If you heard the word ‘Iliopsoas’ (illy-oh-soh-as), would you know what that was? Is it the name of a town in Europe? Is it a type of pasta? Is it a disease?! The answer is: none of the above. It is a muscle group, consisting of three muscles: psoas major, psoas minor, and iliacus, also known as the deep hip flexors.
The deep hip flexor muscle group initiates the forward movement of the leg, such as when taking a step. After this muscle has engaged, the large muscle groups of the legs and glutes take over to perform a full walking or running gait cycle. The deep hip flexors also help to stabilise the lumbar spine during movements of the torso.
Muscles generally become tight for two reasons: they are overworked, or they are underworked. In today’s society, the deep hip flexors can often become under facilitated, weak, and shortened from the positions we find ourselves in throughout the day. Driving a car, sitting at your desk for prolonged periods of time, constant sit ups, and running without activating your glutes can all contribute to tight deep hip flexors.
When these muscles get tight, they often manifest as lower back pain through the pain referral process. They can also cause the pelvis to tilt forward, which in turn constricts the muscles through the back, causing restriction through mid to lower back movements, creating a compressing pain in the lower back.
An Anecdote:
The trigger points in the iliopsoas, or deep hip flexors, can also mimic the pain you feel when experiencing appendicitis. I recently had a patient come to me with sharp, stabbing pain in her lower abdomen. When it first occurred, she was convinced her appendix was rupturing and, rightly so, took herself off to the hospital. After many hours at the hospital, she was discharged with the comment that her appendix was fine and she must be imagining it. She had come to see me about lower back tightness originally, but after some thorough assessment, I concluded her deep hip flexors were tight, causing a pain referral to the area where her appendix is located. After massage and manual therapy to release her deep hip flexors and glutes, the patient reported feeling a significant decrease in pain, as well as an improvement in movement through the lower back.
Some tips to help alleviate this lower back pain:
- Deep hip flexor stretching – stretching into a lunge
- Strength training for deep hip flexors
- Simple movement exercises performed in yoga, such as cat/cow and threading the needle
- Glute strengthening exercises
- Myotherapy to release muscular tension through the iliopsoas to reposition the pelvis
Myotherapy can release the tension in the muscles, and physiotherapists can help to strengthen and retrain the deep hip flexors and glute muscles. This allows the pelvis to be better supported.
So don’t forget about your hip flexors, they could be the source of your symptoms!
