Treating trigger points in the psoas muscles - Dr. Jonathan Kuttner MD
Contrary to some common misconceptions, trigger points in the psoas musclescan be treated safely and effectively with manual therapy
Trigger points in these muscles are too frequently overlooked and are often the source of lower back complaints.
Whilst the muscles are buried deep, they are often not as difficult to treat for trigger points as many might assume.
Whilst special care must be taken when treating the iliopsoas group (iliacus and the psoas), they can generally be treated effectively by a trained therapist.
About the Psoas Muscles
The psoas major and iliacus are considered part of the posterior abdominal wall because of their position and cushioning role for the abdominal viscera.
However, based on their action of flexing the hip joint, it would also be relevant to place them with the hip muscles.
Note that some upper fibers of the psoas major may insert by a long tendon into the iliopubic eminence to form the psoas minor, which has little function and is absent in about 40% of people.
Bilateral contracture of this muscle will increase lumbar lordosis.
Psoas Major (left) and Iliacus (right) - Common trigger point sites
[Greek psoa, loin muscle; Latin major, larger; ilia, the flanks]
Psoas major: bases of transverse processes of all lumbar vertebrae, (L1–L5). Bodies of 12th thoracic and all lumbar vertebrae, (T12–L5). Intervertebral discs above each lumbar vertebra.
Iliacus: superior two-thirds of iliac fossa. Internal lip of iliac crest. Ala of sacrum and anterior ligaments of lumbosacral and sacroiliac joints.
Psoas major: lesser trochanter of femur.
Iliacus: lateral side of tendon of psoas major, continuing into lesser trochanter of femur.
Main flexor of hip joint ( exes and laterally rotates thigh, as in kicking a football). Acting from its insertion, exes trunk, as in sitting up from the supine position.
Antagonist: gluteus maximus.
Psoas major: ventral rami of lumbar nerves, L1, 2, 3, 4 (psoas minor innervated from L1, 2).
Iliacus: femoral nerve, L1, 2, 3, 4.
Basic Functional Movement
Examples: going up a step; walking up an incline.
Psoas - Trigger Point Referred Pain Pattern (posterior)
Trigger Point Referred Pain Pattern (anterior)
(a) Strong vertical ipsilateral paraspinal pain along lumbar spine, diffusely radiating laterally 3–7 cm; (b) Strong zone of pain 5–8 cm top of anterior thigh, within diffuse zone from anterior superior iliac spine (ASIS) to upper half of thigh.
Low back pain, groin pain, increased (hyper) lordosis of lumbar spine, anterior thigh pain, pain prominent in lying to sitting up, scoliosis, asymmetry (pelvic).
Pregnancy (abortion), emotional overload, large lordosis, disc problems in lower back, or facet or spinal joint issues (such as degeneration, sacroiliac joint issues, and spondylolisthesis or spondylolysis in lumbar spine), running, repetitive strain, gardening, putting on shoes/socks while standing, housework, occupational positions, soft mattress, trauma, weak abdominals, abdominal surgery, sexual activity, short leg on one side (PSLE).
Osteoarthritis of hip. Appendicitis. Femoral neuropathy. Meralgia paresthetica. L4–5 disc. Bursitis. Quadriceps injury. Mechanical back dysfunction. Hernia (inguinal/ femoral). Gastrointestinal. Rheumatoid arthritis. Space- occupying lesions.
Quadratus lumborum, multi dus, erector spinae, quadriceps, hip rotators, pectineus, TFL, adductors (longus/brevis), femoropatellar joint, diaphragm, rectus abdominis, obliques, pyramidalis.
Avoid prolonged sitting. Avoid sleeping in fetal position. Self treat low back. Avoid overuse in sit-ups. Strengthen transversus abdominis. Stretching exercises.
|Spray and Stretch||No|
|Deep Stroking Massage||Yes|
|Muscle Energy Techniques||Yes|
About NAT Courses
As a manual therapist or exercise professional, there is only one way to expand your business - education!
Learning more skills increases the services that you offer and provides more opportunity for specialization.
Every NAT course is designed to build on what you already know, to empower you to treat more clients and grow your practice, with a minimal investment in time and money.
About Niel Asher Education
Niel Asher Education is a leading provider of distance learning and continued education courses.
Established in the United Kingdom in 1999, we provide course and distance learning material for therapists and other healthcare professionals in over 40 countries.
Our courses are accredited by over 90 professional associations and national accreditation institutions including the National Academy of Sports Medicine (NASM) and National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). Full details of all international course accreditations can be found on our website.
Printed course materials and other products offered on our websites are despatched worldwide from our 3 locations in the UK (London), USA (Pennsylvania) and Australia (Melbourne).
NAMTPT AWARD 2017
We are honored to have received the 2017 "Excellence in Education" Award from the National Association of Myofascial Trigger Point Therapists.
Since 1999 Niel Asher Education has won numerous awards for education and in particular for education and services provided in the field of trigger point therapy.
Award Winning Instructors
Niel Asher Healthcare course instructors have won a host of prestigious awards including 2 lifetime achievement honorees - Stuart Hinds, Lifetime Achievement Honoree, AAMT, 2015, and Dr. Jonathan Kuttner, MD, Lifetime Achievement Honoree, NAMTPT, 2014.
If you are a qualified/licensed manual therapist or exercise/fitness professional you can expand your credentials with NAT certification.
In addition to national accreditation for continued education, each course that we offer includes "NAT Learning Credits". By taking and completing courses you can accumulate NAT credits to qualify for NAT certification.
There are currently 3 levels of NAT certification. Certifying NAT is a valuable way to show your clients that you take continued education seriously, and to promote your skills and qualifications.
Most of our courses are accredited for CE/CPD/CPE. A full list of CE accreditations can be found by clicking on the link below.
Niel Asher Technique
Since 1999 the Niel Asher Technique for treating trigger points has been adopted by over 100,000 therapists worldwide, and has been applied to the treatment of a number of common musculoskeletal injuries.
The Niel Asher Technique for treating frozen shoulder was first introduced and published in 1997 and has been widely adopted by therapists and exercise professionals working within elite sports and athletics.
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We offer a range of over 50 courses, presented by some of the worlds leading manual therapists. All courses are reviewed annually, and new courses are regularly added.
Our courses are modular, and designed to build on what you already know. For more information, please visit our "Where to Start?" page.
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