Iliopsoas Syndrome_ the Hidden Root of Pain

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Iliopsoas Syndrome

The Hidden Root of Pain

by Stephen ODwyer, CNMT

The Hidden Prankster

The iliopsoas muscle is one of the most complex muscles in the body.

When it becomes dysfunctional (either excessively short and tight, or

overstretched and strained) it can be the source of a bewildering variety

of mysterious and hard-to-diagnose pain.

Among the most common problems caused by dysfunction of this muscle

is lower back and hip pain. But many other regions of the body can also

experience 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.

Anatomy: Two Muscles in One

The iliopsoas is actually comprised of two muscles: the psoas muscle and

the iliacus muscle.

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The psoas major muscle attaches along the lumbar spine and

intervertebral discs then descends obliquely to attach at the upper inner

thigh bone (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 near the lesser trochanter.

The primary function of both the psoas and iliacus is hip flexion,

also known as flexion of the thigh. In other words, these muscles lift the

knee to take a step in walking.

But due to its attachment along the spine, the psoas plays a major role

in maintaining upright posture. It can assist in extending the lumbar

spine and, when excessively short, can contribute to excessive lumbar

lordosis.

Cause 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.

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In some cases, yes, if the proper type of stretching is done. For example,

I have found the technique of Active Isolated Stretchingto be vastly

superior to static stretching, especially in cases where muscles are

stubbornly tight and short.

But in some cases even this type of stretching must be preceded by

manual therapy in order to enable the muscle to fully lengthen. The

reason for this is that the fibers of a muscle can become adhered or stuck

together.

Sometimes this "adhering" is within the muscle itself, and sometimes one

muscle can become adhered to 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 a dysfunctional iliopsoas muscle on the right side of the

body, for example, could result in pain on the left side of the body. The left

side might be getting severly overworked.

But there are many reasons for the variety and complexity of pain from

this "syndrome."

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 whiteknuckles 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


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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.

Potential Regions of Pain

During my 25 years of 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 (iliaccrest), 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 skilledpalpation 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 dont have any practice

at it. The psoas is more accessible but no less intimidating to palpate,

much less treat, if youre unsure of what to do.

What to Do


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Due the outpouring of inquiries I've received about Iliopsoas Syndrome

I've spent the last 6 months developing a self-treatment system for home

use.

This system mirrors the treatment progression I follow when treat ing

clients at my office over the course of a number of weeks.

This system is now available as a 2-Disc DVD set which I've titled,

Healing the Hidden Root of Pain: Self-Treatment for Iliopsoas

Syndrome.

Click on the image or link below to go to the description page for this

product...

NOW AVA I L A B LE

H e a l in g t h e H i d d e n

R o o t o f P a in

S el f - Tr e a t m e n t f o r I l i op s o a s

S y n d r o m e

2 - D i s c DVD S e t

o r

I n st a n t S t r e a m i n g

L a st i n g R e l ie f f o r U n e x p l a i n e d

B a c k , H i p a n d L e g P a in

In the meantime be sure to check out my stretching videos, especiallythose for the hip flexors (your iliacus and psoas muscles are your primary

hip flexors).

Also, if you currently work with a skilled manual therapist (massage

therapist, bodyworker, physical therapist), I have created instructions for

therapistswhich provide a good starting point.

And please join the Iliopsoas Syndrome Forum below. Share your story

and learn from others.

Return to Top of Iliopsoas Syndrome

Go to Lower Back Pain Answers Home Page

Do You Think You Might be Suffering from

Iliopsoas Syndrome?

If so, please share your story here. You might be able to help others who

are also suffering from this pernicious problem.

I try to respond in this forum to stories that seem to be representative of


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this issue. So please be as specific as possible about your history,

symptoms, and the course of treatments you've tried.

Enter Your Title

Click here to see the rest of the form and complete your submission.

What Other Visitors Have Said

Click below to see contributions from other v isitors to this page...

Groin and Hip Flexor Pain

Hi I had bilateral hip arthoscopies last year. My right hip was done in May

2014 and then the left in July 2014. My hip pain actually began in

November

24/7 Chronic Pain

Following more than a decade of sport related pain (so I thought), I was

diagnosed with Spondylolithesis S1/L5 and had a spinal fusion in 1998.

