What Is Iliopsoas And Is It Painful?

Experiencing hip pain? Then you may want to know about this. The iliopsoas muscle is a major mover of your hip joint. The major and minor psoas muscles and the iliacus muscle make up the iliopsoas musculotendinous unit (IPMU), which is commonly called the iliopsoas muscle. 

 

The psoas muscle is the more commonly known muscle and is becoming more and more problematic for clients coming through the clinic doors. If we think of where the psoas muscle is situated, originating from the 12th thoracic vertebrae and all 5 of the lumbar spinal vertebrae, then inserting into the lesser trochanter of the femur (the top-back of the leg), we can then think of what movements it is in control of and when its active. The psoas is the is the biggest flexor of the hip and plays a huge role in stabilising the posterior core during movement and activation. So it’s no surprise that it’s one of the most common causes of hip and back pain. 

 

So why is it one of the muscle groups that’s not known about and sometimes misdiagnosed? We find the answer by again returning to its position, being so deep in our anatomy, as it sits beneath a mass of fascia and other large muscle groups on both the anterior (quadriceps, TFL, abdominal muscle groups) and the posterior (Thoracolumbar fascia & Erector spinae). 

 

These muscles work together to flex your hip and to stabilise your hip and lower back during activities such as walking, running, and getting up from a chair. That’s why injury to the iliopsoas may cause hip pain and limited mobility. 

 

Given its nature of stabilising the spine, and flexing the hip, it can be associated with deep feeling hip pain. It’s commonly seen in sporting contexts where there’s high repetitive load, multidirectional force, fast acceleration and deceleration movement. Outside of these scenarios however there is an ever-growing occurrence of iliopsoas pain and associated issues. Due to the increase in sitting, whether this be work related or just inactivity, this increase in demand alone can have a serious negative effect on the iliopsoas muscle. Being in a “hip-flexed” position we now naturally slouch and takeaway our core activation, increasing the demand on the posterior side of our spine, meaning the iliopsoas (along with more superficial muscle tissue) must support the spine to protect it from excessive pressure. Naturally after a prolonged time of this, the iliopsoas fails and more serious issues in the lumbar occur, such as spinal disc problems. This is when you may find yourself wanting to lay flat to “let your back relax”. This is down to your iliopsoas becoming tight, overworked, restricted, and painful. 

 

Focusing on the front of the hip now, and this is where we find one of the most sensitive areas to treat as therapists. Near the lesser trochanter attachment (top of the leg at the hip) is the insertion point of the psoas muscle, and the second most common occurring pain reported by clients coming into clinic. Here we see an intense amount of the tightness into the attachment and pain going further into the muscle itself and then referring further down the medial aspect of the leg. This is always down to overuse and in some cases when the tightness is left untreated on undetected it can cause a psoas bursitis. This is where the bursa sac (a small, thin, ball of fluid designed to lubricate the muscle of the joint during movement) becomes inflamed and irritated. 

 

This can be intense and, in most cases, requires a more prolonged course of treatment. However if it does not get to that then treating the muscle tightness with sports massage and stretching can help with the pain. It then will require a rehabilitation program to correct the movement error in-place which caused the issue. This will be all around correcting the quality of core and activation to take the pressure off the iliopsoas group and make it more balanced around the core and hips. 

 

Overall, the iliopsoas group can be a neglected and overworked set of muscles. With knowledge of your own biomechanics as well as a look at your work and home environments, then it is easier to avoid problems. By training your body and mind to activate your core and glutes and reduce the amount of posterior demand on the psoas attachment at the back, you will leave a iliopsoas problem-free life. For help with this, just speak to your Fire & Earth therapist.