Iliacus Dysfunction and Pain [Book Giveaway]

by | Oct 17, 2020

Tightness in the iliacus is is something that a lot of people have…it’s not being addressed

Christine Koth

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Iliacus Dysfunction and Pain With Christine Koth

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In today’s epsiode, we’re talking about the iliacus, the lesser known relation of the psoas. Together these 2 muscles make up an important hip flexor composite muscle known as the iliopsoas.

Tight hip flexors, particularly a tight psoas, are often considered responsible for back pain.


“I discovered this technique … that fully allowed me to get access to the iliacus muscle in a very effective way”

– Christine Koth

In her 20+ years of hands-on experience, Christine found that the illiacus was also a common source of dysfunction and pain. It just didn’t receive anything like the same attention as it’s big brother the psoas.

In this episode, you’ll learn how she developed release techniques specific to the iliacus that are central to her therapy practice.

And You’ll discover how Christine found ways for her clients to do these release techniques on themselves when she moved away to another state and wouldn’t be able to treat them any more.

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Tight Hip, Twisted Core: The Key To Unresolved Pain


Tight Hip, Twisted Core: The Key To Unresolved Pain

In her book, Christine explains how iliacus dysfunction is often overlooked as the cause of chronic pain conditions, including back pain.

And, of course, what we can do to address the issue to release the excess tension, relieve the pain and restore function.

For your chance to win your very own copy just enter the giveaway below.


Book Giveaway


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All times UTC-1. It only takes a few seconds to enter the giveaway. You never know, it could be you this time!

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With former chronic back pain sufferer, and

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About Me



Hi, I’m Iain Barker creator of Back Pain Liberation.

I got back pain young and it got worse over time. Like many others in this situation, I saw plenty of doctors and therapists – all to no avail.

In the end self-help worked best – it often does for bad backs. Now I train regularly, focus on what works, and don’t get back pain.

My goal is to share what I learned. To help you find a more effective way when treatment doesn’t hit the spot.





Which musician, DJ and producer who made an award – winning music video featuring a solo dance performance by Christopher Walken said:


“I make music for the hips, not the head”

Answer at the end of today’s show.

Listen on the player on this page, iTunes or wherever you like to listen to podcasts.


Full Episode Transcript


Click for episode transcript - BPL41
Iain Barker

Christine, hi.

Let me just turn on my. Yeah, I’m just turning on my voice recorder so I’m getting you. Yeah, this is only the second time that I’ve used zoom. And I was struggling to get to grips a little bit, but here we are now so. Yeah, exactly. Yeah. Practice makes perfect. Yeah, it really does it Seems like such a silly thing not being able use. Yeah, I generally use Skype. I have done for a lot of years and just kind of happens automatically. And, you know, they’re things like meeting ID numbers and

why do I need that? I know your name. I just want to call you. Why do I need a number. Anyway. Here we are.

Christine Koth

Nice to meet you.

Iain Barker

Yes. Lovely to talk to you. How are you today?

Christine Koth

I’m doing great. Yeah. Wonderful Saturday morning. For me.

Iain Barker

It’s Yeah, it’s Saturday evening for me. We’ve had we’ve had some Yeah, very nice day so far. Although it’s pouring with rain now. Okay. It might even affect the audio because it’s really drumming on the roof. But

can you hear anything?

Christine Koth

No, I don’t. No, I don’t

Iain Barker

Good. Okay, then. Yeah. It’s like a sort of metal roof in this house. And yeah, when it rains really heavily you can you can kind of hear it. But yeah, I guess this microphones. only picking me up, so we’re good to go. So we’re gonna be talking about your your book, which has been come out on Amazon recently. And tight hip, twisted core, the key to unresolved pain, which is doing very nicely, isn’t it? I just had a look at it just now. And you’ve got some really good reviews on Amazon for half stars out of five and on average. Yes, yes. Yeah, you must be very pleased about that.

Christine Koth

I am. It’s been really fun. Getting the feedback and having people reach out to me after they’ve read the book and having some significant aha moments. It makes it all, makes all the work that went into it worth it.

Iain Barker

I totally understand that that’s really what it’s all about, isn’t it? Yeah. Yeah. Before before we go into more detail on the book, just a little bit about you. And I got one thing from the book about you. Apparently you’re in iliacus PTG

Christine Koth

Yes, PTG is the is the term that we use in physical therapy school to self identify with the geekiness that we have about getting super excited about physical therapy related things, you know,

Iain Barker

So you’re a physical therapy geek, especially in terms of the iliacus.

