Iliopsoas Muscle Syndrome: A Hidden Culprit in Back and Hip Discomfort

When it comes to back and hip discomfort, most people think of herniated discs, arthritis, or sciatica. But one lesser-known source of chronic pain in these areas is iliopsoas muscle syndrome. Often overlooked and misdiagnosed, this condition stems from dysfunction in the iliopsoas muscle, a deep-seated hip flexor that plays a crucial role in movement and stability.

In this post, we’ll explore what iliopsoas muscle syndrome is, what causes it, how it’s diagnosed, and the best strategies for managing or eliminating the discomfort it causes.

What Is the Iliopsoas Muscle?

The iliopsoas muscle is actually a group of two muscles—the psoas major and the iliacus—that come together to form a powerful hip flexor. It connects the lumbar spine (lower back) to the femur (thigh bone), playing a major role in lifting the leg, walking, running, and maintaining posture.

Because of its deep location and connection to both the spine and hip, the iliopsoas muscle can affect a broad range of structures if it becomes tight, inflamed, or injured.

Understanding Iliopsoas Muscle Syndrome

Iliopsoas muscle syndrome refers to a condition in which the iliopsoas muscle becomes shortened, inflamed, or irritated, often leading to:

• Lower back pain
• Hip pain or tightness
• Groin pain
• Pain when standing from a seated position
• Discomfort while walking or climbing stairs
• Limited hip mobility

This condition is especially common in athletes, dancers, and individuals who sit for prolonged periods.

Common Causes

Several factors may contribute to iliopsoas syndrome, including:

1. Prolonged Sitting

Sitting for extended periods can cause the iliopsoas to remain in a shortened position, leading to tightness and dysfunction over time.

2. Repetitive Motion

Sports that involve repetitive hip flexion—such as running, cycling, or kicking—can overuse the muscle, causing strain or inflammation.

3. Poor Posture

Slouching or an anterior pelvic tilt can create uneven stress on the iliopsoas and surrounding muscles.

4. Spinal Instability or Weak Core

Weak core muscles may force the iliopsoas to compensate, increasing its workload and stress.

5. Previous Injuries or Surgeries

Scar tissue, altered gait, or movement compensation from past injuries can exacerbate iliopsoas dysfunction.

Signs and Symptoms to Watch For

The symptoms of iliopsoas syndrome can be vague and mimic other conditions, which is why it’s often misdiagnosed. Common signs include:

• A deep, dull ache in the lower back or anterior hip
• Increased pain with hip flexion or extension
• Pain when rising from a chair
• Groin pain radiating toward the thigh
• Clicking or snapping sensation in the hip

Some patients may also experience referred pain, meaning the discomfort is felt in a different area than the source of the issue.

Diagnosis

Accurately diagnosing iliopsoas syndrome can be challenging. Physicians often begin with a detailed history and physical exam. Specific tests may include:

• Thomas Test: Assesses hip flexor tightness
• Palpation: Pressing into the abdomen to assess for iliopsoas tenderness
• Functional Movement Screens: Observing hip mechanics during walking, sitting, or squatting

Imaging (like MRI or ultrasound) is typically used to rule out other causes but may show inflammation or thickening of the muscle in some cases.

Treatment Options

Once identified, iliopsoas syndrome is highly treatable using conservative methods. Treatment may include:

1. Physical Therapy

A customized PT program will focus on stretching the iliopsoas, strengthening surrounding muscles (like the glutes and core), and improving pelvic alignment. Manual therapy may also be used to release muscle tension.

2. Activity Modification

Reducing activities that aggravate the muscle, such as excessive running or deep squatting, can help the area heal.

3. Heat and Cold Therapy

Alternating heat and ice can reduce inflammation and promote blood flow to the affected muscle.

4. Anti-Inflammatory Medications

NSAIDs may be used short-term to ease pain and swelling.

5. Dry Needling or Trigger Point Injections

These therapies can release deep muscle tension and reduce pain in stubborn cases.

Preventing Recurrence

To avoid future flare-ups of iliopsoas syndrome, long-term strategies are key:

• Incorporate regular hip and psoas stretching into your daily routine
• Strengthen your core, glutes, and postural muscles
• Limit prolonged sitting or use a standing desk when possible
• Maintain proper ergonomic setup at your workstation
• Use proper form during exercise and avoid overtraining

When to Seek Medical Help

If you’re experiencing persistent lower back or hip pain that hasn’t responded to basic rest or stretching, it’s time to see a specialist. Early diagnosis and a tailored rehab program can make all the difference in recovery and long-term comfort.

Final Thoughts

Iliopsoas muscle syndrome may be one of the hidden causes behind chronic lower back or hip pain. Because of its deep location and interaction with the spine and pelvis, dysfunction in the iliopsoas can lead to a wide range of symptoms that are often misattributed to other issues.

The good news is that with proper diagnosis and treatment—including stretching, strengthening, and lifestyle modifications—most people can achieve full relief. If you’ve been struggling with unresolved discomfort in your hip or lower back, consider speaking with a healthcare provider about the possibility of iliopsoas muscle involvement. You might be targeting the wrong culprit—and relief could be closer than you think.