Low Back Pain Related to the Iliopsoas Muscle

There are many causes and triggers of low back pain. One that can be difficult to identify is low back pain caused by the iliopsoas muscle. This condition is a particular presentation of iliopsoas or psoas syndrome. Iliopsoas or psoas syndrome are terms that encompass several conditions and are not particularly specific.  

Classically, iliopsoas syndrome often presents with pain or stiffness in the hip and thigh area, clicking or snapping in the hip or groin, pain that worsens when bending, or tenderness in the hip and groin. Iliopsoas syndrome is associated with pain and irritation of the iliopsoas muscle. 

The presentation of iliopsoas pain and irritation we are discussing today is a little different and presents primarily with low back, pelvis, and hip tightness, stiffness, pain, discomfort, and tingling, particularly in the posterior or the back side of your body. Pain with this condition varies from dull to sharp and can become quite severe, but is often difficult to precisely locate. When thinking about what commonly causes tightness, stiffness, pain, and tingling in the back, pelvis, and hip, we may consider muscles in these locations such as the quadratus lumborum, lumbar extensors, and gluteal, and often they are in fact tight, stiff, and hurt. In this situation, massage, stretching, and manipulation of these muscles helps temporarily, but tightness, stiffness, and pain return. This is due to symptoms produced by the iliopsoas muscle, which again is a hip flexor and not easily accessible from the back. That being the case, why do we feel the pain in the back and not in the abdomen or hip where the iliopsoas is located? 

This is due to the structures that the iliopsoas is attached to as well as a phenomenon called referred pain. 

The iliopsoas muscle is composed of several parts: the iliacus, psoas major, and psoas minor muscles. These muscles work together to flex the hip. Nerves that supply the iliopsoas muscle include branches from L1, L2, and L3. The iliacus portion originates in the iliac fossa, which is the inside of the large pelvic bowel, while the psoas portion attaches to and originates from the T12-L4 vertebral bodies, L1-L5 transverse processes, and the vertebral discs between T12 to L4. The 3 muscles come together and insert into the lesser trochanter of the femur. The iliopsoas is a large and powerful muscle. 

As we can gather from the origin attachments of the psoas in the spine and discs, tension in the psoas can pull on the back and discs leading to pain. Causing particular difficulty in determining this cause of low back pain is the psoas’ attachment to discs of the spine, as the psoas can cause disc type pain, as it directly pulls on the discs of the back. Massage, manipulation, exercise, and stretches for the discs of the back can therefore provide some relief, but unless they address the iliopsoas relief will be temporary. 

When irritated, the iliopsoas muscle itself can send pain to portions of the body that are distant from the actual location of the muscle due to the nerve supply to the muscle group. 

We have discussed how the iliopsoas muscle causes low back pain, but why does the iliopsoas become tight and painful? Iliopsoas problems often result from overuse, but can be associated with injuries such as auto accidents as well. As the iliopsoas flexes the hip, activities that require prolonged hip flexion make use of the iliopsoas muscle. The most common activity is sitting. Prolonged sitting in all its varieties such as computer work, watching TV, driving, and using a smartphone contribute to tight and irritated iliopsoas muscles. In regards to car accidents, many patients develop iliopsoas tightness and pain around 1-2 months after an auto collision if they sit for prolonged periods and have not been doing stretches for the iliopsoas muscle group. 

As the iliopsoas is both large and deep in the hip, it can be difficult to stretch. Tight quadriceps can limit the ability to stretch the iliopsoas as they can limit motion before the iliopsoas is stretched. Despite this, quadriceps stretches can help stretch very tight iliopsoas muscles. An example of a quadriceps stretch that can help would include standing with one knee bent while pulling your ankle back to stretch the front of your thigh. This helps to relax your quadriceps muscle and makes it easier to address the iliopsoas. A modification to this quadriceps stretch that can help the iliopsoas is to let up off the leg a little and let it down so you don’t have it fully bent. Next, you can pull it rearward with the goal of feeling tension or a stretch in the front of your hip or abdomen. Often, the sensation is of a mild tension, and this can be unsatisfying as far as stretches go and you may feel as though you are not stretching enough, however, rest assured that the tension in the front of the hip is the sensation we are looking for. 

A more direct stretch for the iliopsoas looks much like a hamstring stretch. When placing your leg rearward and bending your opposite knee as though to stretch the hamstring, you can lean back and away with your upper body to try to get the stretch in the front of your hip and abdomen. You may need to bend both knees a little to get a good stretch. Remember that the stretch may not be very intense, but keep it up and your iliopsoas muscle will relax and become less tense, resulting in improvement of your low back pain. Due to frequent sitting, iliopsoas stretches may need to be performed several times per day. It may be necessary to stretch every hour or so while sitting. 

Our Chiropractors will be able to determine if your iliopsoas muscle is causing your pain and discomfort, as well as provide exercise instructions and manipulation to address the iliopsoas and surrounding muscles and joints. Contact our chiropractic clinic in SE Portland, OR if you are suffering from back, pelvis, or hip pain whether the result of sitting or a motor vehicle accident.