Since

Injured Police Officer

I have spent much of my adult with some low back pain, but never so

much that it was more than a troubling annoyance. Chiropractors told me

I had tight

Pain Came Back with a Vengeance

I am a 34 year female, I was pretty active prior to my injury. I was

involved in a motor vehicle accident almost 14 months ago. I was at a

complete

Pelvic Pain of Unknown Origin

I am a 30 year old female. Former runner and soccer player and what you

would describe as the 'jock' type: always active, strong, and in shape. Ivenever

Trochanteric Bursitis and Iliopsoas Syndrome

The pain started early in January 2012 , but being a stalwart runner, I

thought a couple of weeks off and it would go away. Wrong. While I

waited for

3 Years of Recurring Hip Pain

I never knew what happened to make my hip begin to hurt. I am a

runner. I was running 4-5 miles per day with longer runs on the weekend.

My hip started

From Fit and Happy to Disabled and Depressed

My story is very similar to the others here. I was in terrific shape,teaching 2 fitness classes a day. I had energy to be active in all areas of

my

Is the Psoas Muscle Causing My Husband to Bend Forward?

My husband is 67 and has had every test imaginable (11 different Doctors

and Chiropractors) and nothing has manifested. He walks bent over

sometimes almost

Seven years of pain - is it the psoas?

My daughter has suffered right lower quadrant pain for 7 years. It started

when she was ten. She has had every test you can think of. Doctors


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thought

Desk Stretches Helped

My problem started after high kicks. Most probably it happened because I

started on a cold body and straight away began kicking with high

intensity.

Dull Pain in My Groin

I'm a sheriff's deputy and sit in a patrol car for sometimes hours at a

time. I began experiencing dull pain in my groin, a pulling/aching

sensation behind

Pain in My Lower Back

I am not sure if this is what I have but it sounds a bit like it, in that as

time has gone on, it has developed from one set of nerve pain to involve

different

So I'm not crazy?

I am a 28 year old female with no history of injury. I was a competitive

cheerleader for four years but only suffered occasional leg pain during

that time.

Finally an Answer!!

I'm in my mid 50s, female, very small & fit, active, quite strong. 25 years

ago a chiropractor pulled on my right leg. I not only FELT it like a bullet,

FRUSTRATED WITH MY DOCTORS...WONDERING IF I'M CRAZY

I have been suffering from low back pain on the r ight side for about 10

years now. I thought at first that it was just due to bad posture. I have

always

Multiple Diagnoses & Pain Before and After Hip Arthroscopy

In January of 2011, while at work, I experienced a shooting pain in my

left buttock (which I did not understand at the time was really part of my

hip).

Terrible Time Walking

My present age is 57 and I am female and slim. About 7 yrs. ago, I was

beginning to learn the banjo. I sat a lot holding this 17 lb. instrument

while practicing

My Doctor Thinks I'm Crazy

I have suffered from both low back pain and pain between my shoulder

blades for years. It all started when I was pregnant with my daughter

about 4 years

Diagnosed with Psoas Syndrome

Back in September 2010 I jumped down from the back of a truck and

injured my thigh. I did not realize it was serious until I could not stretch

or do exercises

Hidden Prankster Sufferer

I think that I have this "hidden prankster" syndrome. I have suffered

back pain for many many years. I have tried Pilates but some of the

exercises

Cramping in Upper Thighs

I have been riding a stationary bike for over a year for a minimum of 45

minutes a day followed by sit-ups. I started to have extreme cramping in

my

My Iliopsoas Dysfunction Discovery and Yoga


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I'm a 56 year old female. I have had chronic back pain for over a decade.

I have been to many doctors and every time they found nothing. I had

the usual

Pain After Cycling

4 years ago I returned from a 10 day sea kayaking trip and went straight

on a cycle tour in mountainous terrain. I bent over to pick up a friend's

punctured

Cl i ck h e r e t o w r i t e y o u r o w n .

Finally the Answer to My Dilemma

Ten months ago I suffered a lower back injury while bending repetitively.

After approximately ten sessions of physiotherapy and rest and gentle

regular

Disabled and suffering

I am a student and also suffer from a seizure disorder and fainting spells

which prevent me from exercising and stretching on a regular basis. From

everything

Bike Accident

Fell off my bike in summer 2009 right onto my greater trochanter. I was

traveling at speed and hip took full force because my shoes were clipped

in. I

Injured International Hockey Player

I was an extremely fit international hockey player and one day I finished

a game and was very stiff. My back had seized up and I could hardly walk.

