Aug 2, 2021
Pain & Injury

Tight lower back? It could be a psoas trigger point

Tight lower back? It could be a psoas trigger point

If you’ve experienced lower back pain or tightness, you know how limiting it can be physically (and mentally) in your daily life. You’re not alone — it’s estimated that lower back issues may affect up to 80% of people during their lifetime, and this can happen across all ages.

For some, their lower back pain can resolve pretty quickly with some self-myofascial release, stretching, or massage. For others who aren’t as fortunate, where their lower back has become chronically tight and painful, those methods may only provide temporary relief.

If the pain and tightness you’re feeling in your lower back continues to return, it’s an indication that you have not yet addressed the true root cause of the issue. You have simply been managing symptoms caused by a larger issue hidden from your view.

If you’ve been massaging and stretching your back, but the pain remains, then it’s time for a new angle. It’s time to address your pain head-on with a solution that actually solves your pain puzzle.

It’s all about a core muscle with a silent p — the psoas (pronounced SO-as).

Anatomy and function of the psoas muscle

The psoas major (or simply “psoas” for short) connects to the T12 - L5 vertebrae in your spine and travels through the pelvis, where it then crosses the front of the hip joint and inserts at the lesser trochanter of the femur near the inside of the groin. At this insertion point, the psoas is one of two muscles, along with the iliacus, that come together and create what is known as the iliopsoas tendon.

The iliopsoas muscles are your main hip flexors and help to provide support and stability for your lumbo-pelvic hip complex (which consists of the lumbar spine, pelvis, and hips). They connect the upper and lower halves of your body together at your “core” and are used in nearly everything that you do on a daily basis, including:

  • Helping create the motion of hip flexion, which is used when walking or running (and using higher steps, as in marching)
  • Providing postural support for the lower back and pelvis when sitting or standing
  • Stabilizing the lumbo-pelvic hip complex to prevent injury and perform at your best while working out, playing sports, picking up your kids, or being active

These are some pretty important jobs that your psoai (plural of psoas) perform!

As you can imagine, these tasks require your hip flexors to be working constantly and they rarely get the chance to relax. Because of this, it’s easy to overexert your psoas muscles. When life’s demands consistently exceed their ability to fully recover, they become tired, tighter, and weaker — this is the perfect recipe for trigger points to develop in your psoas and cause pain.

anatomy illustration of the psoas and iliacus muscles

What are psoas trigger points?

A psoas trigger point is a contracted area within the muscle or fascial tissue of your psoas that likes to stay tight and doesn’t seem to ever let go. Sometimes referred to as “muscle knots,” these trigger points can be the cause of your pain, tightness, and range of motion restrictions felt in your body.

Common symptoms of psoas trigger points

Trigger points can develop anywhere along the entire length of the psoas muscle. Common symptoms of psoas trigger points include both localized and referred pain patterns.

  • Localized pain — felt in the immediate area surrounding the muscle knot.
  • Referred pain — felt elsewhere in the body.

This concept of referred pain is exactly what may be contributing to your lower back pain!

Localized pain from psoas trigger points

Localized pain from psoas trigger points is typically felt deeper in the core (anywhere between the belly button and the anterior superior iliac spine, or ASIS, of the pelvis), at the front of the hip, and the inside of the groin.

Referred pain from psoas trigger points

Referred pain from psoas trigger points is commonly felt in the lower back muscles, like the spinal erectors and quadratus lumborum (QL).

Since the psoas connects to the transverse processes of the T12 - L5 vertebrae, these pain referral patterns can be confused for issues with the discs or joints of the lumbar spine.

Additionally, you may find that pressing on the part of the iliopsoas higher up towards your waist (the iliacus) refers pain down into the upper thigh and quadriceps muscles. This could be an indication that you also have trigger points in your iliacus muscle that need to be addressed.

Other possible indicators of psoas trigger points

Aside from the localized and referred pain patterns we just discussed, there are other common signs and symptoms that you should be mindful of that may indicate you are holding tension or have trigger points in your psoas muscles.

A tight psoas inhibits your ability to fully engage the glute and hamstring muscles to extend your hip. This may result in pain or discomfort when performing this motion, such as pushing off with each step when walking or running, when going from seated to standing, and even when standing for longer periods of time.

