Pain in the lower back on the sides of the spine, as well as in the groin and on the front of the thigh, can occur as a result of problems with the iliopsoas muscle. Watch the video to the end and find out the causes of this pain, therapeutic exercises to eliminate discomfort at home, as well as useful recommendations for preventing the recurrence of pain.
Lower Back Pain & Iliopsoas Muscle
The iliopsoas muscle consists of three muscles: the iliacus muscle, the psoas major and the psoas minor, which is not always present and is present in about 50% of people.
At the top, the psoas major and minor muscles attach to the spine, go down and in the pelvic cavity they unite with the iliacus muscle, attaching to the femur.
At the point where it exits the pelvis, the iliopsoas muscle passes through a narrow space along with the femoral nerve. Pinching of this nerve by tight areas of muscle can cause pain in the groin, scrotum, and labia.
Iliopsoas Trigger Points
Specific areas of tension or trigger points of the iliopsoas muscle can be located in three places.
The first trigger point is localized in the area of attachment of the psoas muscle to the spine.
The second trigger point is located in the area of attachment of the iliacus muscle to the ilium.
The third trigger point is located in the area of attachment of the iliopsoas muscle to the femur.
The first trigger point mainly reflects pain in the lower back, spreading along the spine. The second trigger point reflects pain in the back and in the sacroiliac region. The third trigger point can reflect pain in the back, as well as in the groin and along the front of the thigh. There is evidence of a connection between the affected iliopsoas muscle and pain in the lower abdomen, in the scrotum or labia, and even in the interscapular region.
liopsoas Syndrome
When the iliopsoas muscle is affected, the pain increases in an upright position and is almost unnoticeable when lying on the back. Difficulty in getting up from a deep chair and the inability to sit up from a lying position may be noted. In the most severe cases, mobility is so limited that the person can only move on all fours.
Pregnancy, sleeping on the side in the fetal position, sitting for long periods at the computer or driving a car can lead to overload of the iliopsoas muscle. Hard fecal matter located in the rectum can put pressure on the trigger point area and cause the characteristic pain described above.
A person with active trigger points in the iliopsoas muscle in a standing position usually transfers body weight to the unaffected leg and at the same time bends the leg on the side of the affected muscle, abducts it at the hip joint and rotates the foot outward. In addition, he slightly leans to the side opposite the affected muscle. When trying to bend forward in a standing position, he leans even more to the unaffected side in the first 20 degrees of flexion, and then, as he bends further, the position is somewhat straightened.
When walking, the iliopsoas muscle is constantly active, so people with trigger points in the iliopsoas muscle try to relieve the load on it and as a result, slouch when walking. They have hyperlordosis of the lumbar spine and excessive forward tilt of the pelvis. This increases the load on the intervertebral discs and over time can lead to the formation of an intervertebral hernia in the lumbar spine.
Iliopsoas Muscle Test
To determine problems with the iliopsoas muscle, you can perform the following test. Lie down on your back on a table or couch. Bend one leg and bring it close to your body. Bend the other leg slightly at the knee and straighten it at the hip. Normally, the thigh of the relaxed leg should drop below the table level.
If the iliopsoas muscle is sharply contracted, the thigh will be above the table level.
If the leg being examined is too strongly bent at the hip joint and straightened at the knee joint, the rectus femoris muscle is also involved in the pathological process. The influence of a tense rectus femoris muscle can be detected if the leg is completely straightened at the knee joint. If straightening the knee improves hip extension, this indicates that a tight rectus femoris is limiting hip extension, and tight iliopsoas is increasing this effect. If straightening the knee does not increase hip extension, the rectus femoris is not affected and the primary problem is iliopsoas injury.
Iliopsoas Trigger Points Massage
Usually, to eliminate pain and trigger points in muscles at home, the exercise program should include strong mechanical action on the muscle followed by stretching. But since the iliopsoas muscle is located deep, it is quite problematic to massage some of its areas on your own.
Pain in trigger points can be identified by pressing in three areas while lying on your back or lying on your stomach. While lying on your back, press your fingers on the area located near the attachment point of the muscle to the femur. Press the muscle against the outer wall of the femoral triangle.
Since the femoral nerve runs along the inner edge of the iliopsoas muscle, it is best to slightly move the thigh away from it in order not to touch it. Pinching of this nerve can cause pain in the groin, scrotum and labia. If there are trigger points in this area of the muscle, then when pressing, the pain from them will be reflected in the lower back, groin and along the anterior inner surface of the thigh. Massage this area of the muscle for 1-2 minutes. Stop at the most painful area for 30 seconds and then continue the massage movements. In cases where the muscle is severely spasmodic, it is necessary to slightly bend the hip and place the leg on a pillow to reduce muscle tension.
When examining the second area of the iliopsoas muscle, it is necessary to relax the abdominal muscles and press the fingers along the inner surface of the iliac crest, pressing the muscle to the bone.
If this area of the muscle is affected by trigger points, the pain will occur mainly in the lower back.
When examining the third area, place your hand on the abdominal wall so that the fingertips are lateral to the outer edge of the rectus abdominis muscle. Smoothly immerse your hand below the level of the rectus abdominis muscle and move it medially towards the spine, pressing the muscle mass to the vertebrae.
