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Low Back Pain – Origins of Internal Abdominal Muscle

This article is written at a level that requires some knowledge of anatomical attachments, ie: muscle origins and attachments, as well as muscle names.

If you want to know more, I encourage you to search online for an anatomy atlas or dictionary to help you with the muscles and definitions you don’t understand.

You can find one by searching for ‘anatomy’ in any search engine.

I have been developing my diagnostic and massage treatment skills in a fitness setting for two years and as a massage therapist in a private home clinic setting for five years.

Many of the clients who come to me for injury therapy complain of back and buttock pain.

The glutes meet at the top of the hips and are primarily responsible for lifting the femur, or upper thigh, up and out, which we call abduction. These muscles are also used in conjunction with the hamstrings that flex the leg back at the knee and extend the leg back at the hip.

For those of you reading this article with little or no anatomy background, I will detail the insertions of the ilio-psoas.

First of all, the iliopsoas is a combination of two muscles, the iliacus and the psoas major.

The iliacus originates from the inner or medial side of the ilium or hip bone. It continues caudally through the pelvic bone to the inner thigh, where it joins the femur. When the iliacus contracts, it anchors the pelvic bone or ilium with the hamstrings, causing upward pressure on the leg, causing the hip to flex and the thigh and knee to move upward. This is one of the most important muscles to evaluate for gait dysfunctions.

The psoas originates from 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 tense, which is seen when the hands are not symmetrical. aligned to the sides of the column. pelvis, when the client is standing.

There are psoas muscles on both sides of the spine, one for each leg. An imbalance in one can cause spinal rotation leading to muscle sparing and further dysfunction.

The psoas attaches to the iliacus muscle at the middle of the ilium (hip bone) and attaches to the same attachment 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 pelvic alignment visually in a frontal view, I generally notice one of two signs; Firstly, the hands are anterior to the frontal plane of the body, or secondly, the position of the hands is asymmetrical, that is, they are not placed equally on both sides of the pelvis. With a tight left iliopsoas, one would note the right hand to the side, and the left hand placed more anteriorly in the frontal plane and adducting toward the midline. The left hand may also have moved posteriorly to the left buttock. With a tight right iliopsoas, the hand position would be reversed.

*:frontal plane: it is the plane seen from the front, perpendicular to the viewer, of a line that is drawn through the body from the head to the feet, separating the front from the back.

Physical assessment: With the client in the prone position, face up, I perform a buttock stretch bringing the knee to the chest. This tells me if the glutes are contracted and adding resistance to the mobility of the pelvis. Second, I bring the knee across the chest to the other side, to test the lateral resistance of the piriformis and obturator. Third, I place the left leg in a figure four position with the plantar surface of the left foot against the inner or medial border of the right knee of the opposite leg.

This allows me to assess adductor tightness, which also contributes to pelvic strength and mobility. My experience has led me to conclude that in almost all cases of iliopsoas dysfunction it has been associated with hypertonic (tight) adductors on the same side (ipsilaterally) as the tight or dysfunctional iliopsoas. However, there is not always an associated hypertonicity of the buttocks.

My findings are that there is often an associated contraction of the gluteal and adductor muscles, including the adductor magnus, which also involves the hamstring.


First, I warm up the obliques and six pack to allow for deeper treatment of the iliacus and psoas.

Second, I treat the iliacus by adducting the leg in a rolling motion with the knee.

Third, I work my way to the junction of the iliacus and psoas and release any tension there with acupressure.

Next, I find the belly of the psoas with the client performing a knee-to-chest contraction and then release the psoas with the leg rattling towards the table and turning the thigh out to further lengthen the psoas.


The interesting finding is that there is sometimes a contralateral relationship with contraction of the iliacus and psoas. If I have a tight lower back on the right side, with hypertonic (tight) quadratus lumborum, I will also detect a short leg on the right side, prone or supine, I will also detect a tight psoas on the right side often with an iliac tight on the left side (in compensation mode) and a slightly to moderately tight psoas on the left side. The iliacus on the affected side may be slightly contracted or not involved at all. There are also some cases 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.


Ilio-psoas release results in a release of tension in the lumbar spine and surrounding tissues, including but not limited to the obliques abdominis and quadratus lumborum, which are the flexion brakes that attach the ribcage to the pelvis. . Marked relaxation of the entire spine down to the nexus and occiput is usually observed.

A return to a balanced pelvis is often seen after treating the iliopsoas when prior to treatment there was an anteriorly rotated pelvis on one leg and an obvious short leg on the side with a tight iliopsoas.

The short leg appearance usually goes away after treating the iliopsoas (when there is no tension in the quadriceps or hamstrings). Treating the iliopsoas first when dealing with a client presenting with low back pain often resolves the pelvic rotation problem without treating the hamstrings or quadriceps. Although there is often a tight quadriceps with opposing hamstring tension associated with a tight ilio-psoas complex.

Follow-up: Since writing this article, I have observed a client who had psoas tightness and lumbar twisting as a result of knee reconstruction.

What had happened since its reconstruction was that the unreconstructed leg had become weaker in the quadriceps and hamstrings, and in the ilio/psoas muscle complex than the reconstructed leg. The consequence was a tighter iliopsoas in the reconstructed leg and also a lumbar twist to the opposite side.

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