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Are You Considering The Iliacus In Low Back Pain?

By December 15, 2013March 10th, 2017Osteopathic Techniques, Osteopathy

Most manual practitioners view the iliacus muscle and the psoas major muscle as one muscle. These two muscles do share something in common and that is they both insert into the same tendon. In many books you’ll see them referred to as the ‘iliopsoas’ and are described as hip flexors. The ‘iliopsoas’ or even more often the psoas is blamed for a lot of back pain problems, especially when one has a difficult time straightening out.  The psoas is implicated for a lot of back pain issues. The iliacus, on the other hand, is difficult to reach as it is located on the inner aspect of the pelvic bones and is often forgotten. If not forgotten, it is assumed that it does what the psoas does. So if  the psoas is treat and relieved, it is assumed that the iliacus has resolved as well.

The Iliacus Muscle Can Be The Cause Of Your Back Pain

The Iliacus Muscle Can Be The Cause Of Your Back Pain

While I was going through training, I often noticed that when one would teach palpation and treatment of the ‘iliopsoas,’ they would only teach palpation and treatment of the psoas major muscle. The iliacus portion was never directly palpated or treated. Everyone assumed that if you treated the psoas muscle and it felt better, then the iliacus was no longer an issue. The iliacus, however, is a separate muscle that requires evaluation and treatment separate from the psoas because it is a different muscle and does not necessarily respond to a treatment aimed at the psoas muscle. Let me emphasize that these are separate muscles and have different innervation.

Speaking from personal experience as someone who suffered with severe back pain for over a year due to iliacus tightness, this is an important muscle that anyone who does manual medicine should assess and treat for low back pain issues. As an Osteopathic Manipulative Medicine (OMM) provider, I routinely check for tenderness at the iliacus when low back pain is an issue. Furthermore, one should never assume that because a psoas dysfunction has been resolved, iliacus dysfunction has been resolved simultaneously. Although not easily accessible, a portion of the iliacus can be palpated by pushing the inside wall of the hip bone from the front. Assessing patients regularly who have back pain, it is rare for iliacus not to be tender and sensitive even after psoas tension has been relieved. It is time we stop viewing the iliacus as simply just being part of the psoas major muscles. Helping your patients backs could depend on it.


Daniel Lopez, D.O.

Author Daniel Lopez, D.O.

Daniel Lopez, D.O. grew up with a lot of pain trying many things that did not help. Realizing that if he could not help himself, he would be unable to help others effectively, he dedicated himself to finding real answers. Since that time, Dr. Lopez has found a unique but powerful style where he has patients from around the country and the world that travel to see him for headaches, TMJ issues, eye issues, neck pain, back pain, and more. Daniel Lopez, D.O. is an osteopathic physician with Osteopathic Integrative Medicine. Prior to that he had a private practice in NYC for 6 years. He is the author of the Amazon best seller "Unwinding the Body and Decoding the Messages of Pain: An In-Depth Look into the World of Osteopathic Physicians and How They 'Magically' Use Their Hands for Healing." He lives in Aurora, CO with his wife and daughters.

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Join the discussion 4 Comments

  • Samar says:

    I really love all your articles, and thank you for sharing your knowledge and experience with us.. Is it possible that you Can you make a videos explaining some unclear tests, like testing iliacus muscle or like tongue spasm in your previous articles and also AC joint in the shoulder, that would more helpful and clear

    • Daniel Lopez, D.O. says:

      Hi, thank you for the compliment and that is a great idea. It’s actually something I have on my agenda and hope to get to soon.

  • Jose L. Harper says:

    I’ve been experienced back pain and I was really shock! How can a 25-year-old woman experience back pain? In a couple of days it disappears but it keeps on going back and I don’t know why. There was a time that I can’t move my head up because my back hurt so much. I hope this is just a muscle disorder and can be treated by back pain treatment and not a serious type of disease.

  • John says:

    Hello Doctor,

    I am a 33 year old male who tore his iliacus back in September. The tear was 4cm long with retraction. I have been PTing the injury since then and I felt great up until a couple of weeks ago.

    After a solid week of PT, really started to get moving, I woke up one morning to find extreme lower back pain. We are going on two weeks now of trying to loosen up my back. We have even tried “dry needling” on several occasions.

    Im getting concerned that this could be a long term issue…

    Thank you for the above article it really shed some light on my situation.


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