Causes of psoas trigger points

Common causes of psoas trigger points include:

Sitting too long can create psoas trigger points

Spending a lot of time with the hips flexed, such as when sitting at your desk, lounging on your couch, driving your car, sleeping in the fetal position, etc. places your psoas muscles into a shortened position. Over time, these muscles begin to develop a “muscle memory” for this shortened position, become tighter, and have difficulty lengthening. This is the perfect environment for trigger points to form.

Workouts without hip flexor recovery

Excessive use of the hip flexors without adequate recovery — lots of running, biking, hiking, kicking, climbing up stairs, and even sitting — require the psoas muscle to be engaging constantly for extended periods of time. This can fatigue your muscles, make them weaker, and cause them to hold tension.

Weak hip flexors

Weakness in the hip flexors may lead to the development of trigger points in the iliopsoas. Different activities, such as lifting with good technique, running a marathon, or even simply sitting in good posture, require a certain amount of strength and endurance to perform optimally.

Relative to the task at hand, when the required demand for a muscle to be used exceeds the capability of your muscles to perform, compensations may occur and cause the psoas to hold tension in an effort to protect the body.

Hypermobile joints

People who have hypermobile joints are more prone to the development of trigger points in their iliopsoas than you might think. While they may be able to stretch their bodies into an extended position, this can actually be too much range of motion coming from the hips and/or lower back where it makes the body feel unstable. The psoas muscles may then kick into overdrive and hold tension in an attempt to create stability and prevent injury from being overly flexible.

For example, someone may be getting super deep into their yoga poses, moving their joints beyond the “normal” range of motion that it was designed to do. Another example is women during pregnancy, where the joints and ligaments in the pelvis become more lax to create space for the baby moving through the birth canal. In both these cases, the degree of flexibility creates instability, causing the iliopsoas muscles to tighten in response.

What is the best way to release iliopsoas trigger points?

When it comes to releasing trigger points, there are typically 3 main ways that people try to help relieve their pain: by stretching, massaging, or applying pressure on their muscles.

Stretches for psoas trigger points

While hip flexor stretching plays an important role in the recovery process, alone it is likely not enough to get rid of your iliopsoas trigger points. Stretching, or generally overusing a muscle that has a trigger point, also carries the potential to increase referral pain through activation.

Stretching a muscle makes it longer by moving the body in a certain way that causes it to lengthen. For example, the lunge stretch can support the reduction of tightness in the stretched psoas and iliacus muscles by bringing some blood flow into the area to warm it up and help increase its flexibility.

When trigger points are present, stretching typically provides only temporary relief. This is because the muscle is still holding some tension, even though you are lengthening it with a stretch. You’ll stretch, then move around, but the tightness returns because the knot is still present.

It should also be noted that over-stretching a muscle that has trigger points could actually make the pain and tightness worse. Don’t force your body to stretch into a position that it isn’t capable of getting into.

Instead, be more gentle and ease yourself into your stretches and focus on taking slow and controlled breaths. This can help calm the nervous system and make the brain feel safe letting the muscles lengthen and move deeper into the stretch.

Self massage for psoas trigger points

Massaging a muscle involves rubbing and moving it in different ways. However, trigger points don’t respond well to these techniques. In fact, rubbing or rolling a foam roller over trigger points can just make them angry and irritated. Trigger points require direct and prolonged pressure to the muscle knot for it to fully release.

Massaging a muscle does come with the possibility of increasing your pain. This happens when a latent trigger point exists in the muscle, where rubbing on it activates the trigger point and makes your symptoms worse. If this happens, don’t panic. Just shift your technique to steady, direct pressure.

Prolonged pressure release for psoas trigger points

Applying prolonged pressure to a muscle is different than getting a massage, rolling on a foam roller, or performing a stretch. Trigger point release techniques involve finding the sensitive and contracted area of muscle tissue and pressing directly on it, or very close to it, for an extended period of time (at least 90 seconds).

At first, this pressure on the trigger point may be uncomfortable and even result in a slight increase in pain, including referred pain to other areas of the body. This is completely normal and okay...just keep breathing and try to relax.

