Those stubborn quads. You’ve rolled them, stretched them, and massaged them but they’re still tight and/or sensitive to pressure. It’s time for a new angle: let’s look up the chain to find out where that tension is coming from.

There’s no doubt that your quads are working hard, and it’s true they may be holding tension. But they’re also part of a much larger team of muscles that works synergistically while you’re running and even while you’re sitting.

Just because the pain is in your quads doesn’t mean the problem is in your quads

I’m going to bring your attention up the chain to your iliopsoas muscle, an important member of the hip flexor family.

The iliopsoas is actually two muscles: the iliacus and the psoas. Many runners mistakenly refer to these muscles interchangeably, or believe when they’re releasing the psoas they’re also releasing the iliacus. But these two muscles each have distinctive locations and roles, and they both need to be addressed.

One part of this muscle – the psoas– travels from your lower back, across the front of your pelvis, and attaches to the femur (thigh bone). This muscle crosses diagonally through your body in a direction we rarely think about.

The other part of this muscle – the iliacus – travels from the iliac fossa (the pelvic bone) and crosses over the hip joint and also attaches to the femur.

Functionally, these muscles attach your upper body to your lower body, and have the extremely important job of both stabilizing your pelvis and lifting your leg.

Nearly all runners have a tight iliopsoas. Running utilizes the iliopsoas to swing the leg forward in a running pattern while simultaneously stabilizing the spine and hips. The leg strides forward using the iliopsoas and when the leg extends behind the body, that muscle is stretching. Any time you have one leg forward and the other leg behind while using this muscle, there is a good chance for one of the iliopsoas muscles to develop tightness because they have to shorten and lengthen all while stabilizing your spine and hip area. And when this tightness is chronic, this muscle can form something called a trigger point.

What is a trigger point?

A trigger point is a muscle knot that refers pain to a completely different place than where it’s pressed (hence the name; it triggers pain elsewhere). For example, if you have a knot of the trigger point type in the top of your shoulder and you press on it, it might hurt right where you’re pressing, but it could also refer trigger point pain into your neck or head, resulting in a headache.

Trigger points are important to understand because often we have pain in certain areas of the body that are actually coming from a different location.

So back to those stubborn thighs…

An iliacus trigger point can refer pain to the thigh

If you have an iliacus trigger point, you may experience referred pain to the top of the thigh. This may feel achy or tight. If you have a psoas trigger point, you may also experience referred pain that specifically runs vertically along your lumbar spine: this is the trigger point pattern for the psoas and iliacus.

While trigger points often show up in iliospoas muscles on both sides, they are typically more active in one side over the other. But for you special cases out there, it is possible to have them equally active on both sides.

Because the nerves from the lumbar spine are lodged within the psoas muscle, trigger points in either the psoas or iliacus muscle can also entrap nerves, creating symptoms of weakness in the leg and/or sensations of numbness, tingling, or pain.

Tension in these muscles not only affects the nerves and the pain patterns, but they cause a twist in the core resulting in issues from the spine down to the mechanics of the toe. It’s a pretty big deal. I wrote a whole book about it: Tight Hip, Twisted Core: The Key to Unresolved Pain.

What causes trigger points

Iliopsoas trigger points can form from overexertion on an unconditioned muscle, a sudden overload (as in, falling and catching yourself), or regularly sleeping in a fetal position (with your knees drawn up to your chest).

Trigger points can also be aggravated when a muscle is in a contracted position for an extended amount of time (hello, desk chair and long drives), especially in positions where your knees and higher than your hips. Even more so if you are leaning forward at the same time.

Keep in mind that any posture or activity that activates a trigger point, if not corrected, can also perpetuate it.

Foam rolling is not the (only) answer

A trigger point can remain inactive, existing as a knot in the muscle tissue, but not causing any other issues. However, if you go to town rubbing on the trigger point or stretching it, it can become active. Once activated, this “active” trigger point can cause referred pain without being pressed. (Spoiler alert: you don’t want that.)

Foam rolling and stretching your quads can be part of the solution: increasing circulation, releasing tension and softening those muscles absolutely helps. However, when the rectus femoris muscle (that big one on the front of your thigh) is shortened, the iliopsoas muscle also becomes shortened, making it more susceptible to forming and perpetuating iliopsoas trigger points. So even if the origin of your quadriceps tension was actually in your thigh, it is now tugging on the entire chain.

In my experience, many runners with tight iliopsoas muscles have resolved their pain in other parts of the body such as the glute, knee, foot, and toe, by releasing the tension in the core, the iliacus muscle itself.

Trigger points release best with direct, prolonged (90 second) pressure

You need to access this muscle directly to release the trigger point. If the trigger point was in your shoulder, you could easily release it with a tennis ball, a partner, or a well-placed doorframe. The psoas and iliacus muscles are a bit trickier because they are located up against the pelvic bone and you need more angled tools to reach them.

Your first option is to see a physical therapist who can manually release these muscles with their hands. Your second option is to use a tool to release your iliopsoas at home. Some runners have been known to use a kettlebell handle or a massage ball. But there are a couple of tools on the market that address the psoas and only one that addresses both the psoas and the iliacus.

One psoas release tool is the Pso-Rite. It has two arches that curve upwards and you lay over them. For some runners, they are able to get the angle they need for psoas release using this tool, but be aware that it’s a one-size-fits-all tool. Your body needs to be a certain width for those spots to match up with your psoas muscles and the pressure point is non-specific.

Another other psoas release tool is the Hip Hook, which first releases the psoas, then angles inward to perform an iliacus release. For trigger point release specifically, you want hands or a tool that can access the specific nooks and crannies of that muscle and provides pinpoint pressure like only a therapist’s thumb could do otherwise.

Sometimes a trigger point may be right in the belly of the muscle, but sometimes it may be further towards the origin or insertion point. Engage your patience and curiosity: you may need to do some exploration to find the right spot: that’s where a skillful practitioner or specific tool comes in handy.

Iliopsoas trigger points pull on other places, too

Because the iliopsoas muscles are part of a larger functional unit, it is likely you also have trigger points or tightness on the back of your hips and legs due to trigger points in the iliopsoas. So don’t ignore your backside. The antagonists (muscles designed to work opposite the iliopsoas) are also likely to develop trigger points: especially the gluteus maximus (your largest butt muscle), hamstrings (backs of your legs), and adductor magnus (tippy-top of the inner thigh to your inner knee).

This best practice of direct, prolonged pressure applies to these muscles as well. For your gluteus maximus, lay on your back with your knees bent and place a lacrosse ball, tennis ball, hip flexor release ball, or solid dog toy under your hip to release these muscles. Trust me: you will know the spots when you reach them. Breathe and imagine your muscle melting over the ball for 30-90 seconds and you’ll feel that muscle releasing. You can also let your knee fall out to the side to achieve deeper pressure. Then roll the ball a couple inches in any direction and find the next spot. Use this same technique with a foam roller or ball for your hamstrings and adductors.

How to prevent iliopsoas trigger points

Sometimes the best way to take care of your runner’s body is to pay attention to what you’re doing in the other moments of your life. Avoid sitting in positions that keep your iliopsoas flexed for long periods of time, and learn to release your iliopsoas regularly as part of your stretching routine. (And if you haven’t already: develop a stretching routine). Your muscles form movement habits that affect everyday functioning. And like every habit, for better or for worse, regularity matters. Think of releasing your iliopsoas like flossing for your core: it doesn’t take long, you have to remember to do it, and your body will thank you for it in the long run.