How to get a knot out of the iliopsoas muscle?

Triathlon Forum
1

I’ve been fighting with an irate hip for about a month now. It is keeping me from running. I have tried everything I can possibly think of as far as getting it to heal. Deep tissue massage (times three), foam rolling all around my hips and glutes and quads and inner thighs, physical therapy - which includes ultrasound and strengthening all the hip muslces, stretching, prayers to the running gods, whining, and none of those are quite getting it. Oh, I tried heat and ice too.

The problem is, I am fairly sure, a tight psoas muscle. I can feel the knot in it, but putting pressure on it / trying to massage it makes it worse.

Other ideas? Witch potions? I am desperate. I got x rays taken yesterday so I can get an orthopedist appt - I am fairly sure the x rays will be clear - so we’ll see what he has to say.

Or if someone would kill me and put me out of my non running misery I’d take that too :stuck_out_tongue:

Thanks.
tc

2

Just curious, any back problems? As you probably know already from researching this, the psoas (major, minor) originates on the spine. Did the PT agree with the psoas diagnosis? There are lots of muscles that cross the hip and the psoas is pretty deep.

Sounds like you are doing all the right things. Unfortunately, all of us, at one time or another, experience an injury that just ‘takes time to heal.’ One thing to do is to look back to see what might have caused this (overuse, etc…) so that you don’t have a similar setback in the future.

Best of luck with your recovery.

JM

3

Find a good massage therapist (someone with 2 to 3 years of schooling). Get him/her to apply some myofascial release techniques to psoas and iliacus and then trigger point work (ischemic compression) to deactivate the “knot.” Get him/her to check and make sure there are no trigger points in the quadratus lumborum along the edge of your PSIS (posterior superior illiac spine). Those can sometime occur at the same time.

A good massage therapist ought to be able to apply these techniques without undo discomfort. Trigger point work always implies a little discomfort, though. Then get them to show you a good psoas stretch. A good piriformis stretch might be in order as well, as sometimes a tight piriformis can make the hips uneven causing a tightening in the psoas as a form of compensation. The 2 muscles are not strictly antagonistic, but they are indirectly connected enough to affect one another.

Good luck!

4

TC in my experience psoas or hip flexor issues rarely occur in isolation. They are often a part of an overall pattern with dominant hip flexors and often weakened or underactive gluteals. The hamstrings may often feel tight as part of the compensation pattern.
You need to work with a good PT or corrective exercise specialist to evaluate if you have any muscle imbalances and work to correct them. All local treatment will do is at best band-aid the problem.
If the ortho rules out any other pathology that could be causing the problem then they will probably give you a PT referral.

Kevin

5

hope it works out for you, I have no advice on that to offer.

I had a somewhat similar experience with a knot in my lower quad a decade ago. massage always hurt and never helped. turned out, for me, to be a bone spur, which I had surgically removed(90% anyway) should have known it wasn’t a knot in hindsight, as when the muscle was manipulated, the “knot” never moved location on the leg.

get better!!

6

Just curious, any back problems? As you probably know already from researching this, the psoas (major, minor) originates on the spine. Did the PT agree with the psoas diagnosis? There are lots of muscles that cross the hip and the psoas is pretty deep.

Sounds like you are doing all the right things. Unfortunately, all of us, at one time or another, experience an injury that just ‘takes time to heal.’ One thing to do is to look back to see what might have caused this (overuse, etc…) so that you don’t have a similar setback in the future.

Best of luck with your recovery.

JM

Thank you for the well wishes.

No back problems in particular but I did have a lot of lower back tightness before it happened and I suppose that could have been part of it.

Cause, most definitely overuse.

Time?! it’s been four weeks!!!

7

TC in my experience psoas or hip flexor issues rarely occur in isolation. They are often a part of an overall pattern with dominant hip flexors and often weakened or underactive gluteals. The hamstrings may often feel tight as part of the compensation pattern.

All true in my case. In PT we are working on glute strength.

8

Find a good massage therapist (someone with 2 to 3 years of schooling). Get him/her to apply some myofascial release techniques to psoas and iliacus and then trigger point work (ischemic compression) to deactivate the “knot.” Get him/her to check and make sure there are no trigger points in the quadratus lumborum along the edge of your PSIS (posterior superior illiac spine). Those can sometime occur at the same time.

A good massage therapist ought to be able to apply these techniques without undo discomfort. Trigger point work always implies a little discomfort, though. Then get them to show you a good psoas stretch. A good piriformis stretch might be in order as well, as sometimes a tight piriformis can make the hips uneven causing a tightening in the psoas as a form of compensation. The 2 muscles are not strictly antagonistic, but they are indirectly connected enough to affect one another.

I’ve had one really good massage that helped a little bit. Guess I need to go back :stuck_out_tongue:

Good info. Thank you.

9

if it’s a bone spur it would show up on the x rays I got taken the other day. Hip surgery now that sounds fun. Lets hope not.

Thanks for the well wishes.

hope it works out for you, I have no advice on that to offer.

I had a somewhat similar experience with a knot in my lower quad a decade ago. massage always hurt and never helped. turned out, for me, to be a bone spur, which I had surgically removed(90% anyway) should have known it wasn’t a knot in hindsight, as when the muscle was manipulated, the “knot” never moved location on the leg.

