Acupuncture for Psoas Trigger Points
The iliopsoas or psoas muscle is a commonly overlooked area of muscle tightness that can cause pain in the front of the hip and low back. The main action of this muscle is to flex the hip (bring the knee towards the chest). It is one of the hip flexor muscles along with the rectus femoris.
The iliopsoas muscle is composed of the psoas major and iliacus. Part of the lateral psoas major muscle fibers fuse with the iliacus muscle fibers to form the iliopsoas muscle. The area is generally referred to as the “psoas” by many people but it can include both of these three muscles.
The psoas major crosses several joints including the hip, sacroiliac (SI), lumbosacral, and lumbar intervertebral. The iliacus crosses over only the hip joint.
The psoas minor is a small, thin muscle that lies anterior to the psoas major but is not considered part of the iliopsoas muscle group and does not cross the hip joint.
The iliopsoas muscle connects the upper body and trunk to the lower body. It helps to maintain posture and stabilize the low back as well as flex the hip. It helps stabilize and support activities like walking, sitting, and running.
Sitting for long periods of time can shorten the psoas and cause muscle tightness. When the psoas is tight or weak it can lead to compensation in other muscles in the low back, hip, and upper thigh which can lead to low back, pelvic, or groin pain. Trigger points in the iliopsoas, rectus femoris, and tensor fasciae latae (TFL) are the common causes of hip flexor pain.
The iliopsoas muscle is involved in creating an anterior pelvic tilt along with the hips flexors and lumbar extensors. Psoas muscle tightness can pull on the spine and ribcage which can lead to difficulty taking a deep breath into the abdomen and shallow, chest breathing.
Injuries associated with the psoas complex include iliopsoas tendinitis (snapping hip syndrome), and psoas syndrome. These issues generally occur due to psoas muscle tightness and hip flexor tightness which pulls on the attaching structures and causes pain and inflammation.
Origin and insertion of the Iliopsoas Muscle
Psoas Major
The psoas major muscle originates along the bodies and transverse processes of the lumbar vertebrae. It inserts at the lesser trochanter. This means that it connects the low back to the leg (femur).
Iliacus
The iliacus muscle originates in the iliac fossa and inserts at the lesser trochanter. This means that it connects the hip to the leg (femur).
Origin and Insertion of the Psoas Minor Muscle
While not technically part of the iliopsoas complex, it is anterior to the psoas major. It is not present in all people. The psoas minor muscle originates at the body and transverse process of the first lumbar vertebrae (L1). It inserts at the superior ramus of the pubis. This means that it connects the low back at L1 to the front of the hip at the pubic bone.
Actions of the Iliopsoas Muscle
Flex the hip (psoas major and iliacus)
May laterally rotate the hip (psoas major and iliacus)
Flex the trunk (psoas major and iliacus)
Tilt the pelvis anteriorly (psoas major and iliacus)
Assist to laterally flex the lumbar spine (psoas major only)
Actions of the Psoas Minor Muscle
Tilt the pelvis posteriorly
Assist to create a lordotic curve in the lumbar spine
Source: Biel, A., & Dorn, R. (2010). Trail guide to the body: A hands-on guide to locating muscles, bones and more. Boulder, CO: Books of Dicovery.
Synergists and antagonists of the Iliopsoas Muscle
When flexing the hip, synergists to the psoas include the rectus femoris and pectineus muscles. They are also assisted by the other hip flexors and adductors. Antagonist muscles include the gluteus maximus, hamstrings, and part of the adductor magnus muscle.
Trigger Points in the Iliopsoas Muscle
Travell & Simons refer to the ilipsoas muscle as the “Hidden Prankster” because it serves many important functions that can cause pain while also being relatively deep and inaccessible. It can also cause changes in posture which affects back and neck muscles leading to trigger points in these areas. Trigger points in the iliopsoas or quadratus lumborum muscles can be part of failed low back pain surgeries.
