The description is appropriate. The iliopsoas muscle is a major body mover but seldom considered as a source of pain. It mimics low back pain, hip pain, and leg pain individually or in combination.

Have you ever had lower back pain that didn’t seem to get better in a reasonably short time? Even with therapy and chiropractic adjustments, did the condition seem to gradually worsen? Did it seem to spread to surrounding areas in the hips, legs and mid back regions? The chances are you were dealing with an iliopsoas muscle spasm. It often accompanies other conditions affecting the low back.

It’s very important to understand the anatomy involved. The iliopsoas muscle is comprised of two parts. The iliacus and the psoas muscles are joined to each other laterally along the psoas tendon. The iliopsoas originates anterior to transverse processes of the T12 (mid back) to L5 (low back) vertebrae and inserts into the lesser trochanter of the femur.

This location, major action and inaccessibility account for it being a great pretender. Since it originates anterior to the tranverse processes and angles internally there is no therapy that will penetrate deep enough to affect it from the posterior. The lumbar (lower back) attachment and innervation account for the pain felt in the posterior lumbar region. Because it is a major flexor, if it is in spasm, it will cause many of the regional muscles to compensate and become over used, hypertonic, spasmodic and painful in their own right. Since it is a muscle not known nor understood by most people, it is difficult for most people to describe the location any more specifically than the low back.

Classic symptoms of an iliopsoas muscle spasm are diffuse achy-type low back pain of a few days onset. The history is generally not specific to an injury that would be considered low back pain, but it can be. The pain seems to spread to the rest of the low back, lower thoracic (mid back) and even into the gluteal and lateral hip regions. Most often a key factor is initial pain upon rising from a seated position which may dissipate in a short time. It is difficult to stand upright quickly. Standing, walking and lying down don’t seem to affect it badly. Occasionally there may be pelvic discomfort and bowel complications in the history. Sitting down often experience relief of pain. However, extending the leg, as in driving, can make the pain worse. The types of physical actions, which seem to cause this condition are standing and twisting at the waist without moving the feet. Any action which causes the leg to externally rotate while in normal extension; and even doing too many sit ups (this is the muscle which completes the last half of a sit up).

The most positive diagnostic test that a person can do is by locating the femoral triangle and pressing a finger approximately 1” deep into this area. Do this in more than one spot on the triangular area of the knee. If your iliopsoas muscle is in spasm you will practically jump off your seat. It is that painful. It has been compared to by many patients as being as painful as childbirth, root canals without being anesthetized, or body piercing with a flaming sword.

Now that you have determined what is causing the pain, how do you treat it? Unfortunately because of its location it is not treatable by most normal therapies. Many times even an adjustment will not relieve the condition, because once the adjustment is done the hypertonic muscle will return the joint to subluxation. In most cases you will need to treat the surrounding regions of associated muscle pain with trigger point therapy within the femoral triangle to the insertion region of the muscle. This is extremely painful, but the results can be phenomenal in its positive effect.

The actual “trigger point therapy” is performed by applying strong pressure into the femoral triangle. When your therapist finds the right spot you will know it because the pain is quite sharp. The pressure should be applied continually without moving the fingers. You will need to tell the therapist when the pain begins to become less sharp or begins to subside, not when it’s all gone, but only when it begins to subside. The therapist will then move their fingers a fraction of an inch in any direction and look for more trigger points. Generally you will have from 3-6 trigger point within the femoral triangle. Once each one has been treated, go over them again to retreat stubborn ones, which have come back. This process will take about 2-3 minutes per leg. When the therapy is done you should stretch each muscle by having the therapist press down on the bent knee and the contralateral hip while you resist the stretch. Hold this position for about 10 seconds. Then relax the leg. At this point the therapist should apply a little more pressure to the leg to give a small additional stretch to the muscle in a relaxed state.

You should have the treatment repeated the next day. Continue with treatment until the trigger points are no longer there when pressure is applied to them. The general sensation of pain will have subsided before this point is reached, but therapy must continue so that the dormant trigger points won’t return.

This condition, like many others we repeatedly face, maybe easily overlooked if you aren’t looking for it. Often it is the low back pain we notice instead. The next time you have low back pain and you don’t respond to therapy as expected, try looking for a different muscle – the iliopsoas – the great pretender.