Christine Koth

And especially in terms of iliacus. Yeah, it happens to be that this, you know, just my life has led me to really understanding this muscle in its entirety, and very much detail and being able to kind of see in so many different people how this muscle has impacted their body, you know, kind of just by chance, having clients come into my office that have had tightness in this muscle and when resolve they resolve their pain, so 20 years of doing that kind of give, give me a good sample size of cases.

Iain Barker

So you’ve been a physical therapist for 20 years and this is a sort of pattern that you’ve noticed Over that time that this is a common issue tightness, particularly in the iliacus causing a variety of sort of maladies, I suppose.

Christine Koth

Yes, yeah. I mean, tightness in the iliac is is something that probably that a lot of people have the, the magic in this discovery really is the fact that it’s not being addressed. Yeah. You know, it’s something that you know, many physical therapists and chiropractors and practitioners group in with the psoas and you know, maybe are working with the psoas or working with other muscles around the hip, but just kind of ignore this muscle. And it does, you know, it doesn’t you know, it has an impact that really should not be ignored.

Iain Barker

Yeah, well, the psoas is quite well known, isn’t it? People know about it, but the iliacus I guess less so. And you say that is tight. In your introduction to the book you say that the iliacus is tight in almost everyone. So that’s a really big deal. That’s a big deal. Well,

Christine Koth

think about this, when muscles are in their shortened position for a really long period of time. They don’t like that they tend to cramp up I don’t know if you’ve ever had the experience where you’ve maybe reached behind like an awkward you know, box or behind a dresser and then your your neck cramps up, you know, because,

Iain Barker


Christine Koth

you know, we’ve all experienced something like that where muscles gotten into too short of a position it gets kind of in an awkward position and that causes muscle contraction and muscle tightness. Yeah. And in our society that we live in, you know, you just take one cause of iliacus tightness which is sitting. Yeah, extrapolate that to all the human beings on this planet who are sitting way too much. You know, our bodies are not meant to be sitting in one place for very long. You know, this muscle is in a certain position for hours and hours on end and you know, what does it choose to do in response, it chooses to become tight and knotted. Yeah, and this is just one of like the three main reasons why iliacus tends to be tight and most people

Iain Barker

well this is quite a common idea, isn’t it the too much sitting causes tightness in the hip flexors, but you say that it’s specifically the iliacus that people need to be thinking about.

Christine Koth

Well, the reason I put a lot of focus on iliacus in this book and really focusing you know my work on that is because there are other tools out there for the psoas; and I am not going to claim the psoas is not important – it is. and it can gert tight from sitting and it can make a big impact on low back pain. But the the methodology there are many tools out there for releasing the psoas and people are thinking about this psoas, but if you release the psoas or if you get the psoas you know, working properly and you don’t address the iliacus your symptoms will not go away, you know, maybe temporarily. And so, you know, both of them need to be addressed in essence. Yeah.

That’s the iliacus, it wants to come out of the closet it wants to be seen…

okay, it’s saying help me!

Iain Barker

Yeah. Yes. When, when a muscle is tight and it does sort of call out for help in terms of pain, you know, your attention is drawn to it.

Christine Koth

Yes. Yeah, absolutely. I mean, one of the things about having it there’s two things that happen as a result of a tight muscle one is what happens to the actual muscle and the sensation that you experience as a result of that muscle being tight. You know, the muscle might be sore itself where it’s attached, attachments might be sore. You may feel like a sense of tension in the area. It’s uncomfortable. Yeah. But then, you know, there’s also So the fact that that tightness has on the mechanics of the rest of your body, you know, what, you know, if that tightness is persisting as you’re going about your day, as you’re walking as you’re sleeping, as you’re, you know, doing your daily life, that constant tug pulls on your spine pulls on the pelvis pulls on the tailbone, yeah, changes the whole trajectory of how the leg, you know, hits the ground. And really, that, you know, though, that’s where you may have, say, for example, knee pain or back pain, and it might be because of that tightness in the hip that’s causing this trajectory.

Iain Barker

Yes, I’ve actually experienced exactly that. Yeah, knee pain, as a result of tightness in the front of the hip, whether I could pin it down to exactly the iliacus I don’t know. But I found that by consciously relaxing that the hip flexors, the front of the hip, I could just ease off on the knee pain.

Christine Koth

Yeah, changes the whole, the whole alignment of the kneecap, the knee joint itself. Yeah, takes the strain off of the ligaments and the joint surfaces, meniscus all that, you know, just as a result, your hip is really your hip and your pelvis is your foundation. Yeah, everything, you know, either you get rooted from, you know, the pelvis down to your feet, or you sprout up from the pelvis up to your your head. And if that foundation is not in alignment, or it has something tugging on it, or it’s, you know, an unhealthy unstable segment per se, that, you know, things on the way up and on the way down, you know, have the potential for being unhappy as well. Yes,

Iain Barker

yeah. I know exactly what you mean.Yes. So you talk about discovering the iliacus using a technique This is technique you use in your practice, you sort of developed sort of quite early on and are still using.

