The Many Faces of Iliacus Dysfunction

Iliacus Dysfunction comes in many shapes and sizes. If you're experiencing chronic or recurrent pain (or tingling, numbness, aching, or hot/cold sensations) in any of the following regions...

  • Lower abdomen

  • Groin

  • Buttocks

  • Down the leg

  • Hip Joint

  • Lower back

  • Sacroiliac Joint

  • Across the top of the hip bone (iliac crest)

  • Wrapping around to the lower back or buttocks

... and these symptoms have not responded to treatments such as injections, physical therapy, rest, etc. and/or the diagnosis has been inconclusive or vague, then you may be suffering from Iliacus Dysfunction.


Anatomy of the Iliacus and Psoas (aka Iliopsoas)


Tucked inside your hip bone and hidden from easy hands-on access lies one of the most potentially troublesome muscles in the body: the iliacus muscle.

This muscle is the often-ignored neighbor of the more well-known psoas muscle.

Together the iliacus and psoas are often referred to collectively as the iliopsoas because they share a common attachment at the upper inner thigh, the lesser trochanter.

Here's what the two muscles look like together:

The muscle attaching along the lumbar spine is the psoas.

While they are both primary hip flexors with a common attachment, they are distinct muscles and can cause unique problems.

Here I will focus on the iliacus. Over many years of treating chronic pain I have found that this muscle is the root of much unexplained misery.


What's the Basic Problem?

One very common problem of the iliacus is that it can shorten over time. This can be due to prolonged sitting and/or driving and the absence of regular stretching. Shortness in this muscle can be a particularly tenacious problem in athletes who don't stretch enough because their iliacus muscles may be quite strong.

A strong, flexible, resilient muscle is a good thing.

But a strong, dense, short, inflexible muscle is not.

Prolonged sitting with the iliacus in a shortened state, or just the lack of stretching over time, can lead to the iliacus getting used to its shortened position. Put another way, the iliacus adapts to the shortened position. It becomes its natural state or typical state.

Once in an adapted state, the iliacus has trouble returning to its normal resting length. And this is where the trouble starts.

Chronic Muscular Contraction

If a muscle cannot return to its normal, healthy resting length, it then resides in a state of chronic contraction and numerous undesirable consequences can result:

  1. A chronically contracted iliacus can become ischemic (low blood flow). Imagine the white knuckles of a clenched fist. No blood flow there. An ischemic muscle is often a painful muscle.

  2. A chronically contracted iliacus can develop trigger points which refer pain (or numerous other possible sensations – thermal, tingling, numbness, aching) either radiating out from the muscle or felt in other parts of the body. Triggers points in the iliacus can refer sensation to the groin, the hip, down the leg, etc.

  3. A chronically contracted iliacus can distort the movement of the hip joint. For example, movement at the front of the hip joint could be reduced or restricted thus overworking other muscles in the hip.

  4. A chronically contracted iliacus can cause a variety of compensations or distortions in the body. If, for example, a tight iliacus reduces movement in one hip, then the other hip or the spine or other parts of the body may be called upon to compensate and change their normal pattern of movement.


Potential Regions of Pain Due to Iliacus Dysfunction

What this means for an individual whose iliacus is tight and short and ischemic (low blood flow) is that pain might be experienced in any of a variety of places in the body. During my twenty years of treating iliacus dysfunction, clients have presented with pain in all following areas of the body:

  • Lower abdomen

  • Groin

  • Buttocks

  • Down the leg

  • Hip Joint

  • Lower back

  • Sacroiliac Joint

  • Across the top of the hip bone (iliac crest)

  • Wrapping around to the lower back or buttocks

The problem an individual may face when being examined by a physician not trained in soft tissue problems is that examination of any of the above areas of pain may reveal exactly nothing.

Many standardized allopathic tests, including neurologic tests, will come back negative because they are not designed to evaluate soft tissue problems. Such problems can only be properly assessed with skilled palpation and structural evaluation.

Of particular difficulty in the case of the iliacus is the fact of its hidden location. This muscle is not easy to palpate if you don’t have any practice at it. On top of that, an ischemic muscle is often extremely sensitive and painful to the touch.

Palpation of the iliacus that is too deep or sudden or rough can elicit a defensive reaction causing inflammation and bracing in the muscle. Great care and gentleness is required in order to effectively treat it.

If I think this is the problem, can't I just stretch it out?

Yes, definitely. Sometimes stretching alone can relieve iliacus dysfunction. And stretching should always be part of an ongoing preventive strategy.

But often a tight, ischemic iliacus will not release without some gentle and detailed hands-on treatment.

Reason: Because a muscle that has become chronically locked and ischemic will often respond to the act of being stretched by clenching protectively. This can be true of any tight muscle in the body but seems particularly true of the iliacus.


Treatment for Iliacus Dysfunction

Iliacus Dysfunction can be remedied. Muscles that are extremely tender and ischemic often respond quickly to careful, gentle, and detailed hands-on treatment.

But treatment can't be rushed. While Iliacus Dysfunction will respond quickly to skillful and patient hands-on treatment it's really easy to try to do too much too quickly.

I will often spend the better part of entire hour applying slow and gentle and gradual manipulations. It's essential to stay in the patient's comfort zone and to not fall into the trap of thinking that pressing harder will be faster. It doesn't work that way.

At times my clients will urge me to "do whatever it takes", or say "just do it, I have a high pain threshold." For a client anxious to be free of chronic pain this is completely understandable. But it's a trap that is the surest way to slow down the treatment. It's far more efficient and more lasting to peel away layers of pain gradually.


how I work with iliacus dysfunction (and all pain issues in the body)

The treatment protocol that I typically follow will generally look something like this:

  1. After listening to a description of the problem and symptoms, we perform a gentle, thorough visual and hands-on evaluation.

  2. The nature of this work is such that evaluation and treatment are a blended process. Trying certain protocols and seeing if they are relieving gives us immediate feedback about the origin of pain and dysfunction.

  3. The protocols I choose to employ are determined by many factors and may include numerous hands-on techniques (including traditional massage, neuromuscular massage, myofascial release, deep tissue methods), movement techniques (including Active Isolated Stretching and Somatic Movement methods), and muscle activation techniques (including toning/strengthening and exercises I will give clients as homework).

  4. If the problem is rooted in the musculoskeletal system (as opposed to being rooted in pathological or neurological issues) then we expect to see some detectable response fairly quickly, often within one or two sessions. If imbalances in the muscles and fascia are at the root of the problem, then over the course of a handful of sessions we expect to see a measurable decline in symptoms.

Learn about self-treatment for this issue here...


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