The Iliopsoas Muscle
Instructions for Manual Therapy Treatment

Introduction to Treatment

The instructions on this page for treatment of the iliopsoas muscle are intended for use only by experienced manual therapists (physicians, massage therapists, physical therapists, etc.)

For information about how and why this complex muscle becomes problematic and painful, please go to Iliopsoas Syndrome: The Hidden Root of Pain.

These instructions are taken directly from the manual I give out to massage therapists in my classes.

The instructions are broken into two parts:

1. Iliopsoas Muscle: Manual Treatment of the Psoas
2. Iliopsoas Muscle: Manual Treatment of the Iliacus

The instructions assume that the practitioner has a solid grasp of both anatomy and hands-on skill. Due to the often extreme ischemia and tenderness found in these muscles, hands-on treatment must proceed very gradually, with great concentration and focus.

Listen to your client and don’t push them. The tissues will release much faster if you remain solidly within the client’s comfort zone and don’t repeatedly press up against their limit. Don’t hurry the treatment along.

Gently coaxing and encouraging the release of the soft tissues, rather than demanding it, will produce far superior results.

Iliopsoas Muscle:
Manual Treatment of the Psoas

I. Treating the Belly

A) Client supine with the knee bent, foot on the table on the treating side

     1. Practitioner stands on the same side of the table as the side to be treated

     2. If you’re having to bend forward, ask client to scoot toward you

B) With fingertips of both hands, locate the midway point between the ASIS and the naval

     1. With fingertips, sink down in a counterclockwise direction obliquely toward the midline (this gently moves organs out of the way)

     2. With your elbow on client’s knee, have them raise knee into elbow to test if you’re in the right place (you’ll feel psoas flex into your fingers if you are)

C) Once psoas is located, have client initiate and release lifting the knee. This action is hip flexion.

     1. This a very tiny movement

     2. Client is in control

     3. Movement just enough so the slightest increase in client sensation is felt upon lifting

     4. Tell client not to push off with the ball of the foot or pivot on the heel, but rather pull up through the top of the knee otherwise the muscle will not be properly engaged

D) See if you can identify:

     1. The top or center of the psoas

     2. The lateral side of the psoas

     3. The medial side of the psoas

     4. Communicate with client regarding level of tenderness

E) Locate the top or center of the psoas

     1. Repeat the contract and relax technique 4-6 times or until tenderness is decreased

     2. Move along psoas superiorly and treat this way

     3. Move along psoas inferiorly and treat this way

F) In some cases, it will be necessary to treat this way along the lateral and/or medial aspects of the psoas as well

G) If psoas in very tender, it’s possible that the psoas has active trigger points

     1. Check for trigger points with 3 communications:

          a. Is it tender?

          b. Does it refer (or is it only a local sensation)?

          c. Tell me when the referred sensation begins to fade.

IMPORTANT! Do not hold trigger points longer than about 12 seconds. If sensation increases rather than decreases either at the local point of contact or in the referred region it means you’re using too much pressure (Arndt-Schultz Law*). Leave the point and return to it later with lighter pressure.

*Arndt-Schultz Law
Weak stimuli activate physiological processes; very strong stimuli inhibit physiological processes.

II. Treating the Insertion

A) Client supine with the knee bent, foot on the table on the treating side

     1. Lay a flat hand onto the crease of the anterior hip to feel for the femoral pulse

     2. Once located, use fingertips to locate the psoas insertion just lateral to the femoral pulse

     3. Test if in correct place by having client engage and release psoas with hip flexion

     4. Use static compression as above while client engages hip flexion, and repeat several times

     5. If it is too difficult to maintain static pressure with fingertips, compress and release several times with client engaging hip flexion

Iliopsoas Muscle:
Manual Treatment of the Iliacus

I. Static Pressure with Client Contracting Iliopsoas Muscle

A) Client supine with the knee bent, foot on the table on the treating side

B) Practitioner stands on opposite side of the table and reaches across abdomen resting hands on iliac crest

C) If you’re having to bend forward, ask client to scoot toward you

D) Very slowly and gently sink thumbs obliquely into iliac fossa near crest of ilium. The iliacus can be very tender!

     1. Gently compress with thumbs just enough to contact muscle

     2. Thumbs should hook under crest of ilium, with the thumb pads angling upward

     3. Fingers grasp and stabilize at hip, gathering tissue to make entry point more slack

CAUTION! Pressure directly down into the table will intrude on organs, so be sure to hook under with thumbs rather than press straight down.

E) Ask client to very slowly initiate raising left knee 1/8 of an inch then rest (when iliacus flexes into thumbs it can be painful if the muscle is ischemic)

     1. This a very tiny movement

     2. Client is in control

     3. Movement just enough so the slightest increase in sensation is felt upon lifting

     4. Tell client not to push off with the ball of the foot or pivot on the heel, but rather pull up through the top of the knee otherwise the muscle will not be properly engaged

     5. The movement ends almost as soon as it starts, just long enough for you and the client to sense the muscle, then relax

F) Repeat 4-6 times or until tenderness is decreased

G) Explore other points along the muscle, making certain you arrive at a static spot before asking the client to initiate movement with leg

II. Gentle Compression

A) Gently compress iliacus along length of ilium, first at superficial level then increasingly more deeply

B) Work in rows, first along the top with gentle thumb compression, then slightly deeper and so on

C) Check for trigger points with 3 communications:

     1. Is it tender?

     2. Does it refer (or is it only a local sensation)?

     3. Tell me when the referred sensation begins to fade.

IMPORTANT! Do not hold trigger points longer than about 12 seconds. If sensation increases rather than decreases either at the local point of contact or in the referred region it means you’re using too much pressure on the iliopsoas muscle (Arndt-Schultz Law*). Leave the point and return to it later with lighter pressure.

*Arndt-Schultz Law
Weak stimuli activate physiological processes; very strong stimuli inhibit physiological processes.

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