Dr. Bri Talks Lady Bits Podcast – The Effect of the Iliacus on Digestion and Pelvic Health with Christine Koth

Christine was recently featured as a guest on the Dr. Bri Talks Lady Bits podcast, discussing the effect that the iliacus muscle has on digestion and pelvic health. See below for the show notes, YouTube video, and a full transcript of the podcast.

Show Notes:

In this interview with Christine Koth, MPT, you’ll learn all about the iliopsoas muscle group, and in particular, the iliacus muscle… A small muscle that has a BIG IMPACT on digestion and pelvic health. Christine Koth is the author of “Tight Hi, Twisted Core.” Discover how to identify and release the iliacus for less pain and better health!

Watch on YouTube.

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Full Transcript:

Brianne Grogan 0:00

I have Christine Koth with me and she has a book that I have with me right here. I know this is going to be on my podcast, if I share it on YouTube, they will see the book. I’m holding it up. But it’s called “Tight Hip, Twisted Core – The Key To Unresolved Pain.” And I got turned on to this book a couple of months ago, I guess. And when it arrived, I literally devoured it, not only because I am an anatomy nerd — I love anatomy — as a physical therapist, of course, I am fascinated by it. But Christine has written the book in such a fun way that it’s really just easy to digest and fun for anybody to read and understand. There’s fun illustrations. It’s a great guide. So the focus of the book is on the iliacus, one of the hip flexor muscles. We’re going to be talking about that today in relation specifically to the iliacus and digestion and pelvic health. So Christine, do you want to say hi, and maybe briefly share why you became so fascinated with the iliacus? And the Iliopsoas muscle group?

Christine Koth 1:08

Yes, absolutely. I’m also a physical therapist. I’ve been practicing for over 20 years and in my practice, I kept seeing this pattern evolve where, you know, as I’m looking at examining people’s bodies, I was noticing that there was tension in this muscle called the iliacus. And that everyone who came into my practice hadn’t really had that addressed. They didn’t even know they had an iliacus muscle. And what I started noticing was that this pattern of tension in this muscle contributing to various conditions. So, today we’re going to be focusing a lot on the pelvic floor, but people were coming in with maybe hip arthritis pain, and they were having tension in their iliacus. Maybe they were coming in with SI joint pain or low back pain, or pelvic floor pain and dysfunction. And then what I was noticing was that this tension was also impacting the mechanics of their body. So, you know, it could be a runner who was having knee pain, and they were focusing on treating their knee, but really, it was coming up from their pelvis and tension in this muscle. So when I started discovering this and started treating it, I kind of developed my own technique of treating the iliacus muscle by putting prolonged pressure on it to try to get it to relax and doing some various physical therapy techniques. And I noticed that oftentimes, for people, this was a missing link. Maybe they had seen 20 or 30 different practitioners, but hadn’t really gotten the relief that they were hoping for. And that once the iliacus was released, it was like the missing piece that wasn’t addressed previously. It was waiting to be addressed and once it was addressed, it really helped them move forward on their healing trajectory. So over time as I continued to realize that this was an area of the body that people weren’t addressing, I kind of took it upon myself to say, “Okay, I guess this is my thing. This is part of what I’m here on this planet to do — is to share information with people about iliacus.” And hence, the development of the book.

Brianne Grogan 3:27

Yeah, and the Hip Hook, which I want to talk about that too. It’s a device specifically designed by Christine to release this muscle yourself. And, I’ve been doing it with my fingers, but I’m really excited to get my Hip Hook because I know it’s going to be a lot easier to release with the tool. And I want to just briefly say that even as a physical therapist who studied anatomy fully — I mean, I know my anatomy, but I will say the iliopsoas is a very challenging muscle group to understand because of the way it hooks into the body. It crosses over so many joints and the way it starts in the back (for the psoas major) and then it goes over the front of the pelvis. Your book really helped outline all of that. Maybe you could give kind of a brief anatomy of where this muscle even is in the body?