I got

20 Months of Pain Getting Worse

I think it may have started at the gym when I overdid an exercise on a

hip-flexing machine. I had a pain in my groin and down the inside of my

right leg

Injured Professional Surfer

I am a professional surfer from France and I have been injured for a totalof 29 months since I pulled something during a surfing session. Since that

day

10 Year History of Pelvic, Groin, and Low Back Pain

I m a 40 year old female and have had chronic left sided groin, low back,

hip, and pelvic pain for about the past 10 years. I have tried many

different

A Crash to the GroundNot rated yet

Hello. I fell from a height of 2 ft. smack down on cement with my legs

stretched out on Nov. 2. I was babysitting my 2 1/2 year old

granddaughter and

Standing too long!Not rated yet

I had been wearing my beloved toe shoes for three years and standing on

concrete floors too many hours. I developed a deep pain in the fold

between leg

Labral Tear with Iliopsoas SyndromeNot rated yet

I suffered an anterior labral tear to my hip three years ago. I cannot take

anti-inflammatory meds but swim and bike as much as I can. Recently, my

Congenital Hip MalformationNot rated yet

Unbeknowst to me, I was born with a congenital hip malformation. One

side of my hip had no hip socket. The femoral ball attached itself to the


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hip

Longtime Runner Trying to Self-DiagnoseNot rated yet

I have been running for close to 20 years, and my body is finally starting

to break down from it's dysfunction and lack of strength and mobility in

my

Sudden Pain Out of NowhereNot rated yet

I had just walked into my home when out of nowhere a very sharp pain

hit me in my hip. I was not sure what had just happened. All I knew is

that I had

My Self-Diagnosis of Iliopsoas SymptomsNot rated yet

I sit for 4-6 hours daily. I get my exercise by walking, gardening,

housework and outdoors activities (swimming, sailing, kayaking and

hiking). I believe

Pilates Trainer with Chronic Hip PainNot rated yet

Hello. I'm 42, female and had fusion surgery 11 years ago in my lumbar

region. I had a quick recovery, got into fitness training a year after my

surgery,

Father of Triplets Can't Stand UpNot rated yet

I first noticed this pain in my mid-twenties while playing in a flag football

league, but it was not as debilitating as it is now. Now Im 36 and one

Runner with Hip and Lower Back AcheNot rated yet

I've been struggling with an aching pain in my hip for some time while

training for a marathon. The pain doesn't inhibit my ability to run but

certainly

Belly Dancer with Back Pain Told to Strengthen AbsNot rated yet

My first memory of back pain was when I was in my mid- teens. I was in a

play and one scene was rehearsed again and again forcing me to stand for

a couple

My Sister Injured While SkiiingNot rated yet

My sister fell while skiing in early December. She believed she injured herknee and the emergency room physician placed her in a universal splint

and

Camel Pose and Table Pose Relieve PainNot rated yet

From time to time I get the sensation of a slightly pulled muscle. This

develops by the next day into a very severe pain which shoots from my

lower left

Suffered for 5 YearsNot rated yet

My name is Jan and I've suffered for at least 5 years with psoas pain. It

started when I had knee pain and went to an orthopedic surgeon. The

MRI didnt

I Thought it Was Sciatic PainNot rated yet

The sharp pain in my sacral area started a few years ago. I get tingly feet

and my legs feel fatigued as if Ive just run a marathon. When I stretch

Lower Back, Lower Abdomen, Aching Legs Not rated yet

I have had several bouts of lower back pain in my life. I'm now 48. I work

a physical job so think nothing of it. Yes, it's my back. But I had a

hysterectomy

Pain at Top Corner of Pelvis, Hip Flexors, and Lower BackNot rated

yet

Pain in my hip area began about 8 weeks ago. I'm a runner, so I stopped

running, as the pain was getting progressively worse. I took it to be a


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standard

Back Pain During PregnancyNot rated yet

I've suffered with lower back pain for the past five years. After MRIs, CT

scans, X-rays, Neurologists etc, I was diagnosed with fibromyalgia and

sciatica.


Extreme Lower Back PainNot rated yet

After spending a month in the hospital and two months resting at homeafter having abdominal surgery, my lower back felt as if I had been hit by

a 4 x

Work injuryNot rated yet

In April of this year I was injured in an explosion at my job. A piece of

metal punctured my abdomen at high velocity like a gun shot. The

projectile lodged

This page has "me" written all over it!Not rated yet

I'm going to try to be as brief as possible! I'm an 18-year-old female

that's has chronic, severe tendonitis in my iliopsoas tendon for over 4

years.

