Iliopsoas tightness can be a true pain that hides unidentified behind unexplained backache or impaired range of motion in the hip area.
Such symptoms, especially with time, can significantly lower one’s quality of life and subsequently affect their productivity and active participation in daily events.
Moreover, if left untreated, the ailment can instill the incorrect distribution of forces in the hip that may be hard to reverse in the future or predispose to further injuries.
Fortunately, the release of the so-called hip flexor trigger points can bring relief and prevent progression of the condition.
For better understanding, we will touch upon few essential information about hip flexor and it’s trigger points, prior discussing different ways to release it’s trigger points.
However, if you are interested you can jump straight to hip flexor trigger point release section.
How Hip Muscles Are Structured?
In human anatomy, multiple muscles cause movement in the hip – we can divide them into five larger groups:
The iliopsoas group, the gluteal group, the adductor group, the lateral rotator group, and other hip muscles that cause minimal movement in the hip joint, yet still offer their contribution [1,4,7].
The Iliopsoas Group
The iliopsoas muscle is the main flexor of the hip. In reality, it consists of two smaller muscles, the psoas major and the iliacus.
The first one runs from the bodies of L1 – L5 lumbar vertebrae down to the lesser trochanter of the femur. In the middle of the way, it merges with the iliacus, which, on the other hand, originates from the iliac fossa of the ilium and similarly attaches to the lesser trochanter.
Simultaneously, it is important to note that the iliopsoas tendon directly overlies the femoral head, hence when the muscle is shortened, its tendon continuously impinges on the femoral head causing iliopsoas tendinopathy .
Trauma, overuse injury as well as rheumatoid arthritis can greatly contribute to this condition.
The Gluteal Group
The main muscle of the gluteal group, alongside the gluteus medius, gluteus minimus, and tensor fasciae latae, is the gluteus maximus.
Having its origin on the ilium and the sacrum, whereas its end on the glueal tuberosity of the ilium, it is the greatest extensor of the hip.
It can particularly be altered when the iliopsoas is shortened, what can later result in the dominance of the hamstrings and adductors of the thigh upon moving .
The other gluteus muscles lie partially covered by gluteus maximus.
The Adductor Group
The adductor group includes the adductor brevis, adductor longus, adductor magnus, pectineus, and gracilis muscles.
They all actively adduct the hip, originate on the pubis and ultimately attach to the medial posterior surface of the femur apart from the gracilis, which has its second insertion below the medial condyle of the tibia.
The Lateral Rotator Group
The name of the group suggests its function in the hip joint.
Concurrently, it consists of the externus and internus obturators, the piriformis, the superior and inferior gemelli as well as the quadrator femoris.
Every muscle of the group has its origin around the acetabulum and finally inserts around the greater trochanter of the femur.
Other Hip Muscles
Other hip muscles embrace the rectus femoris and the sartorius which partly support the movement in the hip joint, yet their main task is to move the knee.
For this reason, they are not always included in the muscles of the hip group.
What Are The Trigger Points For Pain And Discomfort In The Hip Flexors Muscles?
When the iliopsoas is shortened due to any reason, it forms so-called trigger points that refer the pain into the lower back, alongside the spine as well as across the back .
They have been named this way primarily because they mostly cause symptoms when activated, or “triggered”.
What Causes Hip Flexor Trigger Points To Activate?
Many various activities can stimulate the hip flexor trigger points – these include [2,5]:
- Staying in the fetal position for a longer period of time, like when sleeping or resting – it is the most common cause as it effortlessly propagates prolonged static hip flexion
- Intensive, prolonged running and lunging
- Trunk rotations
- Bending to the sides when the core muscles are not strong enough – when the latter happens, especially in relation to the rectus abdominus, the iliopsoas muscle has to compensate
- Any muscle or length differences between your left and right sides
- Unstretched quadriceps muscle
- Any mechanical trauma to the iliopsoas muscle
- Sudden falls
- Lots of sit-ups
- Pregnancy – it naturally puts a bigger strain on the iliopsoas muscle
What Are The Symptoms Of Hip Flexor Tightness And Activated Trigger Points?
As described previously, the main cumbersome symptom of iliopsoas tightness, its tendinopathy, and activated trigger points is pain.
It can get relatively intense, no matter if you are standing or lying down, and radiates in a typical pattern – primarily to the lower back, alongside the spine and across the back, nonetheless, it can also reach the front thigh [1,2].
It can be unresponsive to various attempts of bringing relief. Simultaneously, the so-far-correct model of movement in the hip joint becomes impaired.
First, when the iliopsoas gets shortened, the gluteux maximus, the antagonistic extensor muscle of the former, is altered and later weakened.
This, on the other hand, can later lead to the dominance of the hamstrings and the adductor muscles when moving the hip, which can greatly hinder the intended trajectory of movement.
Afterward, one’s gait becomes visibly affected .
How To Release Hip Flexor Trigger Points?
Cable twists strengthen the core muscles, mainly the obliques, so that the iliopsoas does not have to compensate anymore.
- Attach a handle at the hip level.
- Stand sideways to the handle at an angle with feet pointed slightly away.
- Take a grip of the handle with the nearest hand, then join with the second hand.
- Activate your core muscles and rotate inward and then away from the handle so that you are facing in the opposite direction.
- Carefully return to the starting position.
The hip raises are great both for flexing the muscles of the hip area as well as for strengthening the gluteus maximus what is important in preventing the shortening of the iliopsoas.
