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Treating trigger points in the psoas muscles - Dr. Jonathan Kuttner MD 


Contrary to some common misconceptions, trigger points in the psoas muscles can 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, L
1, 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)



Referred Pain

(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).

Differential Diagnosis

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.

Treatment Techniques

Spray and Stretch No
Dry Needling Yes
Wet Needling Yes
Deep Stroking Massage Yes
Compression Yes
Muscle Energy Techniques Yes
Positional Release Yes




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This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell. 




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