There are three main trigger point areas in the muscle that generally refer pain to the low back, to the sacrum, and to the upper part of the thigh or groin area. Palpation in the abdominal trigger point area generally refers pain to the back along the spine down to the sacroiliac joint, sacrum, and upper gluteal area. Palpation of the lower trigger points may refer pain to the back and also to the upper thigh and groin area.
Trigger points in the iliopsoas are usually associated with trigger points in other muscles like the quadratus lumborum, rectus abdominus, hip flexors, adductors, and paraspinal muscles.
Signs and Symptoms of Psoas Tightness and Trigger Points
Low back pain on one side that goes vertically down the spine or bilaterally that goes across the low back
Pain when standing upright, but remains as a slight ache when sitting
Difficulty getting up from deep seat position
Pain or inability to do sit-ups
Lower right quadrant pain (psoas minor pain can mimic appendicitis)
How Do Psoas Trigger Points Form?
Trigger points in the psoas generally form from activities that keep the muscle in a static position for long periods of time or overload the muscle. Prolonged sitting and sleeping in the fetal position are the most common ways that this muscle tightens and shortens because of the static hip flexion involved. A sudden fall or doing lots of sit-ups can also overload the muscle and create trigger points. Pregnancy also puts increased stressed on the iliopsoas muscle as well as other abdominal and trunk muscles.
The psoas muscle can get overloaded from weak core muscles, especially the rectus abdominus which makes the psoas have to compensate.
Iliopsoas Trigger Point #1
This is the highest iliopsoas trigger point and mainly refers pain to the low back.
Iliopsoas Trigger Point #2
This trigger point is located in the belly of the iliacus muscle inside of the iliac crest of the pelvis. This area usually refers pain to the low back and sacroiliac joint areas.
Iliopsoas Trigger Point #3
This is the lowest of the iliopsoas trigger points and often refers pain to the low back, groin, and front of the thigh.
Travell, J. G., Simons, D. G. (1993). Myofascial pain and dysfunction: The trigger point manual (Vol. 2). London: Lippincott Williams & Wilkins.
How Can Acupuncture and Dry Needling Release Psoas Trigger Points?
Trigger point acupuncture or dry needling can provide a psoas release by identifying the taut bands of muscle that create the pain referral pattern and eliciting a twitch response to relax the muscle to restore function, improve range of motion, and reduce pain.
Identifying trigger points and providing psoas muscle release with acupuncture and dry needling is one of the most effective ways to relieve pain in this muscle group.
The Psoas Muscle and Emotional Trauma
The psoas muscle is a place that our body can store emotional trauma. Dr. Peter Levine found that animals use shaking, tremoring, and flailing their limbs to discharge their body’s tension to complete the fight or flight response after a traumatic event. He developed a therapy style called Somatic Experiencing that provides a body centered approach to therapy for healing trauma. The fight or flight and freeze responses are how our body responds to danger, and our muscles tense up so that we can act accordingly. When we don’t complete this cycle our body store the tension in our muscles and fascia which over time can lead to trigger points and pain.
More about Somatic Experiencing here.
Following this work, Dr. David Berceli developed a set of exercise called Trauma Releasing Exercises which mimic the way animals discharge stored tension following a traumatic event. He found that the psoas muscle is typically inhibited after a traumatic event and that these tremoring exercises can release it.
The psoas muscle connects your trunk to your legs via the lumbar spine and femur and is the strongest hip flexor muscle. This means it controls many aspects of movement from our core area. Research has shown that the psoas muscle is part of the human psycho-somatic experience and is activated when we are faced with dangerous or traumatic situations.
Other Ways to Release the Psoas
Psoas Muscle Exercises
These exercises help activate and engage the psoas muscle:
Sit up (and variations)
Hip raise (and variations)
Cable twist (and variations)
Side bend (and variations)
Psoas Muscle Stretches & Yoga Poses
These yoga poses provide a combination of psoas stretch, psoas release, and psoas activation:
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