Christine Koth

Yeah, yep. When I was a novice physical therapist, one of the things that was a mystery to me was how am I supposed to feel all of these muscles with my hands? You know, you come out of physical therapy school with this, you know, this expectation that you’re going to be able to feel what’s going on in people’s bodies and I was skeptical. But I happened to get my first job out of college and was working in an physical therapy practice that specialized in hands on therapy. So I’ve learned from these really seasoned physical therapists on how to feel things and how different techiques work well for releasing various tissues. And one of the first techniques they taught me was actually a psoas release, you know, as I was, you know, clumsily feeling around in the abdomen looking for the psoas you know, through the abdominal tissue and through the, you know, the digestive system and you know, trying to figure out where that was, I came upon iliacus was like, Ooh, this iliacus is really you know, this is really tight What is this? You know, looked it up in my anatomy books like, Oh, that’s iliacus and, and you know, really, because iliacus is closer to the bone. For me as a novice physical therapist, it became easier to access because I didn’t have to go through all those other tissues. Yeah,

Iain Barker

The psoas is quite deep and

Christine Koth

It is quite, Yeah, it is quite deep. It’s definitely accessible. But um, I started just noticing that when other people weren’t noticing that and then you know, because I was new with my hands. I also didn’t have really great body mechanics or you know, I was coming home, icing my hands after a day’s work

Iain Barker

So this is the mechanics of your own body.

Yeah, okay.

Christine Koth

So you know, I thought well how can I release this muscle? or How can I put pressure on it without hurting myself and that’s how I discovered this technique of going across the body to use the leverage of my body in a safe way for my own self and that fully allowed to get an access iliacus muscle in a very effective way it turns out

Iain Barker

and the point of accessing the iliacus muscle in that circumstance was to apply pressure to it.

Christine Koth

Right correct. Yes. And prolonged pressure is something that is a magical tool. Oftentimes we get when we get muscle work we we work on you know, we get massages or we’re rubbing things you know, foam rolling is another example of you know, rubbing and I talked about this in the book, the difference between stretching, rubbing and pressing. Yeah. Prolonged pressure. is really what helps to change the signals from the brain that are keeping a muscle contracted for a period of time. And it’s with that kind, you know, you really need that type of technique to to resolve long standing tension that is being held in the muscle. And this has been known Travell & Simons are, you know, the Guru’s around trigger point release, they, you know, the manual and trigger point release is written by these amazing practitioners and, and this is the really the primary way that trigger points can resolve or muscle muscle knots can resolve. And so that, you know, being able to sustain pressure for, you know, anywhere from 30 to 90 seconds at minimum is essential, you know, as for releasing tension in the muscle, can we tend to be a little unpatient when it comes to that?

Iain Barker

Yeah, well, if you’re doing something like Well, I’ve tried similar techniques to this, but particularly On the feet to release sort of tight muscles in the soles of the feet, the arch of the foot. And by standing on something like a ball or something. And if you’re just standing with your weight on, on something hard to apply pressure to a muscle, 90 seconds actually begins to feel like quite a long time. Not that it’s painful particularly but it’s just a little bit okay, what do I do now? And you we’re kind of used to thinking we should be doing something instead of just standing there and waiting.

Christine Koth

right that’s right that’s how you That’s why you set a timer so that you don’t try to escape before the time is over. Yeah, yeah.

Iain Barker

I guess it’s part of this, you know, the, the modern lifestyle thing of, you know, we spend too much time sitting. But then we also once want to be engaging our brain in something all the time as well instead of just like standing and being Right for the for even 90 seconds,

Christine Koth

yeah, I also give people a little out I’ll say okay, you know, you can check your you can check your emails on your phone while you’re doing it you can watch and you can read a book, you know, and try to get some. So it’s not

Iain Barker

it’s not a requirement to kind of be in touch with what’s happening then, you know, in your mind,

Christine Koth

not necessarily it definitely is more effective if you can be present and breathe Exactly. But, you know, if that’s what allows people to, to execute the exercise, then you know, that’s a compromise worth making.

Iain Barker

Yeah, understand. Yeah. Okay. So, of course, you know, you’ve done this as a physical therapist and you recommend that people get maybe physical therapy to have pressure applied to the, to the iliacus. But then, you’ve mentioned in your, in your book, the hip hook, which is have you designed this yourself?

Christine Koth

I have Yes.

Iain Barker

Okay. So this is your thing. Yep. Yep. Right.