Christine Koth 4:22

Yeah, sure. And I’ll share for the video folks a little. This the model as I explain it. It is an interesting muscle because it does cross so many different joints and it goes in a three dimensional way through the body. It’s not very linear. It does attach to the spine. As you can see this is the psoas. The psoas attaches to the spine. It goes through your abdomen — from the spine all the way through your abdomen to the front of your hip and attaches to the front of your leg bone (or your femur). And similarly, the iliacus attaches to the inside surface of your pelvis bone. So, when you put your hands on the front of your hips and you feel that bony part that sticks out, right at the front of your hip — right inside of that is where the iliacus lives. And I have a ton of pictures and stuff up on my website and Instagram and everything, so you guys can examine this yourself.

Brianne Grogan 5:15

And just so everyone knows, if you’re listening to the podcast, I will put links in the show notes to Christine’s pertinent information — website, the Hip Hook, that kind of thing.

Christine Koth 5:26

Awesome. Yeah, so this muscle crosses the spine, the SI joint, the hip joint. And so, it works in a three dimensional way. So it is something that is a little bit mysterious. And the other thing that I will mention too is a lot of people oftentimes group the iliacus and psoas together as if they’re one muscle. They’re actually two separate muscles. They’re innervated by two different nerves. And I think that’s part of the reason why the iliacus might not be addressed as much because people feel like “Well, I’m addressing the psoas so I’m probably also addressing…it’s all the same. And it’s actually not. They’re in two different locations, as you can see. And, they do behave differently and have different effects on the body.

Brianne Grogan 6:13

Oh, my gosh, I have so many questions. But let’s go ahead and dive in. With the connection between these muscles. Well, let’s focus on the iliacus since that’s really what we’re talking about today. But the iliacus on the pelvic floor, because I’ve heard you talk about this before. I read about it in your book. But a lot of the women who listen to my podcast and watch my YouTube have conditions such as prolapse, bladder leakage, and/or issues with pelvic pain and tension. So I know that iliacus concerns can affect all of those issues. But maybe you could tell us a little bit more about the connection between the iliacus and pelvic health?

Christine Koth 6:50

Yes, absolutely. So there’s a couple of different layers to that, if you look at the anatomy, the iliacus is on the inside surface of the pelvis. And in terms of its connection to other muscles, and the fascial connection, it absolutely just connects with the pelvic floor, right? I mean, it’s on the inside of the pelvis and then continues on with the pelvic floor muscles at the bottom of the pelvis and works its way up the other side with the other iliacus.

Brianne Grogan 7:18

So if anyone is listening right now to the podcast and can’t see Christine’s hand, she just described it so beautifully because she’s showing a full bowl effect. Like the wings of the pelvis — the inside of those wings have the iliacus muscle, so those are like the sides of the bowl. And then the base of the bowl is the pelvic floor. So you’re saying that because of the fascial connections, it’s really all connected like this big beautiful bowl, correct?

Christine Koth 7:43

Yep, exactly. If you have any muscle in that bowl that is holding tension, it’s going to affect all the other muscles that are around it. Now the iliacus in particular tends to get tight very easily because its job is to help stabilize your pelvis. So it’s helping stabilize your tailbone to your pelvic bones, as well as helping really to stabilize your hip joint. So I talk about this in the book, there’s many reasons why there could be tension that can develop. It could be from sitting too long. It could be from driving a lot, commuting. It can be from stress — there’s a lot of times we hold stress in our pelvic floor. It’s very common, I’m sure you talked about that. It can also be from certain sports and activities. Like for example, running is very common. Cycling, kicking sports and the like. Also, when you’re hyper mobile. For a lot of women, there’s a good population of us that are hypermobile or overly flexible. And when you have that type of body when you born that way, this muscle tends to kind of hold on for dear life to stabilize you.

Brianne Grogan 8:52

See, that’s a big question that a lot of people have had. So if you have anything else to say about hypermobility, I know people will be interested in that too. Like, well, you know, how come I have these issues when I’m already super loose? Like I don’t need to stretch anything. I know I’m super stretchy so how could I have a hip flexor issue? Or, hip flexor or iliacus tension? So let’s keep talking about the pelvic floor, but if that comes up at all for you, please elaborate.

