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IliopsoasMusculus iliopsoas

Deep hip flexor made of psoas major and iliacus, running from the lumbar spine and inside of the pelvis to the lesser trochanter of the femur, and the strongest flexor of the hip.

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LatinMusculus iliopsoas
Origin
  • Psoas major, superficial part: sides of the bodies of T12 and L1–L4 and the discs between them
  • Psoas major, deep part: transverse processes of L1–L5
  • Iliacus: upper two-thirds of the iliac fossa (the inner bowl of the ilium), and the area near the anterior inferior iliac spine
Insertion
  • Lesser trochanter of the femur (psoas major and iliacus share the tendon)
Action
  • Both parts: flex the hip (the strongest hip flexor)
  • Both parts, with the legs fixed: bend the trunk forward on the hip, as in a sit-up
  • Psoas major, one side: laterally flexes the lumbar spine
  • Iliacus: acts only on the hip joint
NervePsoas major: anterior rami of the lumbar nerves (lumbar plexus); iliacus: femoral nerve (L1–L4 (psoas major L1–L3; iliacus, via the femoral nerve, L2–L4))
NameLatin ile, 'groin', and Greek psoa, 'muscles of the loins' — the joined iliacus and psoas.

Palpation

  1. Explain what you are going to do and get the client's consent first. Client supine with the knees bent and feet flat, or with a bolster under the knees, so the abdomen softens.
  2. Find the ASIS. Slowly curl your fingertips over the inside of the iliac crest, just behind the ASIS, and sink gently into the iliac fossa.
  3. Feel the soft, flat iliacus lying against the inside of the bone.
  4. Ask the client to lift the foot a little off the table (hip flexion); feel the iliacus firm under your fingertips. Psoas major lies deeper, beside the lumbar spine behind the abdominal organs.

Landmarks: Anterior superior iliac spine · Iliac crest

The iliopsoas is two muscles that share one tendon. Psoas major runs down beside the lumbar spine, and iliacus lines the inside of the pelvic bowl. They join near the groin crease (the inguinal ligament), cross the front of the hip joint and attach to the lesser trochanter on the inside of the femur. It is the main muscle for lifting the knee towards the chest, so clients who sit for long periods commonly report tight “hip flexors”.

It is the main antagonist of Gluteus maximus. Other hip flexors that help it are Rectus femoris, Sartorius and Tensor fasciae latae. In a relaxation routine you usually work it indirectly: a gentle Passive stretching of the hip into extension, or light work on iliacus just inside the Iliac crest. Direct, deep work on psoas through the abdomen is advanced work. It needs care around the abdominal organs and is not part of a standard relaxation routine. Just below the groin crease the muscle forms part of the floor of the femoral triangle, where the femoral nerve and large blood vessels run, so avoid deep pressure there.

Sources give slightly different details. The Wikipedia psoas article gives the origin as above; its infobox gives transverse processes of T12–L4 and the discs, and the iliopsoas article gives the vertebral bodies of T12–L3. The rotation action is unclear: the psoas article says psoas laterally rotates and weakly adducts the hip, while the iliacus infobox says iliacus medially rotates it (marked “citation needed”). Rotation is minor either way.

Techniques

  • Compression — Pressing straight down into a muscle with the palm, fist or forearm, holding briefly, then releasing and moving on.
  • Passive stretching — The therapist gently moves a relaxed limb to lengthen a muscle to a point of mild stretch and holds it there, with no effort from the client.
  • Passive range of motion — The therapist moves a joint slowly through its easy, comfortable range while the client stays completely relaxed.

Works with

  • Rectus femoris — Spindle-shaped muscle down the middle of the front of the thigh, the only quadriceps muscle that crosses the hip, so it both flexes the hip and straightens the knee.
  • Sartorius — Long, thin strap muscle, the longest in the body, running diagonally across the front of the thigh from the ASIS to the inner knee, which helps flex, abduct and laterally rotate the hip and bend the knee.
  • Tensor fasciae latae — Small muscle at the front of the outer hip, just below the ASIS, that tightens the iliotibial band and helps flex, abduct and medially rotate the hip.
  • Pectineus — Short, flat muscle at the top of the inner thigh, running from the pubic bone to just below the lesser trochanter, that flexes and adducts the hip.

Opposes

  • Gluteus maximus — The largest and most superficial buttock muscle, and the main extensor of the hip.
  • Hamstrings — Group of three muscles on the back of the thigh, running from the sitting bone to below the knee, that bend the knee and extend the hip.

Sources

  1. Wikipedia: Iliopsoas
  2. Wikipedia: Psoas major muscle
  3. Wikipedia: Iliacus muscle
  4. Wikipedia: Femoral nerve