Christine Koth

Yeah. So with so when I was when I was practicing in Wisconsin, I was seeing a lot of clients with tightness in their iliacus. And they were getting great results with using my hands and then I chose to move from Wisconsin to California and left all these wonderful human beings behind without any tool to be able to release their own iliacus and trust me, I have tried everything I have tried every size ball. Yeah, there came remote controls, spatulas, you know, household tools, you know, everything. Okay. And, you know, it just wasn’t anything close to what my fingers could do for but they’re, you know, we’ve used balls and we use foam rollers and we use all kinds of tools to release other muscles in the body, but there was just nothing They could get at the iliacus because it needs to be needs to press towards the pelvic bone at a particular angle in order to get that, you know, to get that. Yes.

Iain Barker

Yeah, that makes sense.

Christine Koth

And so when I, you know, is mainly kind of like out of guilts you know, I just felt horrible. But these poor people had nothing you know, couldn’t come see me, right. And so, I went on a mission of about two years, really trying to figure out how to replicate something like this in a way that they can easily do on their own. How do you create a rotational, like lateral pressure on a muscle, you know, you can grip upward pressure, direct pressure, but how do you get it to, to tilt into the iliacus and that’s really how the hip hook was born. You know, I had gone through many, many prototypes to figure out

Iain Barker

yes I can imagine

Christine Koth

Yeah. Figure out the exact right height, the exact You know what, how wide the Tip should be how to get it to rotate into the muscle, which we use a little lever system around a pivot point. Yeah. And all of that has been perfected, and I’ve tested it out in many clients and they’re like, okay, like, yes, it actually feels like your fingers, you know, and they’re,

Iain Barker

you’ve been replaced

Christine Koth

I’ve been officially replaced.

Iain Barker

Yeah, I had a look at it, actually, because you got photographs on on your website? Yes. Yeah. So I have seen it and I kind of understand how it works. So I guess you put it on the floor, don’t you and then you’re lying in a prone position. And you I guess you get it in the right place, and then your bodyweight kind of presses down on it. Is that right?

Christine Koth

Yes. Yep. So you, you know position it right inside of the pelvic bone where the iliacus lives. You lie in your neck on top of it. So the weight of your body is providing the force Then after, you know, maybe 30 seconds of just letting yourself ease into it. You use your hand to press on the lever which is on the outside, which cause I

Iain Barker

I wondered what that was.

Okay, now I understand that’s a lever. Okay, I get it. Yeah.

Christine Koth

Yep. So the lever allows the pressure to get translated at an angle into the muscle. See, and that’s the that’s how you’re really able to access it where it attaches to the inside surface of the pelvic bone.

Iain Barker

Yeah, got it. Yeah, fantastic. Okay, so there are so that was the introduction to the book. We just kind of covered there. And then after that there are there are sort of it comes in four parts, doesn’t it look a bit like a play and which fits in quite nicely because Part one is called setting the stage and you you took the stage itself is the core of the body.

Christine Koth

Yeah, yep. So we talked talk all about the the core of our body and where the iliacus and the psoas live and all the things that exist around it, you know the organs that exists around it how the different muscles you know how like for example, the iliacus and the psoas are sidekicks I call them to other members of the play like the tensor fascia Lata for example, which exists on the outside of your hip and is responsible for it band problems. So certain muscles are are synergistic with the iliacus and the psoas and when they get tight, when they get tight, they’re oftentimes tight as well, because they just, you know, they’re joined together, you know, we’re all gonna work on you know, rotating this pelvis forward. And then there’s the villains in the story. You know, the villains are those muscles that are in opposition to the iliacus. And psoas. Examples of this Be your glute and your piriformis and your hamstring. And so the muscles that play tug of war with those, the hip flexors on the front. And so, you know, the setting the stage is really about just an orientation for how all these muscles interact with each other and what are the different things that are contributing to, you know, the story that is unfolding about the iliacus and psoas




Thanks for joining me for episode 41 of the Back Pain Liberation Podcast.

More from author of Tight Hip Twisted Core and inventor of the ‘Hip Hook’, Christine Koth

If you find the show helpful don’t forget to rate, review and share with anyone else you know who has back problems.

All the best


Music courtesy: Jahzzar

Photos by Anne Nygård on Unsplash and David Pennington on Unsplash

This website is for your information only. Consult your own doctor for medical advice.

Any guests express their own views and no endorsement  by the Back Pain Liberation Podcast is implied.


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Music courtesy: Jahzzar

Photos by Anne Nygård on Unsplash and David Pennington on Unsplash

This website is for your information only. Consult your own doctor for medical advice.

Any guests express their own views and no endorsement  by the Back Pain Liberation Podcast is implied.

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