by Cindy Lavin, LMT  December 2020

While in school at Healing Arts Institute in Fort Collins, Colorado, we were taught that 85-90 percent of back pain is caused by tension of the iliopsoas muscles. I had always remembered this teaching, but I did not know its importance until I entered the massage therapy industry and realized the extreme prevalence of back pain in society.  

The two muscles comprising the iliopsoas, the ilacus and the psoas, are in themselves a little-known cause of back pain in the medical industry.

Just last summer, I had two clients admitted to the ER with back spasms and unbelievable back pain, where they were administered muscle relaxants and/or pain meds, with no acknowledgement of the actual cause of the symptoms.  Each of them had not been to see me in over a month, and they had been doing things that often cause increased tension on these muscles – primarily sitting, biking, running. And to top it off, these muscles are also muscles of emotion. The psoas muscle is often called the "fight or flight" muscle, whereas stressful experiences allow the muscles to hold an incredible amount of emotional residue. When these clients returned for massage the following week, we were able to release the iliopsoas and reduce/relieve the symptoms plus add new routines for self-release.

Another client, a young gentlemen who had quit his job from the sheer pain of what he thought was his “internal organs”, had been prescribed a colonoscopy and was seeing numerous medical personnel. Once we released his iliopsoas and taught him self-administered release, he has gone back to work and rejoined society.

Yet another example, a  gentlemen in his sixties complained of GI issues, low back pain, tingling in the legs and had undergone an MRI and multiple sessions with medical personnel. After just one session in which we released the iliopsoas, the client sent me this note, “I wanted to let you know that there have been positive results from the therapy yesterday. Back pain was severe last night but is much better today, better than it has ever been. Also, and most important, is the bladder, GI issues I was having seem to have diminished.”  After six weekly sessions, and teaching this client self-guided “how to” release of the iliopsoas, the client has been in relief of these symptoms.

There are an incredible amount of issues that can be caused by a tightened iliopsoas including, but not limited to:

• Back pain
• Knee pain
• Leg length discrepancy
• Shallow breathing
• Poor posture
• GI issues
• Poor posture
• Sciatica

When clients visit my practice and we release either or both of these muscles, there is almost always immediate relief.  With this release, and with knowledge of the actual cause of these back symptoms, the client can learn to release this on their own and return for periodic massage sessions while being extremely pleased with the results.

Let’s review these two muscles, the iliacus and the psoas.  The psoas major originates at the base of the rib cage (T12) and the lumbar spine (L1-4), moves inferiorly across the rim of the pelvis and inserts at the inner thighbone (femur).  The illiacus originates at the illiac fossa (posterior pelvis) and also inserts at the trochanter.  Together these muscles are known as the illiopsoas.

Most clients complaining of back pain believe the cause to be the back. And, it is possible that pain originates there.  However, normally with low back (SI joint and/or QL) or mid back pain (just inferior to the ribs), I will check the muscles opposite the back.  I will check for hypertension of the iliacus and psoas muscles.  I also often notice that the longitudinal arch of the foot exhibits knotting or tender areas which I associate due to reflexology knowledge and that these areas reflect to the area of the iliopsoas.

So, imagine a tightened iliopsoas.  This shortened muscle, in turn, causes the muscles to pull anteriorly on the spine and pelvis, causing pain and discomfort, primarily noted by clients in their back, but can also cause issues in the lower abdomen in general. If your psoas muscle is tense, it can put pressure on your facet joints, create shearing forces in your lower spine and stress the lower discs. Unfortunately, any tightening of either the illiacus or psoas muscle is going to affect the alignment and freedom of the sacroiliac joints. A tense psoas muscle can change your posture, which can affect your pelvis.  Many times when a professional notes that you have one leg longer than the other, it is, in fact, the psoas pulling on the pelvis and rotating it superiorly, causing a "pseudo" shortened leg.