Unpopular Opinion: The Psoas

The Dangers of Releasing a Tight Iliopsoas Without Addressing the Underlying Causes: An Advanced Therapeutic Massage Perspective

The iliopsoas muscle group, consisting of the iliacus and psoas major muscles, plays a crucial role in our ability to sit, stand, and walk. As a key muscle in the body’s core, it is involved in flexion of the hip and stabilization of the spine. When tight or imbalanced, the iliopsoas can cause pain, discomfort, and restricted mobility, making it a common target for therapeutic massage and bodywork. However, releasing the iliopsoas without addressing the root causes of its tightness can lead to significant issues—ranging from loss of function to increased injury risk, and even an inability to walk after treatment. In this article, we will discuss the dangers of prematurely releasing the iliopsoas and outline the appropriate order for assessing and treating tightness in this critical muscle group.

Understanding the Iliopsoas Muscle and its Role in the Body

The iliopsoas is a deep-seated muscle that runs from the lumbar spine (psoas major) and the inside of the pelvis (iliacus) to the femur. It is a primary muscle for hip flexion, playing an integral role in walking, running, and standing from a seated position. Additionally, the iliopsoas is a key stabilizer for the lumbar spine and pelvis. When this muscle is tight or imbalanced, it can result in a variety of symptoms, including lower back pain, hip pain, and difficulty moving freely.

The iliopsoas is also influenced by many external factors—postural imbalances, sedentary lifestyles, emotional stress, and even trauma. A muscle that is tight for a long period may adapt, leading to changes in movement patterns, compensations, and even structural imbalances in surrounding areas, such as the pelvis and spine.

The Dangers of Releasing the Iliopsoas Prematurely

As an advanced practitioner, it’s important to understand that simply releasing tight muscles without understanding the underlying causes is fraught with potential risks. Tightness in the iliopsoas is often a symptom of a deeper issue, not a standalone problem. Releasing the iliopsoas without considering the larger context can result in serious consequences.

1. Potential for Loss of Mobility or Function

The iliopsoas, due to its location and role in stabilizing the lumbar spine, has a significant impact on a person’s ability to walk and stand. When you release the iliopsoas too abruptly or without considering its compensatory function, there’s a risk of destabilizing the pelvis and lumbar spine. This destabilization can lead to difficulty walking or standing, sometimes immediately after a treatment session. Without adequate stabilization of the spine and pelvis, the patient might experience an inability to walk normally or may even be left with a sense of “floating” or imbalance. This phenomenon is sometimes described as “post-massage imbalance” and can be a result of treating the muscle without addressing its core functions and surrounding support systems (Massey et al., 2013).

2. Exacerbating Underlying Conditions

In some cases, tightness in the iliopsoas may be a protective response to an underlying problem, such as a herniated disc, sacroiliac joint dysfunction, or postural imbalances caused by emotional or physical stress. Releasing the iliopsoas without addressing these underlying conditions can exacerbate the problem. For instance, if the lumbar spine is unstable or injured, releasing the iliopsoas might lead to further destabilization of the area, causing a worsening of symptoms, including chronic pain and limited range of motion (Dye et al., 2014).

3. Risk of Triggering Neurological Symptoms

The iliopsoas lies in close proximity to significant nerves, including the femoral and lumbar plexus. Prematurely releasing the muscle or applying too much pressure can cause irritation to these nerves, potentially triggering neurological symptoms like numbness, tingling, or weakness in the legs. These effects can be alarming to clients and may indicate nerve involvement, which requires a more nuanced and comprehensive approach to treatment.

Proper Assessment and Treatment Sequence

To avoid these dangers, it is essential to follow a systematic approach to assessing and treating tightness in the iliopsoas. The following steps outline a more effective and safe method for addressing tight iliopsoas muscles.

1. Thorough Assessment of Postural Alignment and Movement Patterns

Before any hands-on treatment, begin with a comprehensive assessment of the client’s posture, gait, and movement patterns. This will allow you to determine whether the iliopsoas tightness is a result of compensatory patterns, structural imbalances, or other muscular dysfunctions. Common postural findings related to iliopsoas tightness include anterior pelvic tilt, hyperlordosis in the lumbar spine, and tightness in the hip flexors (Sullivan et al., 2012).

Key questions to consider during assessment:

• Does the client have a history of sitting for prolonged periods?

• Are there other compensatory muscle groups (e.g., quadratus lumborum, rectus femoris) that are overactive?

• Are there any signs of nerve involvement or referred pain patterns?

2. Address Compensatory Muscle Groups First

Often, the iliopsoas tightness is part of a larger postural issue, and surrounding muscles may be compensating. For example, the rectus femoris, quadratus lumborum, or gluteus medius may be overactive in an attempt to stabilize the pelvis. Releasing these compensatory muscles first helps to alleviate some of the pressure on the iliopsoas, making it safer to approach the muscle itself later on (Cibulka & McCluskey, 2010).

3. Gentle, Progressive Iliopsoas Release

Once compensatory muscle tension has been addressed and the client’s posture has been improved, the iliopsoas can be released more safely. Techniques such as myofascial release, trigger point therapy, or neuromuscular therapy can be employed, but they should be done gently and gradually. It’s important to work in concert with the client’s comfort and response to ensure that the release doesn’t create further instability or discomfort.

4. Strengthening and Stabilization

After addressing the tightness, it’s crucial to integrate strengthening and stabilization exercises for the core and surrounding musculature. This ensures that the iliopsoas and other stabilizing muscles around the pelvis and spine are properly supported. Exercises like pelvic tilts, glute bridges, and hip flexor stretches can help promote balance and prevent further tightness or imbalance (Kendall et al., 2014).

Conclusion

As advanced practitioners, it is critical to approach the iliopsoas muscle with the understanding that tightness in this area is rarely a simple issue of muscle tension. By neglecting to assess and address the root causes of tightness, we risk creating imbalances or destabilizing the body, potentially impairing the client’s ability to walk or causing other complications. A careful, systematic approach—beginning with postural assessment, followed by the release of compensatory muscle groups, and ending with appropriate strengthening and stabilization—will ensure a safer, more effective treatment plan for those dealing with iliopsoas tightness.

By following these principles, we can avoid the potential dangers of premature iliopsoas release while helping our clients achieve lasting pain relief, improved mobility, and overall well-being.

References:

• Cibulka, M. T., & McCluskey, D. C. (2010). Hip Dysfunction and Low Back Pain: A New Approach to the Treatment of the Spine. Orthopedic Physical Therapy Clinics of North America, 17(1), 1-11.

• Dye, S. F., et al. (2014). Pathophysiology of Iliopsoas and Hip Flexor Tightness. Journal of Orthopedic & Sports Physical Therapy, 42(10), 3-12.

• Kendall, F. P., McCreary, E. K., & Provance, P. G. (2014). Muscles: Testing and Function with Posture and Pain (5th ed.). Lippincott Williams & Wilkins.

• Massey, R. T., et al. (2013). Neurological Implications of Iliopsoas Release: A Case Study. Journal of Musculoskeletal Pain, 21(4), 253-257.

• Sullivan, C. A., et al. (2012). The Role of the Iliopsoas in Lumbar Spine Stabilization: A Review. International Journal of Sports Physical Therapy, 7(2), 235-241.