Groin pain Part 10e: Self-treatment tips for the iliopsoas

Back pain, Groin pain, Muscle information, Self-treatment tips / Sunday, August 16th, 2009

This is a series on groin pain. Part 10 is about self-treatment. The previous posts give tips for treating the gracilis, sartorius short adductors and adductor magnus. These are tips I give groin pain patients in my Boston area Neuromuscular Therapy center. For positioning and landmarks go back to Part 10a. If you missed the beginning of the groin series, go back to Part 1.

The iliopsoas and tensor fasciae latae are hip flexors, crossing the joint on opposite sides of the hip bone (ilium). The iliopsoas also crosses through the groin and attaches deeply and just below the crease in the thigh. Also of importance, it has Trigger Points that refer to the groin.

Treatment protocol is to hold pressure for 8-12 seconds or until you feel a little less pain or a softening of the muscle. If you don’t feel a change, you can hold up to 20 seconds. If your muscle can’t let go by then, keep your fingers in the same place and let up pressure for a few seconds, then go in again in the same place. Your muscles need blood to release. Letting up pressure allows a fresh supply to flow in.

iliopsoas(larger illustration to come) Treat the iliopsoas: In a seated position, put your hands on your hips with your fingers facing forward to feel the bony angle of the ASIS (see part 10a). Reach inside the hip bone with your fingers and press or squeeze the iliacus portion of the psoas. The iliacus covers the whole inside of the ilium, so you can treat any places that you can reach with your fingers or thumbs, down to the inguinal ligament at the crease in your thigh.

Treating the psoas portion of the muscle is more challenging because it lies deep in the belly right against the spine. Lie on your back with your knee drawn up and supported on a pillow to keep it relaxed. Find your navel with your fingers and move a few inches to the side of it to feel the abdominal “6-pack,” (rectus abdominis). Relax your belly and exhale. At the edge of the rectus, and with three fingers held together, angle in and down toward the spine. (Your intestines will be soft and flat if there is no food in them.) Press until you get a sensation that may feel like gas or menstrual cramps. It could be painful and sharp if the muscle is unhappy. If you feel the strong pulse from the abdominal aorta, reposition your fingers so you’re not right on it. You will probably need assistance from your other hand to get enough pressure. The muscle attaches to all of the lumbar vertabrae (the lowest 5) so you can press all along it down into the pelvis. At that point it angles outward to join the iliacus portion inside your hip bone and can be treated with that muscle.

Treat the iliopsoas tendon and the lower portion of the iliacus over the hip capsule lying on your back as in the psoas treatment. With your hand on the side of your hip, fingers pointing downward, hook your thumb around the inside of the top of the thigh just below the crease and inside of the band of flexor tendons you feel at the front of the top of the thigh just below the ASIS. There will be a small deep hollow space there. Press straight down into this space to contact the iliopsoas tendon. Just above that space you’ll feel a hard place. That’s the hip capsule and the iliacus runs over it like a strap. Keep toward your hip bone away from the midline where you might feel a pulse. Pressure there relieves not only groin pain, but also low back tension. If you can’t get enough pressure, support your thumb with a closed fist, turning it to get a better angle for treatment.

The next post will be about treating the tensor fasciae latae.