Releasing the Iliopsoas and Improving Gliding to Resolve Anterior Hip Impingement in Squats - Movement Equation #34 -
In the previous article, I explained why reduced gliding of the iliopsoas muscle tends to cause a feeling of impingement in the anterior hip.
In this article, I will introduce specific approaches to improve the tension of the iliopsoas and restore its natural gliding ability.
Approach to the area near the lesser trochanter
The first thing to do is to approach the iliopsoas tendon, which attaches near the lesser trochanter.
Tendons are rich in Golgi tendon organs, and applying appropriate pressure stimulation can be expected to reduce muscle tension.
While it is difficult to directly approach the anterior surface of the lumbar spine, which is the proximal attachment of the psoas major, it is relatively safe to intervene near the lesser trochanter, which is the distal attachment.
Although it is often depicted from the front in anatomy books, in actual clinical practice, I feel that it is easier to palpate the tendon by approaching from the posteromedial side.
Place the subject in a supine position and palpate the iliopsoas tendon near the lesser trochanter.
Once you have identified the tendon, move your fingers lightly across it.
I often experience in clinical practice that performing this for about 10 to 20 seconds, focusing on the areas where stiffness is felt, significantly reduces the tension of the entire iliopsoas muscle.
After performing this approach, try flexing the hip joint once to check for changes in the feeling of impingement in the anterior hip and the range of motion.
Approach to the iliacus
Next, release the iliacus muscle.
Since the iliacus originates from the iliac fossa, place the subject in a supine position and keep the hip joint in a slightly flexed position.
Flexing the hip joint relaxes the abdominal wall, making it easier to insert your fingers into the iliac fossa.
If the tension in the iliacus is very strong, you can further reduce the tension by having the subject rest their lower limb on your thigh.
In that state, slowly apply pressure with your fingers along the iliac fossa.
This method is also very effective, but since it is an area where tenderness is easily triggered, please be sure to start with light pressure and proceed carefully.
After the approach, move the hip joint again to check for changes in the sensation and range of motion of the anterior hip.
Approaching the iliopsoas from the groin
Next, we will approach the iliopsoas from the groin.
Since tension in the abdomen and groin tends to increase when the hip is extended, I recommend performing this in a hip-flexed position with both knees bent.
If you place your fingers near the inner third of the crease in the groin, you can feel the pulsation of the femoral artery.
Moving your fingers slightly outward from there, you can palpate the iliopsoas muscle.
If you palpate carefully, you should be able to feel that the muscle is divided into two parts.
Generally, these can be palpated as:
Medial: Psoas major
Lateral: Iliacus
as you palpate.
If the iliopsoas is difficult to locate, keep your fingers on the approximate area and have the subject lightly flex their hip by lifting their heel a few centimeters.
The iliopsoas will contract, making it easier to confirm its position.
Short-axis gliding
Once you can palpate the iliopsoas, perform short-axis gliding.
The method is the same as what I have introduced in previous articles.
Place the index and middle fingers of one hand on the medial border of the iliopsoas, and the index and middle fingers of the other hand on the lateral border.
From there, while applying pressure alternately from left to right, move the iliopsoas so that it glides medially and laterally.
If muscle tension is high, pain can easily occur, so be sure to start with light pressure.
After the approach, check if the feeling of impingement has changed by flexing the hip joint.
Improving gliding while moving the hip joint
While short-axis gliding alone is effective, an even more recommended method is to move the hip joint slowly while keeping your fingers on the iliopsoas.
The iliopsoas is a muscle that functions while gliding over the anterior aspect of the hip joint.
Therefore, having the client slowly flex and extend the hip joint, rather than keeping the muscle fixed, makes it easier to improve gliding.
In some cases, adding light internal and external rotation can also improve gliding.
Furthermore, combining this with breathing can enhance the effectiveness.
As I mentioned in a previous article about the diaphragm, the diaphragm and the psoas major are connected via fascia and are also closely related functionally.
Therefore, applying pressure in time with a slow exhalation helps release abdominal tension, making it easier for the psoas major to relax.
The iliopsoas is a muscle that works to stabilize the hip joint, but for it to fully perform its function, it is important for the entire trunk, including the diaphragm, to work in coordination.
By approaching it carefully while coordinating with breathing, you can expect a more natural improvement in muscle tension.
Approaching the proximal psoas major
Once you can palpate the psoas major at the groin, you can also approach a wider area by tracing its path proximally.
However, because the psoas major gradually runs deeper, you can only directly touch it to a certain extent.
Also, since you will be approaching it indirectly through soft tissues such as the peritoneum and intestines, there is no need to push in forcefully.
There are important structures in the surrounding area, so please always proceed with caution.
Summary
The iliopsoas is a muscle located deep in the body, and it is not something that will loosen just by pressing hard.
What is important is:
palpating accurately
approaching carefully with light pressure
restoring the muscle's inherent gliding ability
is key.
As I mentioned last time, the iliopsoas works by gliding smoothly along the front of the hip joint, performing flexion while stabilizing the hip.
Therefore, not only relaxing the muscles but also improving their gliding ability while moving the hip joint leads to the resolution of the sensation of anterior hip impingement and hip flexion limitations that occur during squats.
However, these approaches are merely preparation to "create a state where the iliopsoas can function normally."
To fundamentally improve hip joint function, it is important to subsequently re-educate the iliopsoas so that it can contract and glide correctly.
Next time, I would like to explain specific exercises for that purpose.