10

Want to rehab the HF’s and return your leg muscles to being balanced (or prevent them from becoming unbalanced)? Consider adding PowerCranks to the therapeutic regimen. And, they will help you to maintain your run ability while you are unable to run.

11

I suffered with psoas pain for years, was always short and tight, problem disappeared entirely after a few months of Bikram hot yoga. Actually, alot of recurring problems have vanished since attending regularly.

12

Don’t powercranks engage hip flexors more? overpowerful hip flexors is part of the problem here.

13

Don’t powercranks engage hip flexors more? overpowerful hip flexors is part of the problem here.
Nobody (at least no triathlete) has “overpowerful” HF’s. Your problem, if it is a primary HF problem, is one of an imbalance and inability to relax. All PC’s do is force a balanced effort between the right and left and front and back muscles of the legs. PowerCranks prohibit the development of compensatory patterns that complicate therapy and recovery. The aerobic conditioning of the muscles enhances their ability to relax.

Anyhow, I have never heard of the PC’s complicating this (or any) rehab issue of this type and I have heard plenty of reports of people seeing great results. Here is a video of what many people have experienced in this regards. http://www.powercranks.com/videopages/testimonials-rehab.html I am sure there have to be a few people with HF problems like yours in that video. Check it out.

14

I’ve spent a lot of my life as a swimmer, doing lots of kicking in the pool, and when I’m not doing that, treadmill running = weak glutes and strong hip flexors.

15

Plus, I’m a fishie and a runner. Powercranks would mean I’d have to ride my bike.

:wink:

16

I’ve spent a lot of my life as a swimmer, doing lots of kicking in the pool, and when I’m not doing that, treadmill running = weak glutes and strong hip flexors.
IMHO, your problem is one of balance, not being overly powerful. It also sounds like you have a left right problem because you use the singular when mentioning your problem although you haven’t mentioned a side. John Kenny and Hayley Piersol are on PowerCranks. Sheila Taorimina was also a PC’er. I suspect they all have/had pretty good HF’s from their swimming background yet we haven’t caused any issues here that I am aware of.

Anyhow, it is something to consider. There is a 90 day moneyback guarantee.

PS, I also wonder, since I think this is most likely a R/L balance problem, if it could be related to that upper extremity/neck imbalance issue I thought I might have seen on that picture you posted a year or so ago. Always wondered what came of that issue. Anyhow, good luck in your rehab efforts.

17

Hey,
If you are indeed super active, an in jury that wont clear up can be frustrating.
Before running out and buying any fancy equipment hoping that’s the answer. why don’t you elaborate on the problem. Give some details on where and when it is sore, what aggravates it etc. Asking because you pinpoint the hip flexor as the possible culprit, however treatment has ranged from hips, glutes, quads etc etc, meaning its hard to help figure it out.
I agree that the x-ray will most likely be fine, however there can also be issues with the soft tissues in and around the hip, and/or the labrum and other structures in the hip. If its not going away with treatment, you may be treating the wrong thing!
Martin

18

Tennis ball. Lie on top of it with the ball under the psoas. Raise the leg on the side of the problem, and stretch out the opposite hand. You’ll feel it when the ball is in the right spot. Works great.

19

Mr. SpicedRum, you have given me a little bit of hope. Will try!

20

If you are indeed super active, an in jury that wont clear up can be frustrating.

Understatement of the year :slight_smile:

hy don’t you elaborate on the problem. Give some details on where and when it is sore, what aggravates it etc.

Sure. Injured hip is the right one:

Initial injury was a Friday. I had run: 13 on Wed., 9 mi with two of those miles fast on Thurs., 9 miles Fri and threw in some hills. I normally run flat on the treamdill. It was sore Friday. I’m dumb, so I ran Saturday… 20 minutes easy in the AM and 40 minutes easy in the PM. It was still sore. I think I ran for a couple more days before it became too absolutely painful to run. Yes, this was a dumb thing to do. I already said that.

Initial pain was with hip flexion. That could be something as slight as lifting the foot from the gas pedal of the car to the brake. (If you don’t believe me, think about it when you drive home tonight: there is a little bit of hip flexion.] THAT HAS GONE AWAY fortunately. As has the inflammation over the ‘crease’ of your hip (where torso and thigh meet if you’re sitting). It used to hurt with backstroke kick but I am ok with that now.

I really only have pain walking and running. When my hip is extended it hurts. IE, a lunge position hurts when the sore hip is in extension. So that part of gait in running, where the hip is extended from pretty much when you’ve pushed off with your calf/foot and are trying to then pull your leg forward, is painful. I can pull it forward fine but that extension part hurts.

My left IT band has always been tight and I think that probably caused some of this initially. The spot where the left IT band inserts on the Iliac crest is a bit painful and has been since late July. Maybe that tightness resulted in whatever this is.

The good news… and I am realizing this now that I am writing it and thinking of how sore/inflamed it used to be vs what I can do now… is that it’s getting better.

But it could get better faster :slight_smile:

Does that help at all? Would love any more thoughts. Obviously glute strength + external rotator strength + stretching out all hip muscles and low back and IT band are integral in recovery.