This article is written at a level which requires some knowledge of anatomical attachments, ie: origins and insertions of muscles, as well as names of muscles.
Should you wish to know more I invite you to look online for an anatomy atlas or dictionary to assist you with muscles and definitions you do not understand.
You can find one by looking for 'anatomy atlas.org' in any search engine.
I have been developing my massage diagnosis and treatment skills in a fitness setting for two years and as a massage therapist in a private home clinic environment for five years.
Many of the clients who come to me for injury therapy complain of back and gluteal pain.
The gluteals attach at the top of the hips and are responsible mostly for lifting the femur or upper thigh up and outward, what we call abduction. These muscles are also used in conjunction with the hamstrings which flex the leg backwards at the knee and which extend the leg backwards at the hip.
For those of you reading this article with no or little anatomy background I will detail the attachments of the ilio-psoas.
Firstly the ilio-psoas is a combination of two muscles, the iliacus, and the psoas major.
The Iliacus originates in the inside or medial side of the ilium, or hipbone. It proceeds caudally down the pelvis bone to the inner thigh where it attaches to the femur. When the iliacus contracts it anchors the pelvis bone or ilium by the hamstrings, which causes an upward pressure on the leg and causes the hip to flex and the thigh and knee to move upward. This is one of the most important muscles in assessing gait dysfunctions.
The Psoas originates on the sides of the five lumbar vertebrae and also attaches to the transverse processes of those vertebrae, contributing to some rotation of the lumbar spine when tight, which is what is observed when the hands are not symmetrically aligned at the sides of the pelvis, when client is in standing pose.
There are psoas muscles on either side of the spine, one for each leg. An imbalance in one may cause rotation to the spine and cause muscle guarding and further dysfunction.
The psoas joins the iliacus muscle midway down the ilium (hipbone) and attaches to the same insertion on the inner thigh or femur. The psoas assists the iliacus in hip flexion and also flexes the torso when the action is reversed.
Visual assessment:
Upon investigation of pelvis alignment visually in frontal view, I usually notice one of two signs; firstly either the hands are anterior to the body's *frontal plane, or, secondly, the position of the hands is asymmetrical, ie: they are not equally positioned on both sides of the pelvis. With a tight ilio-psoas on the left one would notice the right hand at the side, and the left hand positioned more anteriorly on the frontal plane and adducting towards midline. The left hand may also have moved posteriorly towards the left gluteal. With a tight iliopsoas on the right the positioning of the hands would be reversed.
*:frontal plane: is the plane when viewed from the front, perpendicular to the viewer, of a line which is drawn through the body from head to feet separating front from back.
Physical assessment: With the client in the prone position, on their back, I perform a gluteal stretch by bringing up the knee to the chest. This tells me whether the gluteals are contracted and adding resistance to the pelvis mobility. Secondly, I take the knee across the chest to the other side, to assess piriformis and obturator for lateral resistance. Thirdly, I place the left leg in a figure four position with the plantar surface of the left foot against the medial or inside edge of the right knee of the opposing leg.
This allows me to assess adductor tension which also contributes to pelvic resistance and mobility. My experience has led me to conclude that in almost every instance of ilio-psoas dysfunction has been associated with hypertonic (tight) adductors on the same side (ipsolaterally) as the tight or dysfunctional ilio-psoas. There is however, not always an associated hypertonicity of the gluteals.
My findings are that often there is associated gluteal and adductor contractedness of muscles, including adductor magnus which implicates the hamstring also.
Treatment:
Firstly I warm the abdominal obliques and six-pack to allow deeper treatment of the iliacus and psoas.
Secondly I treat the iliacus by taking the leg into adduction in a waving motion with the knee.
Thirdly I work my way up to the iliacus-psoas junction and release any tension found there with acupressure.
Next, I find the psoas belly with the client performing a knee to chest contraction and then I release psoas with leg ratcheting to the table and rotating thigh externally to lengthen psoas further.
Findings:
The interesting finding is that there is sometimes a contra-lateral relationship to the contractedness of iliacus and psoas. Should I have a tight low back on the right side, with quadratus lumborum being hypertonic(tight), I will also detect a short leg on the right side, in prone or supine position, I will also detect a tight psoas on the right side with often a tight iliacus on the left side (in compensating mode) and a slight to moderately tight psoas on the left side. The iliacus on the affected side may be slightly contracted or not implicated at all. There are also some instances where there is only tension in the iliacus muscles bilaterally and not as predominant in the psoas. However, the reverse is never true; where there is tension in the psoas there will always be tension in the iliacus.
Conlcusion:
The releasing of the ilio-psoas results in a release of the tension in the lumbar spine are surrounding tissues, including but not exclusively the abdominal obliques and quadratus lumborum whicfh are the flexion brakes joining the ribcage to the pelvis. There is usually observed a marked relaxation of the whole spine up to the nexk and occiput.
There is often observed a return to a balanced pelvis after treating ilio-psoas when previous to the treatment there was an anteriorly-rotated pelvis on one leg and an obvious short-leg on the side with the tight ilio-psoas.
The appearance of the short leg is usually gone after treating the ilio-psoas(when there is absence of tight quadriceps or hamstring). Treating the ilio-psoas first when confronted with a client presenting with low back pain often resolves the issue of pelvic rotation without treating hamstrings or quadriceps. Although there is often a tight quadriceps with opposing ham-string tension associated with a tight ilio-psoas complex.
Follow-up: Since writing this article I've observed a client who had psoas tension and lumbar torsion which was the result of knee reconstruction.
What had happened since his reconstruction was that the non-reconstructed leg had become weaker in the quad and hamstring, and ilio/psoas muscle complex than the reconstructed leg. The consequence was a tighter ilio-psoas on the leg which had been reconstructed and also a lumbar torsion towards the opposite side.
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