The Iliopsoas Muscle and its Frequently Overlooked Syndrome

The iliopsoas is comprised of two muscles: the iliacus and the psoas.


Situated deep within our core, the iliopsoas muscle is one of the most complex structures in the body, playing crucial roles in hip flexion, postural stability, and walking.

However, its significance extends well beyond these roles, as it holds the key to unraveling a wide range of pain and dysfunction that cannot be detected through standard allopathic testing methods such as MRIs, X-rays, CT scans, or neurological tests.

Conditions like back, hip, groin, and abdominal pain often find their explanation in two notable conditions that can arise when the iliopsoas muscle becomes dysfunctional:

  1. Iliopsoas syndrome, a muscular condition...
  2. Pelvic torsion, a misalignment of the pelvic bones...

Both of these conditions are highly prevalent, yet they remain poorly understood within the realm of conventional medicine.

While our primary focus in this article will be on exploring Iliopsoas Syndrome, it is important to note that this syndrome often serves as a precursor for pelvic torsion. Therefore, when one condition is present, it is not uncommon for both to be present.

For a comprehensive discussion on pelvic torsion, refer to the complete article here.

iliopsoas anatomy: two muscles in one

The iliopsoas muscle consists of two individual muscles - the iliacus and the psoas - which, despite their different origins, share a common attachment point.

The psoas major originates from the lumbar spine and intervertebral discs, descending obliquely to attach to the lesser trochanter, a part of the upper inner thigh bone (femur).

Originating in the upper two-thirds of the iliac fossa, the iliacus merges with the psoas major tendon, with some of its fibers directly connecting to the lesser trochanter.

The primary function of the iliopsoas is hip flexion, responsible for lifting the leg during walking and other activities.

Due to its attachment along the lumbar spine, the psoas also plays a crucial role in maintaining upright posture and can assist in extending the lumbar spine in coordination with the back muscles.

Prolonged periods of sitting, such as during driving or desk work, can lead to shortening and tightening of the iliopsoas, especially if regular stretching is neglected.

Right side view of psoas muscle. Hypercontraction can reduce natural lumbar lordosis.

the diaphragm muscle, the PSOAS muscle and breathing

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.

Diaphragm and iliopsoas

If we look closely, we can see the actual interweaving of the two muscles at T12 through L2.

Diaphragm and psoas muscles. Close front view.

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.

Digestive organs packed in below the diaphragm and on top of the psoas.,
Digestive organs packed in below the diaphragm and in front of the psoas. Side view.

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:

  1. Abdominal clenching -- that is, the abdominal muscles held in a persistently contracted state -- reduces the space and capacity for the diaphragm to flex downward, thus disabling a full breath, and severely limiting the beneficial downward pressure on the water balloon-like peritoneum.
  2. Abdominal clenching reduces flood flow to the region. Like a clenched fist in which the knuckle goes white, persistently contracted abdominal muscles push a healthy blood flow out of the abdominal region setting the stage for the iliopsoas to become ischemic.

Ischemia, then, sets the stage for Iliopsoas Syndrome.

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.

Potential regions of pain

Over the course of thirty years in clinical practice treating iliopsoas dysfunction, clients have presented with pain in following areas...

  • Lower abdomen
  • Groin
  • Buttocks
  • Down the leg
  • Hip
  • Lower back
  • Sacroiliac joint
  • Across the top of the hip bone (iliac crest), sometimes wrapping around the lower back or buttocks

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.

causes of Iliopsoas Syndrome

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.

consequences  of chronic  muscular contraction

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:

1. Ischemia

A chronically contracted muscle can become ischemic (low blood flow). Imagine the white knuckles of a clenched fist. No blood flow there. An ischemic muscle is often a painful muscle.

2. Trigger Points

A chronically contracted muscle can develop trigger points which refer pain (or numerous other possible sensations – thermal, tingling, numbness, aching) either radiating out from the muscle or felt in other parts of the body.

3. Distorted Movement Patterns

A chronically contracted muscle can distort the movement of the joint it crosses. For example, a chronically tight iliacus could reduce movement at the front of the hip.

4. Muscular Compensation

A chronically contracted muscle can cause other compensations or distortions in the body. If a chronically tight iliacus, for example, reduces movement in one hip, then the other hip or the spine or other parts of the body will be called upon to compensate or to change their normal pattern of movement.

5. Nerve Entrapment

A chronically contracted muscle may be responsible for entrapment of nerves, another cause of pain. In the case of the iliopsoas, entrapment of the following nerves is possible: the femoral nerve, the lateral femoral cutaneous nerve, the femoral branch of the genitofemoral nerves, the iliohypogastric nerve and the ilioinguinal nerve.

