Hip Flexor (Iliopsoas) Pain Reduction Strategies

Hip Flexor (Iliopsoas) Pain Reduction Strategies
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If you’re back to ice sports, cycling, are sitting or driving more, or have been hauling heavy packs, you may be at risk for hip flexor tightness and pain. The biggest and deepest of the hip flexors is the iliopsoas, which begins as one muscle and splits off into two, the psoas major and the iliacus. About 50% of the population also has a psoas minor muscle.

Iliopsoas trigger points can cause pain in the most unusual places, including the mid and low back, upper buttocks, hips, groin, abdomen, and pelvic floor.

Hip flexor pain can be so debilitating, you may back off from your favourite activities, have a hard time sleeping, and may not be able to stand straight without pain. Tight iliopsoas muscles can also increase scoliosis, misalign the hips, and put compression on the intervertebral disks. There are so many ways to go about releasing these deep muscles that it’s a shame for anyone to suffer because they’re tight.

Some strategies:

• Active Stretching. There are a number of good iliopsoas stretches out there, such as the Sphinx and the Psoas Stretches.

The Sphinx: Lie on the floor on your belly, place your forearms flat on the floor with the elbows under the shoulders and the forearms on the floor in front. Allow your belly to press into the floor, while also keeping your shoulders pulled down away from your ears. Remain in this gentle stretch for a few minutes at a time.

The Psoas Stretch. This one by Stuart McGill of the book Low Back Disorders: Evidence-based Prevention and Rehabilitation:

Psoas
Stretch

Stand in a wide stride step, with the right foot back and the left foot forward. The right back foot ‘must’ be pointed straight forward and back, heel raised slightly. Bend your left knee forward, keeping your right thigh where it is. Do a pelvic tuck by pulling your belly button towards your spine. Lift your right arm out to the side as if it’s a raised stop sign, secure your balance, and lean slightly from the waist to the left. You should feel a stretch in the low back and hip area. Hold for 10 to 30 seconds.

• Passive Stretching. Highly recommended, Egoscue’s Supine Groin Stretch can take some time at first, but it’s worth it. Because hip flexors are often tight for a long time, the nervous system sets that tightness as the normal default. With this stretch, you’ll be coaxing the muscles to release, while at the same time retraining the nervous system to recognize a new, less-tense default. You’ll need a chair and a stack of books (or other suitable prop) for this stretch.

Egoscue’s Supine Groin Stretch: Lie on your back on the floor, place your right calf and foot on the chair with the knee at about 90 degrees, arms out to the sides. The left leg lies straight out, with the toe pointed up. You’ll need to place the stack of books or other prop on the outside edge of your foot to keep the toe

Left Supine
Groin Stretch

pointed straight up. If it drops out to the side, the stretch won’t work. Now all you do is lie there, allowing the tension and tightness in the back and hips to release. At first you may have to do this up to 45 minutes, until your body learns how to release. Once learned, you’ll find 5 or 10 minutes will often do the trick. Don’t forget to do both sides.

This and other great body release and alignment stretches can be found in Pete Egoscue’s book Pain Free: A Revolutionary Method for Stopping Chronic Pain.

•

Trigger Point Release. When you’re in a lot of pain, trigger point release of those naughty muscle knots can bring you fast relief. I highly recommend Clair Davies’ The Trigger Point Therapy Workbook, an excellent how-to guide that explains iliopsoas self-massage in depth. Pick up a copy of this book and familiarize yourself with the psoas method before giving it a try.

When doing the trigger point self-massage, Davies says, ‘You will recognize the exquisite tenderness of trigger points in the psoas when you touch it. When they’re bad, even light massage can be nearly unbearable, but don’t let the discomfort make you quit. Trigger points in psoas muscles must be dealt with and direct massage is the most effective way to handle them.’

Psoas Massage

I use self-iliopsoas trigger point release often during broomball and biking season...so year round. It keeps me sane and pain free.

Some cautions: It’s important not to put pressure on blood vessels, so if you feel a pulse shift your finger position. Be cautious about working higher than the belly button to avoid putting pressure on the kidney ureters. And normal massage contraindications apply.

• Acupuncture. It's actually quite amazing how well acupuncture can work for psoas pain and spasm. Many physios, chiropractors, and physicians are trained in Contemporary Acupuncture, which is geared towards muskuloskeletal issues. This type of acupuncture tends to be painless and relaxing.

• Physiotherapy. Make an appointment with your local physiotherapist to find out if you have any muscle imbalances, gait issues, or posture or joint problems that are leading to your psoas issues. They can set you up with a treatment program that progresses as you do.

Even if you’ve suffered for years, you’ll be amazed at how effective these hip flexors strategies can be. And with less tightness and pain you can get back to doing what you love.

Photo Credit: Fernando Weberich

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