The iliopsoas muscle is one of the most complex and least understood muscles in the body. Comprised of two muscles -- the iliacus and the psoas -- there are two separate origins (or starting attachments to bone) but one common insertion (ending attachment to bone).
The psoas major attaches along the lumbar spine and intervertebral discs then descends obliquely to attach at the upper inner thigh bone, called the lesser trochanter of the femur.
The iliacus muscle attaches to the upper two-thirds of the iliac fossa then descends to join the psoas major tendon, with some of its fibers attaching directly to the femur at the lesser trochanter.
The primary function of the iliopsoas is hip flexion, also known as flexion of the thigh. This is the muscle which lifts the leg to take a step in walking.
But due to its attachment along the lumbar spine, the psoas plays a major role in maintaining upright posture.
It can also assist in extending the lumbar spine in conjunction with the muscles of the back.
When hypercontraction causes this muscle to become functionally short, the psoas distort the lumbar vertebrae and can contribute to pelvic torsion.
Long hours of sitting, whether driving or seated at a desk, can allow the iliopsoas to adapt into a shortened position especially if regular stretching is not done.
One of the least-discussed topics in the literature is the relationship between the diaphragm muscle, which controls breathing, and psoas muscle which is positioned just below it.
The diaphragm is what pulls air into, and expels air out of, the lungs. Here is its action. The animation is interactive. You can zoom in, spin the model around, etc.
If we consider the diaphragm and the psoas together we can begin to get a sense of the importance of their relationship. Here the diaphragm and the psoas muscle are shown together.
If we look closely, we can see the actual interweaving of the two muscles at T12 through L2.
What's most unique about the diaphragm muscle and the psoas muscle, however, is their physical position and orientation to the abdominal viscera.
As you can see below, all of our digestive organs are packed into the space just below the diaphragm.
All these organs are contained within a sac called the peritoneum. Imagine this sac as being like a big water balloon.
In normal, healthy, relaxed breathing, the diaphragm flexes down on this water balloon causing it to flex and bulge. With every breath, this bulging and reshaping acts as a kind of massage for the psoas.
The normal respiratory rate for an adult is 12 to 20 breaths per minute. That calculates to 720 to 1200 breaths per hour or 17,280 to 28,800 breaths in a 24 hour period.
That's an extraordinary opportunity for the action of breathing to be exerting a positive impact on the psoas.
When our breathing is shallow or paradoxical, on the other hand, the diaphragm does not flex down fully in this beneficial manner.
In shallow or paradoxical breathing, the abdominal muscles can remain clenched causing two unwanted effects:
Ischemia, then, sets the stage for Iliopsoas Syndrome.
When the psoas muscle or iliacus muscle becomes ischemic it can be the source of a bewildering variety of mysterious and hard-to-diagnose pain.
In Myofascial Pain and Dysfunction: The Trigger Point Manual, by Janet Travell M.D. (personal physician to President John F. Kennedy) and David Simons, M.D., this muscle is referred to as "the hidden prankster.”
These two eminent and long-time pain researchers could hardly have come up with a more fitting label for this muscle.
In my clinical experience I have found that dysfunction of the iliopsoas — commonly referred to as Iliopsoas Syndrome — is responsible for more unexplained back, hip and leg pain than any other single cause.
During my 30 years in clinical practice treating iliopsoas dysfunction, clients have presented with pain in following areas...
The problem an individual may face when being examined by a physician not trained in muscular problems is that examination of any of the above areas of pain may reveal exactly nothing.
Many standardized allopathic tests, including neurological tests, will come back normal because they are not tests designed to evaluate muscular problems. Such problems can only be properly assessed with skilled palpation and knowledge of musculoskeletal dysfunction.
Of particular difficulty in the case of the iliacus is the fact of its hidden location. This muscle is not easy to palpate if you don’t have any practice at it. The psoas is more accessible but no less intimidating to palpate, much less treat, if you’re unsure of what to do.
A very common problem for the iliacus and psoas is that they both can shorten over time, especially in those individuals who sit for long periods of time.
Prolonged sitting in which muscles are in a shortened state for extended periods can lead to the muscles adapting to this position.
Once in an adapted state, muscles have trouble returning to their normal resting length. This is a basic characteristic of muscle function.
The Cross-Bridge Theory, which attempts to explain the contractile action of muscle tissue, asserts that, once contracted, a muscle cannot lengthen on its own.
The contractile units of the muscle (sarcomeres) must be stretched back to their original resting length by an outside force (such as an opposing muscle group) before the muscle is able to actively contract and relax again.
Can you just stretch the muscle out then?
Yes... if the proper type of stretching is done. For example, I have found the method of Active Isolated Stretching to be vastly superior to static stretching, especially in cases where muscles are stubbornly tight.
In some cases the stretching is enhanced by manual therapy because muscle fibers can become adhered or stuck together.
Sometimes this "adhering" is within the muscle itself. Other times the compartment of one muscle can become adhered to the compartment of another muscle.
In both cases the attempt of the muscle to fully lengthen or fully contract is impeded. This results in a dysfunctional muscle which can be painful in and of itself, but also can result in compensatory muscle patterns throughout the body.
This is one reason, for example, a dysfunctional iliopsoas muscle on the right side of the body could result in pain on the left side of the body. One side of the body might be fixed in place while the other side might be strained from overuse.
If a muscle cannot return to its normal resting length, it then resides in a state of chronic contraction and numerous undesirable consequences can result:
Lastly, it’s essential to look closely at the relationship between Iliopsoas Syndrome and postural distortion.