Iliopsoas Syndrome & Pelvic Torsion

When the iliopsoas muscle experiences ischemia, both the iliacus and psoas muscles can suffer from dysfunction, as discussed previously.

However, one specific way in which the iliopsoas can become dysfunctional is through an asymmetrical shortening of the hip flexors, resulting in pelvic torsion.

Pelvic torsion occurs when the iliacus muscle on one side and the psoas muscle on the other side both become locked in a shortened state.

The tight and shortened iliacus on one side causes the pelvis to rotate forward, while the tight and shortened psoas on the other side holds the pelvis fixed in place.

As a consequence, the pelvis becomes misaligned, altering the level of the hip joints and leading to a functional leg length discrepancy. This chain reaction triggers muscular compensation throughout the body, potentially resulting in various discomforts and dysfunctions.

For a comprehensive understanding of pelvic torsion, refer to the detailed article available here.

It is important to note that the conditions giving rise to Iliopsoas Syndrome are the same conditions that contribute to pelvic torsion. Consequently, these two conditions often manifest concurrently.

To address these issues, I have developed comprehensive self-guided video courses that can be followed in the comfort of your own home.

These course options are described below in the What To Do section.

How to resolve Iliopsoas Syndrome & Pelvic Torsion

Years ago, I was receiving a lot of inquiries from all over the world about an earlier version of this article about Iliopsoas Syndrome.

Those writing in believed that they were suffering from this condition and were desperate for help.

While a few were able to visit my clinic in Vermont, that was impossible for most.

So I began to develop protocols that anyone could do at home, protocols that would mimic how I helped individuals to relieve Iliopsoas Syndrome.

Those protocols became the self-guided course, "Healing the Hidden Root of Pain: Self-Treatment for Iliopsoas Syndrome."

The 2013 Course for Resolving Iliopsoas Syndrome

In 2013, I launched a self-guided online course dedicated to resolving Iliopsoas Syndrome: "Healing the Hidden Root of Pain: Self-Treatment for Iliopsoas Syndrome."

This course presents a comprehensive 4-Phase process designed to address the underlying causes of the syndrome. It includes various methods and techniques, such as self-massage, proper breathing, Somatic Movement, stretching, and strengthening exercises, specifically tailored to enhance iliopsoas function and provide long-term resolution.

While this course is still available for purchase, please continue reading below to discover how you can receive this course for FREE.

The 2022 Course for Correcting Pelvic Torsion

What’s not included in the 2013 course is instruction for resolving pelvic torsion, despite the fact that these two conditions are closely related.

Back then, I had not yet developed an easily accessible protocol that the general public could use for correcting pelvic imbalance.

Because pelvic torsion can be confusing (even to health practitioners) and because great care must be applied when applying corrective techniques to remedy pelvic torsion, I felt a separate course was needed.

Nearly ten years later, that course became a reality.

In 2022, I introduced the "Postural Blueprint for Correcting Pelvic Torsion: The Complete Guide to Restoring Pelvic Balance."

This course incorporates six distinct exercise groups, including:

  • Somatic Movement
  • Pelvic Counter Rotation
  • Active Isolated Stretching
  • Improving Squatting Competence
  • Core Strengthening
  • Back Line Strengthening

The Postural Blueprint for Correcting Pelvic Torsion is the only course of its kind available anywhere, providing a comprehensive solution for addressing the widespread and persistent problem of pelvic torsion.

Better Together

Given the close relationship between Iliopsoas Syndrome and Pelvic Torsion, I wanted to ensure that as many people as possible have access to both courses.

Because these two courses work synergistically, I have bundled them together...

For a limited time, when you enroll in the "Postural Blueprint for Correcting Pelvic Torsion," you will also be automatically enrolled for FREE in "Healing the Hidden Root of Pain."

Released a decade apart, these two courses offer the most comprehensive self-treatment available anywhere, allowing you to resolve Iliopsoas Syndrome and correct pelvic torsion effectively.

While many individuals have successfully resolved Iliopsoas Syndrome with the guidance of "Healing the Hidden Root of Pain" alone over the past ten years, the "Postural Blueprint" specifically addresses the challenging condition often associated with Iliopsoas Syndrome: pelvic torsion.

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Anatomy Images Courtesy of BIODIGITAL

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What Other Visitors Have Said

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Stephen O'Dwyer, cnmt

Neuromuscular Therapist & Pain Relief Researcher

Stephen O'Dwyer, CNMT


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