Christine Koth 9:19

Yeah, we should definitely talk about that. You know what, let’s just talk about that now so we don’t forget because I think it’s very, very important. And then we’ll go back to how the iliacus impacts the pelvic floor. So when people use the word tight, right, and that that word means a lot of different things to a lot of people. I also talk about this in my book — it’s one of my pet peeves. “Tight” can mean one of two things. It can mean either that you can’t lengthen the muscle very well. For example, if you can’t touch your toes means your hamstring isn’t fully lengthening. That is one version of “tight,” meaning the muscle won’t fully lengthen, to allow your joints to move. So when you do a stretch, for example, you are using your own joints to help kind of teach that muscle how to elongate or become longer. There’s another version of “tight” which is holding tension. So you know, this would be an example of like, in your shoulder, your upper trapezius muscle on top of your shoulder — if you touch that, and it’s hard, and it’s not relaxed, that is another thing that people describe as tight, right? So it’s when your muscle is holding tension. Now you can have a muscle that’s holding tension that will completely elongate. But then when you go back to rest, it is still holding tension. And I use the example of, like, if you’re lying down on the ground, and you’re not doing anything, you know, you’re just lying there — you have nothing to do nowhere to go. Theoretically, every muscle in your body should be relaxed. So if you were to touch every muscle in your body, it should be nice and squishy and soft. If you put your hand on the inside of your pelvic bone, and you touch it, it should be just like butter. And if it’s not, then you’re holding tension. So you can be actually very, very flexible. You could go into the deepest yoga pose and not feel a thing but your body could be holding tension in that muscle you could consider as being tight. And the reason that’s important is because if you’re holding tension, and you’re going about your day, that is going to be not only changing the mechanics of your body, you know, muscles should be contracting and relaxing, not just holding tension constantly. And it’s also affecting all the muscles around that. So it is important to discern when you are very flexible, and you can stretch and you feel like “I don’t need to stretch because I’m already really mobile,” you may actually be holding more tension than you think in muscles. It’s a different phenomenon. And that’s where the prolonged pressure comes into play. A lot of times when your muscles are holding tension, you can stretch them and that does help to some degree. It helps increase circulation and helps to get the muscle to be a little bit more healthy. However, it doesn’t necessarily do enough to actually release that tension. And that’s where we use tools like the Hip Hook and balls and rollers and things like that to help your body, learn — your brain basically — learn how to release that tension. So that’s an important distinction.

Brianne Grogan 12:36

You’re talking about that tension and that difference between flexibility and then just the holding tension. It reminds me so much of the pelvic floor and how many people just hold chronic tension in the pelvic floor muscles themselves. And so is that one relation right there, potentially, to the tension that’s chronically held in the iliacus?

Christine Koth 12:58

Yes, absolutely. Like I was mentioning, in this area of the body we hold a lot of our essential organs and a lot of our survival, you know, our procreation is in the pelvic floor. So it’s a very common space for the brain to choose to hold tension in because it’s a protective mechanism. And another common place is at the base of the skull. Protecting our brain, also very important.

Brianne Grogan 13:27

And the reproductive organs, it makes sense.

Christine Koth 13:35

Yeah. So, we don’t even realize that we’re holding tension in that area of the body. You can be sitting at your desk holding tension in that it’s oftentimes related to stress, or even trauma in that area. And we’ve all experienced that on the emotional or physical levels. So that definitely is a big component to that. And the iliacus fits right into that group and that tightness party. Tension party.

Brianne Grogan 14:05

For sure. And so what about prolapse specifically? Do you have any information on that and with relation to the iliacus?

