Iliacus Trigger Points

Introduction

The iliacus is a deep hip flexor muscle responsible for hip flexion, pelvic stabilization, and postural support. When trigger points develop in this muscle, they can cause hip pain, lower back discomfort, and groin tightness, often mimicking hip arthritis, hernias, or lumbar disc issues.

Name and Area

  • Name: Iliacus

  • Area: Located in the inner pelvis, spanning from the iliac fossa to the lesser trochanter of the femur, where it merges with the psoas major to form the iliopsoas.

Indications

Iliacus trigger points may contribute to:

  • Pain in the front of the hip and groin (mistaken for hip flexor strain or hernias)

  • Pain that extends to the lower back and SI joint (can mimic lumbar disc issues or SI joint dysfunction)

  • Tightness in the hip that limits movement (difficulty with deep squats or lunges)

  • Pain when standing up after sitting for long periods (common in office workers and drivers)

  • Discomfort or weakness when walking, running, or climbing stairs

  • Pain that worsens when sleeping in a fetal position or with tight hip flexion

Pain from this muscle is often mistaken for hip arthritis, lumbar disc problems, or pelvic organ dysfunction.

Muscle Action

  • Flexes the Hip: Brings the leg toward the torso (important for walking, running, and climbing stairs).

  • Stabilizes the Pelvis: Works with the psoas and lower back muscles to support posture.

  • Assists in Trunk Flexion: Helps bend the torso forward when the legs are stationary.

The iliacus is essential for functional movement, postural stability, and lower body coordination.

Signs and Symptoms

Individuals with iliacus trigger points often report:

  • Pain in the front of the hip or deep in the groin (feels like a "pinching" sensation).

  • Pain that extends to the lower back, SI joint, or inner thigh (can resemble nerve compression or sciatica).

  • Tightness in the hip that restricts leg mobility (difficulty bringing the knee toward the chest).

  • Pain or stiffness when standing after sitting for long periods (common in office workers, drivers, and frequent flyers).

  • Discomfort or weakness when running, sprinting, or engaging in explosive hip movements.

  • Pain that worsens when sleeping with the hips in a flexed position.

Pain worsens with prolonged sitting, excessive hip flexion, or sudden movements.

Perpetuating Factors

Common causes of iliacus trigger points include:

  • Prolonged sitting or sedentary lifestyle (shortens the iliacus and leads to chronic tightness)

  • Repetitive hip flexion movements (running, cycling, martial arts, sprinting, kicking)

  • Tight hamstrings or weak glutes (leads to overuse of the hip flexors)

  • Postural imbalances (anterior pelvic tilt, swayback posture, or leg length discrepancy)

  • Chronic stress or anxiety (can increase abdominal and hip muscle tension)

Trigger Point Referral Pattern

Trigger points in the iliacus refer pain to:

  • The front of the hip and groin (can mimic hernias or hip arthritis)

  • The lower back and SI Joint (mistaken for lumbar disc problems or SI dysfunction)

  • The upper thigh and inner leg (can resemble nerve pain or tight adductors)

Pain from this muscle is often confused with hip arthritis, lumbar disc herniation, or pelvic dysfunction.

Differential Diagnosis

Iliacus trigger points may be mistaken for:

  • Hip arthritis (deep groin and hip pain that worsens with movement or weather changes)

  • SI joint dysfunction (pain in the lower back and buttocks, worsens with sitting or walking)

  • Lumbar disc herniation (lower back pain with radiating symptoms into the leg)

  • Hip flexor strain (sharp pain in the front of the hip, worsens with running or lifting the knee)

  • Pelvic organ dysfunction (can cause deep pelvic pain or discomfort, especially in women)

A thorough hip, pelvis, and lower back examination is necessary to rule out these conditions.

Associated Trigger Points

Iliacus trigger points often co-exist with:

  • Psoas major (deep hip and lower back pain, contributes to postural dysfunction)

  • Quadratus lumborum (lower back and SI joint pain, affects pelvic stability)

  • Gluteus medius and minimus (outer hip pain and gait instability, mimics sciatica)

  • Rectus femoris (anterior thigh and hip flexion weakness, affects running and sprinting mechanics)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Iliacus Iliac fossa, sacrum Lesser trochanter of the femur (via iliopsoas tendon) Femoral nerve (L2–L4)

The iliacus is innervated by the femoral nerve, which also controls hip flexion and lower limb coordination.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules deep in the iliac fossa and front of the hip.

  • Hip Flexion Strength Testing: Assess pain and weakness when lifting the knee toward the chest against resistance.

  • Gait Analysis: Look for hip instability, limping, or difficulty maintaining pelvic alignment while walking.

  • Pelvic and Lumbar Spine Testing: Rule out SI joint dysfunction, lumbar disc herniation, or pelvic imbalances.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the iliacus, reducing muscle tightness and improving hip mobility.

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots in the iliacus and hip flexor area.

  • Massage Therapy: Helps improve circulation and reduce hip muscle tension.

Stretching

  • Hip Flexor Stretch (Lunge Position): Gently extend the hip backward while keeping the back straight.

  • Supine Hip Stretch: Lie on your back, bring one knee to the chest while keeping the other leg extended.

Strengthening Exercises

  • Glute Bridges: Strengthens the posterior chain to counterbalance tight hip flexors.

  • Leg Raises: Improves hip flexor endurance and core stability.

  • Single-Leg Balance Drills: Helps enhance pelvic stability and lower limb coordination.

Postural and Movement Adjustments

  • Avoid prolonged sitting without hip extension (take standing breaks every 30–60 minutes)

  • Use proper walking mechanics (engage the glutes to reduce hip flexor overuse)

  • Ensure proper core activation during movements (prevents excessive iliacus compensation)

Conclusion

The iliacus plays a crucial role in hip flexion, pelvic stabilization, and postural control, but trigger points in this muscle can cause significant hip, lower back, and groin pain. By incorporating dry needling, manual therapy, stretching, and strengthening exercises, individuals can reduce pain, improve mobility, and prevent future dysfunction.

➡️ Learn more about Trigger Points

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.