Groin PainNot rated yet

I have suffered with groin pain for about 3 years. I had cortisone shots in

my hip and groin area 2 years ago. When it didn't work they gave me

another

Running Out of Non-Surgical OptionsNot rated yet

I am a low back (L5-S1) patient that has had everything done over the

past four years without any success (only local 3-4 level pain when

walking that

Terrible Hip pain!Not rated yet

During my 22 years in the Army I always had some back problem but

nothing I could not stretch out and continue exercising and have normal

movement.

Condition arose during pregnancy!Not rated yet

I'm 7 months into my first pregnancy and I am in absolutely excellent

health. I have not gained much weight and am just starting to show a

belly. For

TIGHT ILIACUSNot rated yet

My physiotherapist diagnosed a tight iliacus and psoas last January. After

only one massage treatment the psoas loosened up but it's been 4

months and

Feeling Much BetterNot rated yet

Dear Stephen O'Dwyer, I can not find words to tell you how grateful I am!

You literally saved my life from every day and every night pain. It all

Dangerous Condition?Not rated yet

Sounds like me, I have the symptoms almost to the core of what you say

can present. Dr. hasn't figured it out yet. Haven't had MRI yet but hoping

for

Distance Runner Hip PainNot rated yet

I am a collegiate distance runner who has been out for 4.5 months. From

December 20th to March 7th I was recovering from bilateral femoral

stress fractures.

Hip and groin painNot rated yet


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I am a 55 year old woman. About 10 years ago I began having pain deep

on my hip in the middle of the night. Sometimes it was my left hip, other

times my

Long Distance Driving Causing PainNot rated yet

I am a 54 mother of three teenage children. I am 5'2" tall and weigh

about 8 stone (128 lbs I think). Until the children started at secondary

school

Pain and Weakness in My Right LegNot rated yet

I'm not exactly sure how it happened, either by dead-lifting or by doing

yoga. It started out as a little bit of tightness in my h ips and general

Lower Back Pain for 4 YearsNot rated yet

I got pregnant with my daughter 4 years ago and about 8 weeks later my

lower back pain started. I was in pain my entire pregnancy, unable to

enjoy any

Goodluck to Me & My Iliopsoas SyndromeNot rated yet

I just read about this iliopsoas on your site and I think this is what I have.

I've been suffering for 10 years now from this hip pain and every time

I've

"Hip Pain"Not rated yet

I'm an athlete who has been having this aching pain in my "hip" for

almost a year now. Luckily it has not yet affected my performance

because I don't usually

Nerve Pain Might Be Iliopsoas SyndromeNot rated yet

I am an accountant so I sit for most of the day. I am very active but I

have been limited over the last few years due to my hip problems. I had

sciatica


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6 Comments Sort by

Gustavo Bessone

Co-Founder and CEO at Taggify

Hi, I have a similar pain for almost 2 years now (5th november

2010 it started), done dozens of studies and seen dozens ofdoctors and nobody has a clue of what I got fo r now.

Wonder if this might be related to it.

It started one night in a bar where I had too much beer, really

needed to pee and the line to the mens room was much longer

than usual. Had to hold it until my bladder was about to explode.

When I finally got to the urinal it just didn't come out. I tried to

force it (i believe I might have injured something at this point).

Later that night pee started coming out drop by drop until

... See More

Like Reply Sep 24, 2012 12:33am

Laverne Ishihara Higashionna

Registered Nurse at Kuakini Medical

Sometimes researching your own symptoms of pain u canstumble upon something like this and possibly say

"EUREKA!".....glad to know I amnot alone in having low right

sided pain near the SI joint AND hip/groin pain at he

sametime...my ortho didn't see how having both were even

related...go figure .

Like Reply 2 Sep 12, 2012 1:05pm

Sharen Clozza Malone

Love this website. I've only recently started having back pain

and terrible spasms. Everything I've read points to a contracted

iliopsoas, so I'm hoping to fix this before it becomes

debilitating. Thanks for this.

Like Reply May 24, 2012 5:08am

Norma Lundquist

Anoka-Ramsey Community College

I am reading this article because because I have been having

pain that started between my spine and my hip on the L side.So

far NOYHING helps it.I am a nurse and have had 2 back

surgeries.

Like Reply Jan 25, 2012 4:44am

Teresita U. Tiu

that's very helpfull.

Like Reply Jan 8, 2012 12:26am

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Iliopsoas Syndrome_ the Hidden Root of Pain