It’s the iliopsoas, stupid!

What do low back pain, knee problems, poor pelvic alignment, hip popping, and weak glute muscles have in common? Besides the fact that all of these things suck and they are common complaints in my clinic. . . read on.

illustration of iliopsoas musclesThe iliopsoas (the p is silent) muscles run from the lumbar vertebrae (lower back) and interior of the ilium (hip/pelvis bones) to the inside of the femur (thigh bone). There are actually two muscles that make up this group: the psoas major (origin at T12-L5 vertebrae) and the iliacus (origin at iliac fossa of ilium). They are generally considered together, and they generally act together and insert together at the lesser trochanter of the femur. Phew. Ok. Why should you care about these little dudes?

Mirror muscles, they are not. Because they’re located deep to other structures, it’s not easy to see and feel them, so many people aren’t even aware that they’re there until something goes awry. But they are critically important to function and performance. The iliopsoas mucles are major hip flexors, pulling the thigh up to the abdomen, and stabilizers of the trunk and pelvis. They get major action with movements like running and cycling, or the constant external rotation of things like ballet, but they can also get weak and tight from sitting in a chair for long periods of time. Think about where those muscles go and what your position is doing to them. Sitting followed by hard training? That sounds like a perfect storm. No wonder they are often troublemakers!

What happens when things aren’t right in iliopsoas land? Sometimes it’s hip-specific problems like:

  • snapping hip syndrome, thought to be related to iliopsoas tendinitis or tendinosis
  • Iliopsoas bursitis, painful inflammation of the cuishioning fluid sacs
  • iliopsoas syndrome- pain and stiffness that can travel to the abdomen, butt, groin, lower back, hip, and thigh

But the trouble can also be more insidious. Tightness or weakness in the iliopsoas can also inhibit proper glute firing and contribute to pelvic instability, allowing anterior tilt and from there, the whole chain starts to experience problems— back pain, knee and foot issues, the whole nine.

Some exercsise movments that stretch and strengthen the iliopsoas:

  • Hanging leg raise— to engage the hip flexing and core stabilizing properties of the muscles.
  • “Gut smash” from mobility WOD— to unglue tight tissues. This feels weird at first— you’re rolling on your abdomen  on a ball on the floor— but can be very effective at “waking up” this hard-to-reach area.
  • Lots of yoga poses— warrior one, triagle, and extended side angle all stretch the back side while strengthening the front side, particularly when you work to isometrically engage the muscles in the legs and trunk. Boat can also engage the flexing action of the iliopsoas, and pigeon can stretch it (back leg especially). BUT, to get benefit from these poses, they must be done with awareness and engagement!
  • Anything focused on strengthening core, hip, and glute muscles, particularly with an aim to correct pelvic alignment (a PT is a really good resource for help with this).

In my opinion, there are two major ways to combat iliopsoas problems. The first is to spend less time sitting in a chair. Stand, move, squat, cylce through different positions, get up frequently, walk around. Use whatever tools you can— a standing desk, a stool, a headset so you can walk and talk on the phone— but don’t sit in a chair more than you absolutely must. The second is to attend to your hip and trunk range of motion as part of your regular routine. Warm up well for a run or a ride including things like leg swings both forward and sideways. Do some stretches or mobilizations like the ones described above as part of your daily maintenence rountine. Remember that those muscles are there and try to find them when you’re moving around. I find the interrelated mechanics of the bones, muscles, joints, and tissues so fascinating— hope you found this as interesting as I did!

3 thoughts on “It’s the iliopsoas, stupid!

  1. knightgardens says:

    As you know, but maybe others don’t, it is often
    just referred to as psoas. When I first tried to look it up, I had a problem finding it because I didn’t know the p was silent!

    • zabbylogica says:

      right you are! i think there’s some confusion around the fact that the muscles have two origins but one insertion. i think when people say “psoas” they are sometimes referring to the psoas major alone, but sometimes referring to the complex of the two. or sometimes not realizing that there are two at all! so, lisa k-night, i’m glad you figured out how to find the p-soas!

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