- Lie down comfortably on a mat or on the ground with your knees bent and feet flat on the floor. Keep your arms on the sides of your trunk.
- Activate your core and glutes to raise your hips from the ground so that your body forms a straight line from the shoulders to the knees. Stay in this position for a while.
- Gently lower your body back to the starting position.
- To engage the muscles even more, you can secure a handle or any other appropriate object on the front of your hips with the hands so that your body has to overcome more weight.
- Lie down on your stomach and place any ball high up towards your hips.
- As you transfer body weight onto the ball, relax as much as possible to let the ball push inside your pelvis. Breathe calmly and deeply. Maintain this position until you feel the muscles are relaxed.
- Move the ball to a different position and repeat. Release the tension in all found trigger points.
The boat pose effectively strengthens both the hip flexors as well as the muscles of the core.
- Sit with your knees bent on the floor, place the hands behind the knees.
- On an inhale, engage the back and core muscles and lift the chest.
- Engage the thigh muscles to draw your lower belly in and up more accurately.
- Arms should stay parallel to the floor.
- The legs should be fully straightened.
- Maintain this position for a couple of breaths.
Pigeon pose is excellent for increasing hip mobility while especially targeting the iliopsoas.
- Start from all fours.
- Bring your right knee towards your right wrist. Place your right foot next to the left hand so that the shin lies perpendicular to the left leg.
- Make yourself comfortable in the position. You can either keep your back straight up or lower yourself to the ground so that your forehead lies on the floor to deepen the stretch even further.
The triangle pose strengthens not only the core muscles but also those of the hip. Moreover, it is refreshingly energizing.
- Start from the five pointed star pose, standing with your legs at a 90 degree angle and your arms straightened parallel to the ground on the sides of your trunk.
- Turn the left foot outwards so that it is perpendicular to the second foot.
- Inhale and extend the torso towards the left side, gradually bending at the hips.
- Exhale and bring the left hand towards the floor. Place it behind the left foot.
- On an inhale, stretch the right arm up.
- Breathe to get into the pose more deeply.
Acupuncture can successfully provide iliopsoas release by identifying and addressing the pain-referring trigger points [5,6].
Consequently, the muscle becomes stronger and its function is restored, similarly to the hip joint range of motion. Ultimately, one does not experience the associated pain anymore.
A massage performed by a trained professional will effectively alleviate the symptoms of the shortening of the iliopsoas muscle .
Similarly to acupuncture, the technique is so beneficial since it can effortlessly target every trigger point that the patient has, as well as simultaneously address the surrounding muscles for an enhanced effect.
The efficacy of massages has been confirmed by multiple studies.
5. Steroid Injections
Research shows that steroid injections into the iliopsoas trigger points can notably mitigate the back and thigh pain as well as the impairment of joint function associated with the shortening of the muscle [1,7].
This technique is extremely precise since the injections are ultrasound-guided.
Usually, it is implemented short-term, yet can be repeated when recommended by a medical professional.
Further Details On Hip Flexor Trigger Point, And Different Ways To Release The Activated Trigger Points.
- Zhaochen Zhu, Jieyuan Zhang, Jiagen Sheng, Changqing Zhang, and Zongping Xie; Low Back Pain Caused by Iliopsoas Tendinopathy Treated with Ultrasound-Guided Local Injection of Anesthetic and Steroid: A Retrospective Study
- INSYNC PHYSIO Sports & Orthopaedic Rehab; Myofascial Release for Hip Flexors to Relieve Low Back Pain
- Shirin Aali, Amir Letafatkar, Ismael Ebrahimi, Amir Hossein Barati, and Malihe Hadadnejad; Does Iliopsoas Tightness Affects Synergistic Muscle Activity in Hip Extension During Stance Phase of Gait?
- Wikipedia; Muscles of the hip
- Morningside Acupuncture; ACUPUNCTURE FOR PSOAS TRIGGER POINTS
- Christian Haser, Thomas Stöggl, Monika Kriner, Jörg Mikoleit, Bernd Wolfahrt, Johannes Scherr, Martin Halle, Florian Pfab; Effect of Dry Needling on Thigh Muscle Strength and Hip Flexion in Elite Soccer Players
- Antonio Frizziero, Filippo Vittadini, Andrea Pignataro, Giuseppe Gasparre, Carlo Biz, Pietro Ruggieri, and Stefano Masiero; Conservative management of tendinopathies around hip
- Joanne L Kemp, May Arna Risberg, Andrea Mosler, Marcie Harris-Hayes, Andreas Serner, Håvard Moksnes, Nancy Bloom, Kay M Crossley, Boris Gojanovic, Michael A Hunt, Lasse Ishøi, Nicolas Mathieu, Sue Mayes, Mark J Scholes, Mo Gimpel, Daniel Friedman, Eva Ageberg, Rintje Agricola, Nicola C Casartelli, Laura E Diamond, H Paul Dijkstra, Stephanie Di Stasi, Michael Drew, Matthew Freke, Damian Griffin, Joshua Heerey, Per Hölmich, Franco M Impellizzeri, Denise M Jones, Ara Kassarjian, Karim M Khan, Matthew G King, Peter R Lawrenson, Michael Leunig, Cara L Lewis, Kristian Marstrand Warholm, Michael P Reiman, Adam Semciw, Kristian Thorborg, Pim van Klij, Tobias Wörner, Mario Bizzini; Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network