In order to resolve a wide range of mysterious, persistent, or “unexplained” pain and symptoms throughout the body, including Iliopsoas Syndrome, it can be crucial to resolve postural distortion.
First, there are two primary postural distorton patterns:
1) Pelvic torsion, also known as a twisted pelvis, and...
2) Hyperflexion, also known as a forward head posture.
Distortion patterns like these are caused by muscle imbalances.
In other words, when some muscles are tight and short, and other muscles are weak or strained, the body can get pulled out of vertical, balanced alignment.
For example, in the case of a twisted pelvis (pelvic torsion) it's common to find one of the iliacus muscles to be stuck in a tight, fixed position.
In the case forward head posture (hyperflexion), it's common to find the iliopsoas to be locked tight and short on both the right and left sides.
Two final questions to answer:
Do Iliopsoas Syndrome CAUSE postural distortion?
Or does postural distortion CAUSE Iliopsoas Syndrome?
The answer is that both can be true.
Muscular imbalance or dysfunction in the iliopsoas (as a result of not stretching, habitual sitting, shallow breathing or other causes) can result in postural distortion.
Likewise, postural distortion caused by imbalances in other muscles of the body (for example, tight leg or shoulder or torso muscles) can result in Iliopsoas Syndrome.
Therefore, relieving Iliopsoas Syndrome is often greatly enhanced by also resolving postural distortion patterns.
Due to the outpouring of inquiries I've received about Iliopsoas Syndrome, I have developed two self-paced online courses for addressing this problem. The first was released in 2013, the second in 2020.
Included here is an overview of both courses, including what’s specifically covered in each, their differences and their particular strengths.
In 2013 I released my first online course: Healing the Hidden Root of Pain: Self-Treatment for Iliopsoas Syndrome (Also available as a 2-Disc DVD set).
Because of the many, many online inquiries I was receiving about Iliopsoas Syndrome I decided to create a course that could be available to a wider audience than those who could come to my clinic in Vermont.
The course mimics the treatment protocol I use with clients when working with them over a period of weeks and teaches a 4-Phase system.
The 4 phases are specifically designed to provide lasting relief for the dysfunction of the iliacus and psoas muscles, collectively referred to as Iliopsoas Syndrome.
This course is detailed and targeted and, for many, it is a solid starting point for relieving Iliopsoas Syndrome.
But it is not the only possible starting point to resolve this problem.
Let me explain…
What’s not addressed in Healing the Hidden Root of Pain is the larger issue of postural distortion.
As I discuss above, postural distortion can be a root cause of Iliopsoas Syndrome.
But why, then, wasn’t this addressed in Healing the Hidden Root of Pain?
Because in 2013 I hadn’t yet developed a clear, accessible protocol that anyone could use for improving postural distortion. I hadn’t yet created the Flexibility Diagnostic, my proprietary flexibility scoring system.
The Flexibility Diagnostic allows anyone, anywhere to comprehensively identify ALL their tight and short muscles, from head to toe.
Why is this important?
Because it is our tight and short muscles are responsible for pulling the body out of alignment.
It is our tight and short muscles that are responsible for postural distortion.
The first step in resolving postural distortion to clearly identify ALL tight and short muscles and regions of the body.
This can be difficult because tight and short muscles are often NOT symptomatic.
It’s more common for strained and weak muscles to be symptomatic and painful, and for us to focus all our attention on these.
Because tight and short muscles often don’t hurt, we don’t notice them. In effect, tight, short muscles can remain HIDDEN from view.
The Flexibilty Diagnostic solves this problem.
The second step in resolving postural distortion is to comprehensively lengthen ALL tight and short muscles and muscles groups.
This brings us the course released in 2020:
Stretching Blueprint for Pain Relief and Better Flexibility: The Complete Guide to Active Isolated Stretching.
The Flexibilty Diagnostic is one of the central components of the 2020 course.
The 2020 course — Stretching Blueprint for Pain Relief and Better Flexibility: The Complete Guide to Active Isolated Stretching — picks up where the 2013 course left off.
But the Stretching Blueprint has a much wider focus, designed to relieve pain in the whole body.
Through years of clinical practice and research it has become clear to me that the greatest number of problems can be resolved with a whole-body focus. This is also how we achieve the most lasting relief.
The Stretching Blueprint tackles this ambitious goal.
Not only is the 2020 course designed to address problems with the iliopsoas caused by postural distortion, but it aims to relieve pain and dysfunction in the whole body.
With the aid of the Flexibility Diagnostic, individuals are guided through a comprehensive self-assessment for the entire body which results in the creation of a highly individualized stretching routine — Your Stretching Blueprint.
First, you can’t go wrong here. All my courses have an unconditional 30-day refund guarantee. So you are free to try out one or both courses to see what works for you. If a course isn’t of value, you can simply request a refund. No questions asked.
But which course should I start with?
If you are experiencing so much pain that simple movement and activity is fairly restricted, I would recommend this order:
1. Healing the Hidden Root of Pain (Targeted relief)
2. Stretching Blueprint for Pain Relief and Better Flexibility (Global relief)
But if your pain is a persistent annoyance but doesn’t prevent simple activity, I would recommend this order:
1. Stretching Blueprint for Pain Relief and Better Flexibility (Global relief)
2. Healing the Hidden Root of Pain (Targeted relief)
The only course available anywhere specifically designed to relieve the pain and symptoms of Iliopsoas Syndrome.
This course breaks new ground in relieving stubborn "unexplained" pain in the whole body as well as resolving postural distortion patterns.
Take advantage of direct checkout and a 30% discount with a 2-course bundle. Save $64 over the price of purchasing courses separately.
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