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Osteopathic Approach To A Dysfunctional Iliacus Muscle

An Approach To Treating Iliacus Dysfunction

An Approach To Treating Iliacus Dysfunction

The iliacus muscle lies on the inside of the pelvic bones. Although it can be a big factor in low back pain, is seldom evaluated or treated. I have previously written that often times when we treat a dysfunctional psoas major, we assume that we are also treating a dysfunctional iliacus muscle. However, I rarely find that a treatment for psoas major truly does help resolve a dysfunctional iliacus. Although these two muscles share a tendon, they are two separate muscles with separate innervation. It has been my experience that to treat iliacus dysfunction requires a different approach than treating a psoas major dysfunction. Below I will discuss how I approach a dysfunctional iliac us during my Osteopathic Manipulative Treatment (OMT) that has given me success in many cases. This approach has helped save me a lot of time because treating other structures first will help get the best result.

Step 1: Evaluate the iliacus muscle
From the supine position, a portion of the iliacus muscle can be palpated by finding the anterior superior iliac spine (ASIS) and then SLOWLY let your fingers sink down putting gentle pressure on the medial aspect of the innominate bone. If the iliacus is dysfunctional, then you will not be able to sink your fingers very deeply and will be met with resistance. In addition, there is often a reflexive startle and/or withdrawal response where the patient will jump from the stimulation of the muscle. Neither of these are proper responses. Evaluate both sides.

Step 2: Evaluate oblique muscles and lower rib cage

In my experience, I have found when the iliacus muscle is that hypersensitive that there is quite regularly associated hypersensitivity and hypertonicity to the obliques on the same side of involvement and the lower rib cage as well. By putting pressure lateral to medial on the abdomen under the rib cage, it is possible to assess whether the obliques are dysfunctional as well. Furthermore, the lower ribs will regularly be tender at certain focal points in the intercostal muscles between the ribs. These points are often very sensitive when palpated and make the rib cage feel less pliable when gentle pressure is placed on them.

Step 3: Treat the intercostal muscles

I recommend starting with doing a treatment for the abdominal diaphragm prior to specifically focusing on the intercostal muscles. I will not describe diaphragm treatment here. When you find the hypersensitive areas between the lower ribs, find the points that you feel are the worse and gently and slowly spread the two ribs apart to take up the slack at the area of tenderness. Once a release is felt, then move on to any other hypersensitive points. As these points release, then re-evaluate the oblique muscles. The hypertonic oblique muscle fibers should no longer feel hypertonic and should be less sensitive to the patient. If the obliques are still hypertonic, then it is important to go back and check the lower ribs more carefully to make sure there are not more hypersensitive areas missed. I rarely find the obliques will stay hypertonic and hypersensitive when the rib cage has been properly treated.

Step 4: Re-evaluate and treat the iliacus muscle

The Iliacus Muscle Can Be The Cause Of Your Back Pain

The Iliacus Muscle Can Be The Cause Of Your Back Pain

At this point, if you have been successful and the obliques and lower rib cage are no longer sensitive, then chances are that the iliacus muscle is no longer as hypersensitive.  The iliacus can then be palpated deeper into the abdomen without the resistance or response that was initially present. If iliacus tenderness continues, it usually not as pronounced. Many times, there is nothing left to do at this point. However, sometimes the iliacus still needs further treatment. Now it can be treated directly. To treat the iliacus, flex the knee and the hip and sometimes letting the knee fall outward or inward can improve the response of the treatment. One hand will put gentle pressure on the iliacus in a similar manner to evaluating it. The other hand pushes on the iliac crest of the pelvic bone on the same side being treated. Next, rotate the hand on the iliac crest to rotate the pelvic bone anteriorly until a relaxation is felt in the iliacus muscle. Once the most relaxed position is achieved, then wait until further relaxation is felt in the muscle.  After this is completed, then re-evaluate the iliacus muscle.

If the iliacus muscles are involved with low back pain, some patients describe a sensation of increased blood flow and an ‘opening’ sensation in their legs. In addition some may feel less tenderness and improved range of motion in the sacra-iliac joints, the sacrum, coccyx and the lumbar spine. Not all have such strong reactions because there are varying levels of how one’s body may respond and compensate for these problems.

My conclusions from these treatments are that dysfunctions in the lower rib cage, whether the problem is in the diaphragm, intercostal muscles or oblique muscles play a significant role not just in back pain, but in causing iliacus muscle dysfunctions. I believe that perhaps the obliques attaching to the iliac crest in close proximity to the iliacus muscles can activate and make them hypersensitive and hypertonic. The exact mechanism is unknown and would require further research.


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.

More posts by Daniel Lopez, D.O.

Join the discussion 7 Comments

  • Sue Jannino says:

    This information, I believe, is the key to the problems I have been suffering with for the past 50 years! Why is it that doctors don’t have this kind of knowledge? It sickens me that I’ve suffered for all of these years and have had to endure two ruptured discs due to the strain this caused on my spine when it could have easily been treated early on if only someone had had the knowledge. All doctors want to do is to throw drugs at the problem! Thank you for putting this information out there!

    • Daniel Lopez, D.O. says:

      Hi Sue, thank you for your comments. Doctors are not taught how to think this way nor do they learn to understand what they feel on a physical exam with that much depth. I wish they were; medicine would be very different. I hope you have found some relief. Thanks again.

  • Cathy says:

    I have CFS and severe back problems due to multiple injuries. I have been having successful Osteopathic cranial treatment off and on over the years but in the last few years I have been having extreme reactions, even though my treatment is only for about ten minutes because I’m so sensitive. The reactions are severe pain in my entire body, especially my back and severe nausea which can last for days or even weeks.
    The pain prevents me from sleeping and I can’t eat, making my CFS even worse. This reaction leaves me even more debilitated than before. I dread having treatments now, sobbing from pain for days on end This is not how it’s supposed to be, is it?
    Why am I having such strong reactions? I want my back to get better as that in itself is debilitating but not at the expense of making my whole health worse. What should I do?
    (My Osteopath knows about my reactions.)

    • Daniel Lopez, D.O. says:

      Hi Cathy, I’m sorry to hear about all the pain you’re in and how much trouble you’re having tolerating your treatments. If you’re currently so sensitive and having such negative reactions to the treatments, they may not be right for you at this time. There may be other things that may need to be addressed first. Given my limited knowledge of the overall picture, I cannot know what your next step should be other than going back to your osteopath and primary care doctor to discuss with them and try to address any nutritional deficiencies. Chronic fatigue syndrome is not easy because there can be many reasons for it. I’m sorry I cannot give you more helpful information.

  • Roberta says:

    I have suffered for over 8-10 years of bilateral foot pain. After going to many doctors, from fusing the bones in my feet to reconstruction of the feet and of course custom made orthotics. I recently went to a physiatrist telling me I have a pelvic oblique. It took this long. My feet are literally beat up, shoes is a real problem.

    I was wondering if osteopathic treatment would help with this, I would appreciate it. Thank you

    Please let me know.


    • Daniel Lopez, D.O. says:

      Hi Roberta, thank you for your question. Theoretically, yes, osteopathic treatment could help. That’s the best I can tell you without being able to evaluate and treat.

  • Todd says:

    Thanks for this information. Here is the web search I had to enter to find it: “iliacus muscle pain -iliopsoas” That is, a search for iliacus pain only brought up iliopsoas results! 🙁 After I removed those, I found this great article. I wish I were in your area so I could get checked out.

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