When you work with this trigger point yourself, you can bend your legs at the knees and lower them to the side, on the side opposite the muscle you are going to work on. Massage this area with the fingers of both hands. To confirm the correct position of the fingers, raise your head for a minute, thus forcing the rectus abdominis muscle to contract. Your fingers should be positioned at the outer edge of the rectus abdominis muscle, then they are in the correct position to massage the iliopsoas muscle.
Pain from this area of the muscle occurs in the lumbar region. Be sure to examine the opposite iliopsoas muscle, performing the same sequence of actions.
After this, it is necessary to stretch the iliopsoas muscle.
Iliopsoas Stretching Exercises
The main function of the iliopsoas muscle is flexion at the hip joint. With a fixed pelvis and spine, its contraction brings the leg closer to the body. With fixed legs, it tilts the pelvis forward and brings the body closer to the legs. The optimal position for stretching the iliopsoas muscle is a position in which the hip is extended at the hip joint without abducting it to the side, combined with internal rotation or a neutral position of the leg.
The simplest exercises are the following. Lie on your stomach. Bend your arms at the elbows and place them at the sides near the body. Look up and slowly bend your lower back.
Hold this position for a minute, breathe smoothly and deeply through your nose, feel the stretching of the muscles. You can increase the degree of stretching by straightening your arms at the elbows and leaning on your hands. In this position, do not allow pain to occur in the lower back due to excessive arching in the lumbar spine.
For a more intense stretch of all parts of the iliopsoas muscle, kneel down. Place the foot of your right leg in front of you so that the angle at the knee joint is about 90 degrees. For stable balance, your legs should be hip-width apart. Lift your hands off the floor and place them on your thighs. Raise your body up and back, straightening your spine in the lumbar region. Hold the final position for one minute.
To further stretch the iliopsoas muscle, place the foot of your left leg on the toe and straighten your leg. If you can raise your arms in this position and stretch upward, this will further enhance the stretch of the iliopsoas muscle.
If you have a bench at home, you can rest your hands on its edge and place your straightened leg on it. Slowly lower your pelvis, breathe deeply and hold the final position for one minute.
You can do a similar exercise in a doorway or use large pieces of furniture, such as a table or closet, to help you maintain balance.
To further stretch the rectus femoris, which performs a similar function, you need to put a blanket under your knee and bend your leg at the knee joint.
If you can’t grab it with your hand, use a belt or yoga loop.
You can also lie on a bench or couch with your back and lower your relaxed right leg. The tension is increased if you bring the knee of the other leg to your chest. To stretch the iliopsoas muscle, you can also sit on the edge of a chair without armrests. Bend your leg at the knee joint, grab it with your hand and straighten your thigh at the hip joint.
When performing any of the exercises described above, you must also do the exercise in the opposite direction.
There are a number of exercises in yoga practice that help stretch the iliopsoas muscle. These are dhanurasana or bow pose,
ushtrasana or camel pose, urdhva dhanurasana or bridge pose, and a number of other asanas in which the thigh is extended at the hip joint.
After doing the stretching exercises, it is necessary to do several cycles of active movements that involve the iliopsoas muscles. For example, lying on your back, exhale, bend your legs at the knees and hip joints and bring them closer to the body. Inhale, return your legs to the starting position.
Or, for example, in a standing position, place your feet at the width of the pelvis, bend your legs slightly at the knee joints and, exhaling, bend your body towards your legs. Inhale, return to the starting position. Repeat this exercise 5-10 times.
To prevent the pain from recurring, avoid excessive hip flexion when sitting for long periods. If this is not possible, stand up more often to straighten your legs and stretch the iliopsoas muscle. It is essential to learn abdominal breathing, which lowers the diaphragm and provides the iliopsoas muscle with short-term relaxation.
If you are used to sleeping on your back, place a small pillow or rolled-up blanket under your knees. If you sleep on your stomach, which is not the best sleeping position, place a pillow or blanket under your thigh. This causes a slight flexion in the hip joint, which reduces tension on the iliopsoas muscle. When sleeping on your side, avoid the fetal position with strongly bent legs.
Do not attempt strength exercises that involve the iliopsoas until you have completely eliminated your trigger points.
Iliopsoas Muscle Pain & Other Muscles
The iliopsoas works in concert with the rectus abdominis. If the rectus abdominis is weak, the psoas tries to compensate and is at increased risk of trigger points. If you can do this exercise from a supine position without using your feet as support, your rectus abdominis is in good condition.
Trigger points in the iliopsoas muscle are rarely found as isolated myofascial syndrome and are often combined with trigger points in the quadratus lumborum muscle. It should be taken into account that coughing or deep breathing increases pain with affected quadratus lumborum muscles. This is an important diagnostic difference.
The hamstring muscles make a large contribution to the development of myofascial pain syndrome of the lower back, and before stretching the iliopsoas muscle, it is imperative to achieve their relaxation. A large massage roller, a two-liter bottle of warm water, or a large massage ball can help with this. Massage these muscles for several minutes, and then move on to working on the iliopsoas muscles.
Pain in the groin and along the anterior inner thigh can also be caused by problems with the tensor fasciae latae and hip adductor muscles. You can watch detailed reviews of these muscles in this playlist. I would be happy if you subscribe to my YouTube channel
