (lack of hip extension causing SI and lumbar hypermobility, plus inhibition of hip abductor/extensors)
- Older patients with stenosis (lack of hip extension causes lumbar hyperextension, further closing the stenosis)
- Hip capsular patterns – will improve hip external rotation
- Posteriorly rotated ilium
- Pt’s with diffuse anterolateral thigh complaints from compression of the femoral nerve
- Pt’s with spondylolisthesis may help in conjunction with soft tissue work to the paraspinal
- And a stabilization program
Have your patient lay supine with knees and hips flexed. Use an even finger grip, both 3rd and 4th fingertips with your elbows flared out so that your fingertips have even contact. Start about 2-3″ laterally to the umbilicus and slowly move from superficial to deep until you can’t move any further.
The abdominal contents will move out of the way. If you move too quickly, you will activate the rectus abdominus and the contraction will push you out.
How do you know you’re on it?
Here are two signs to make sure:
- It’s not pulsing, if it is, goes more lateral as you’re on the descending aorta!
- Ask the patient to slightly flex their hip; as soon as they do, you should feel it contract under your fingertips
Start with oscillations, and you can progress to functional release movements starting with heelside (you push proximally as patient slides heel distally), ipsilateral upper extremity elevation, combination upper extremity elevation, and heel slide, then anterior pelvic tilts.
The last is the most uncomfortable, and maybe even the first time you can get a patient to posteriorly pelvic tilt correctly, as they want to move away from your hands!
What is psoas syndrome?
Psoas syndrome is an uncommon and often misdiagnosed, condition that can appear as refractory lower back pain (pain that stays even after treatment) accompanied by other symptoms. The condition occurs when the psoas muscle—the long muscle (up to 16 inches) in your back—is injured. The psoas muscle is located in the lower lumbar region of the spine and extends through the pelvis to the femur. This muscle works by flexing the hip joint and lifting the upper leg towards the body. A common example of the movement created from this muscle is walking.
Psoas syndrome is a very rare condition. Other conditions—disc herniation, arthritis, facet or sacroiliac pain—are much more common. When those conditions are treated, often with physical therapy, the psoas muscle is also stretched and strengthened. This can help treat psoas syndrome without it ever being diagnosed.
Who gets psoas syndrome?
Anyone can get psoas syndrome, but athletes, runners, and those engaged in plyometric jumping exercises (short-term, high-energy exercises like jumping rope) are at higher risk for the condition, due to the nature of their activities.
What causes psoas syndrome?
Psoas syndrome may have no identifiable cause. Care should be taken in people who are immune-compromised (due to transplant, cancer, or infectious causes) to ensure that there is no infectious cause or associated myositis (weakness) in the psoas muscle that presents in a related fashion.
What are the symptoms of psoas syndrome?
Psoas syndrome can cause a variety of symptoms, including:
- Lower back pain, the most common symptom, although this can be symptomatic of many conditions
- Pain in the lumbosacral region (the border between the lower part of the spine and the buttocks that can radiate up to lumbar vertebrae or down to the sacrum) when sitting or particularly when changing positions arising from sitting to standing
- Difficulty/pain when trying to stand in a fully upright posture
- Pain in the buttocks
- Radiation of pain down the leg
- Groin pain
- Pelvic pain
- Limping or shuffling stride when you walk
Many of these symptoms can mimic other, more serious conditions. Hip arthritis, kidney stones (ureteral calculi), hernias, femoral bursitis, prostatitis, salpingitis, colon cancer, and colon diverticulitis can also cause severe back pain. It is important to consult your doctor if you have any of the above symptoms.
Psoas Trigger Points and Referral Areas
*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
The information provided is for educational purposes only and is not intended as diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. These statements are not expressions of legal opinion relative to the scope of practice, medical diagnosis, or medical advice, nor do they represent an endorsement of any product, company, or specific massage therapy technique, modality, or approach. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.