Managing Lower Abdominal Strain and Iliopsoas Pain
By Caitlin Mari V. Oliveros, PT, PF-1, BSPTS-1
The abdominal muscles are a group of muscles that make up the walls of the trunk. The most common muscles to note are TVA (transversus abdominis), rectus abdominis, internal obliques, and external obliques. These muscles vary in depth (superficial vs deep layers) and function. As a whole, they protect the spine & allow for proper load transmission. When an abdominal strain occurs, it may be due to poor stability/bracing by these muscles- perhaps due to an imbalance in muscle length or strength, for various reasons (overuse, overstretching, trauma, general weakness, etc).
What is the iliopsoas?
The iliopsoas is another pair of muscles, the iliacus and psoas major, that make up the strongest hip flexor. [Both have significant connections, originating from the inner walls of the pelvic fossa and T12-L5 vertebrae to the lesser trochanter of the femur.] In simpler terms, the iliopsoas connects your lower back and inner pelvis by merging across your hip joint and into your upper thigh bone. Aside from its primary function as a hip flexor, it also stabilizes the pelvis in standing and influences in side-bending the trunk due to its connection to the posterior abdominal wall. An iliopsoas strain can occur due to the same reasons as an abdominal strain, but because of its prime location between the trunk and lower limbs, it is more prone to injury– you may have heard of iliopsoas tendinopathy, psoas syndrome, bursistis, etc.
It is important to note the connection between the abdomen and hip flexor muscles. The abdominal walls that make up the trunk are greatly responsible for intraabdominal pressure (IAP), which is a baseline internal pressure that fills our trunk. When muscles in the abdominal walls are too short and/or long, this pressure fills the areas of least resistance, causing an imbalance in both trunk shape and internal pressure. When an individual lacks the symmetry and balance of the trunk, compensations by other parts of the body can start to occur and lead to other dysfunctions– postural issues, improper breathing techniques, pain/tightness, poor grounding, impaired gait, etc. In the same way, muscles that have connections in the thorax, such as the hip flexor, can also pull on these abdominal walls and influence the IAP.
How do you treat an abdominal strain?
Most people believe that resolving a strain on the abdomen or hip flexor is to rest it completely. While rest is essential for recovery, it is still necessary to reeducate the muscles to function properly, little by little. This means doing gentle movements like heel slides or partial leg raises in supine- to your available, pain-free range of motion. As your pain levels lower and your range improves, you can clear up any consequential tightness by gentle stretching and strengthening (see below).
ABDOMINAL EXERCISES
COBRA
stretching: Lay flat on your belly with elbows bent, palms down to either side of your armpits. Gently push your body up into a cobra to stretch your belly. If you feel compression on your low back, only lift halfway or up to tolerance. Take a few deep breaths in this position before resting.
TOE TAPS
strengthening: Lay on your back with hands on hips. Focus on keeping both sides of your hips even (do NOT dip to one side) and keep a neutral spine. If you find that you are over-arching your back, or pressing it heavily into the mat, readjust your spine to a neutral position. Bring one leg up to the table top position (90-90 position). Inhale, tap your toes towards the floor; exhale, and draw your belly button to the spine, as you return the leg. Stick to one side at a time, doing 8-10 reps for practice.
ILIOPSOAS EXERCISES
HALF-KNEELING
stretching: Kneel on the ground with one leg in front (foot in contact) and the other behind (knee in contact). Ensure that you are not rotating the pelvis too much, by checking that your hips are fairly even with each other. Lean forward and let the back hip flexor open. You can either hold this position for 20 seconds or rock back and forth a few times to stretch the area.
BUTT TAPS
strengthening: Start by standing in front of a chair with hands on hips. Inhale, begin hinging your butt backwards- allowing the chest to fall forward, hovering over the chair (or until your butt taps the chair). Ensure that both hips/buttocks drive backwards simultaneously. Exhale, step on both feet evenly to stand.
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