Continue to apply pressure to the trigger point, taking deep breaths, and making sure it is more of a “hurts so good” kind of feeling. As 30...60...90 seconds pass by, the localized and referred pain that you may have been feeling may begin to dissipate. The brain sends signals to the muscle to release, where it can return to a more softened and relaxed state.

Be smart about using this technique. Like the other methods already discussed above, doing too much, not enough, or forcing more than what your body will tolerate can cause an increase in pain. Ease yourself into it by starting off with gentle pressure and then slowly increasing the intensity over time.

Can I release my own iliopsoas trigger points?

Yes, you can release most of your own iliopsoas trigger points by yourself. Remember that trigger points and muscle knots can exist in the muscle fibers anywhere along this muscle (not just the places with the Xs), so it takes some trial and error to find the best spots on your body. There are common iliopsoas trigger point locations that may develop in people, which are depicted in the image below.

I’m going to focus specifically on the places that you can safely access and release.

Iliacus Trigger Point

This trigger point lies primarily in the iliacus muscle. In the diagram above, it’s the furthest out on the pelvic bone. Because of its location on the inside surface of the pelvic bone (or ilium), it requires a certain angle to access this spot. A trained professional, such as a physical therapist or massage therapist, should be able to access and release this muscle for you while you’re lying on your back and fully relaxed.

To release this by yourself, it is best to use an iliacus release tool that is designed specifically for this area of the body. You can try using a massage therapy ball to see if that provides any benefit for you, but its rounded shape won’t be able to achieve the angle and precision needed for the most effective release.

woman releasing her iliacus muscle using the Hip Hook tool

Psoas Trigger Point

This trigger point lies within the muscle tissue where both the psoas and iliacus come together in the pelvic region, forming the iliopsoas.

The “X” seen in this picture is located near the hip crease. Since this area is much closer to the surface of the body and not within the pelvis, you may be able to access this area yourself using a massage therapy ball.

Be mindful that there are more nerves and blood vessels that run through this area, so if you feel any throbbing or tingling when applying pressure to this area, simply move your tool a little higher along the muscle and above the hip crease area.

Using a massage therapy ball for the iliopsoas

As you experiment with finding your iliopsoas trigger points, and move higher up along the muscles, it begins to run deeper within the pelvis. At this point, that same massage therapy ball (or lacrosse ball) that could access the lowest trigger point in the hip crease area likely won’t do the trick anymore because it can no longer reach this muscle to apply enough pressure. As with the previous trigger point, an iliopsoas release tool can help you reach these higher spots to release it yourself.

Pressing here with a specifically designed iliacus release tool can be close enough to the trigger point to where the brain sends signals for the muscle to release its tension being held in that spot. Plus, there’s the added benefit of hitting the psoas and iliacus muscles at the same time!

A tight psoas and tight iliacus affects the whole body

If you have been troubled by tightness in your hip flexors and want to learn more, I encourage you to read my book “Tight Hip, Twisted Core - The Key to Unresolved Pain.” I’ll share with you my knowledge of the body and clinical examples from my experience as a physical therapist for more than 20 years.

Frequently asked questions about psoas trigger points

How do you release the psoas muscle?

To release the psoas, apply prolonged pressure to the muscle (at least 30 to 90 seconds). Because the psoas muscle is located deeper within the core, it may require the help of a skilled therapist or use of a psoas release tool like a Hip Hook to effectively release it.

What happens when your psoas muscle is tight?

When the psoas muscle is tight, it affects the alignment of the lumbar spine, pelvis, and hips. If the psoas muscles on both sides of the body are tight, they can pull the spine and pelvis into an anterior (or lordotic) position. When one psoas is tighter than the other, it can cause a twisting of the spine and pelvis to where a functional scoliosis and functional leg length discrepancy may be observed.

Where do you feel psoas pain?

Psoas pain may be felt deeper within the core: in the lower back muscles that line the lumbar spine, at the front of the hip, and/or in the groin or upper thigh. This can be caused by tightness or even the presence of psoas trigger points within the psoas muscle.

What causes psoas trigger points to develop?

Psoas trigger points typically develop as the result of the psoas muscle being held constantly in a shortened position, such as when sitting down or sleeping in the fetal position. They can also develop from consistently overusing the psoas muscle (during activities such as running or cycling) and not having an adequate recovery.