Christine Koth 14:14

Yeah. In a general sense, like we were talking about how, you know, there’s tension in the iliacus, there can be tension in the pelvic floor, or vice versa. It’s like the chicken or the egg? When there’s tension in the muscle, not only does that area not function mechanically, but it also does not function well neurologically. There’s all kinds of nerves in that area of our body that are going to different organs or that are going to muscles. There are nerves that can produce pain, like the pudendal nerve for example. And when nerves are tugged on, or compressed, they are not happy. Nerves do not like to be pulled on and do not like to be pushed on. So in that scenario and that phenomenon, if you have tension in a particular area of the pelvic floor, it can absolutely pull on a nerve and even in just a subtle way. And that tension can make it so that that particular part of your body is not functioning well. For example, if part of the job of your muscles are to hold your organs in place, and you have a nerve or you have muscle tension that is kind of pulling them out of whack, that can definitely impact the function of that particular part of the body. Another thing that’s important too, is that when muscles are tight, they actually become weak, which seems kind of counterintuitive. You think if they’re tight, they’ll be strong, you know, they’re holding tension. But if you’re holding tension for a very long period of time, you can imagine how that muscle would be exhausted. Muscles are the healthiest and most able to produce the force that are required of them, when they can relax and contract and also when they’re in the right length. They’re not being tugged on or pulled out of alignment. So you can see how this is like a complex ecosystem, right? And our pelvic area and pelvic floor — there’s just so much going on in there and really one thing can affect another. You end up with this set of symptoms that you don’t even know how this even started. That’s all it was — I was doing a lot of running and then all of a sudden, my pelvis started hurting, and then all of a sudden I am having incontinence and then the trajectory just goes on and on.

Brianne Grogan 16:27

Well, absolutely. And I want to just briefly share quickly a little bit about my story. I have right sided tension, which is very common. I know that from your book that that’s the most common, correct? And I am right handed and, of course, I drive with my right foot on the brake and the gas, etc. Looking at this condition, now, connecting the dots backward, I was always a runner in college, and in high school. And especially in college, after a few years of driving under my belt, long trips back and forth from college to where my parents lived and that kind of thing. I noticed that I started getting terrible shin splints when I was running. And it turns out, I was horribly over pronating on my right side. So my right arch was collapsing inward for anyone who doesn’t know what that is. And that contributed to shin splints. And so when I got arch supports and better footwear, it definitely helped. But connecting the dots back with my very, very, rotated pelvis on my right side, because of my tight hip muscles, my tight iliacus. That was causing this chain reaction down the road of my leg to actually contribute to that overpronation of that right foot when I was running, and step after step, causing those shin splints. And in addition, tying into digestion, I learned from you this fascinating thing. And who knows, I think it’s connected, that my right sided tension is definitely there. And I’m working on it now. But I have a long standing history of gut issues and one of them is SIBO. And when you said at some point that, because of the placement of the iliacus and the placement of the ileocecal valve, can you go into digestion a bit and the iliacus and particularly SIBO — small intestinal bacterial overgrowth?

Christine Koth 18:27

Yes, absolutely. This is a discovery that I happened to have the opportunity to work side by side a wonderful group of naturopathic doctors in my career. And as you may know, one of the things that people tend to go to naturopathic doctors for is digestive issues.

Brianne Grogan 18:47

Oh yes. I’ve spent many dollars and many, many hours in naturopathic doctors’ offices.

Christine Koth 18:53

Yeah, exactly. So, I started just discovering this correlation. And often the great thing is that these doctors that we’re working with, were super smart. And they were also like, “I wonder if the iliacus is impacting what’s going on here” digestively. So I was seeing people that were having issues with their ileocecal valve not closing properly. And also various digestive issues that can be result of that, but also just other things that are going on. And there is this really interesting correlation. So, again — it’s chicken or the egg — if you have a lot of inflammation in your digestive system, or things are not functioning well, your body’s tendency is going to want to kind of protect that area, right? And so that’s one reason why you could develop tension there. Say you just ate some bad food at a restaurant and your digestion is off for like a day. Your muscles can choose to protect that area because you’re in pain and you’re not feeling well, or something like that, and then that tension can decide to stay there. So then it creates this long term effect where it’s pulling on the nerves and the digestive system is pulled out of whack and all of that. On the flip side, if you have developed muscle tension, which might be like in your situation, you’re talking about being a runner. You know, you develop tension in this area of your body. That tension was pulling on the digestive system itself because of its connection to the fascia because again, the nervous systems connection, and that could have set you up for maybe like a subtle like — maybe your ileocecal valve just wasn’t quite closing well. And then over time, a little bit of the bacteria wasn’t quite flowing in the way that it was supposed to. And then over time, here you are 20 years later with these issues that have developed, just as a result of something being non optimal for a very long period of time. So there’s this definite connection. And what we were seeing in the clinic was that when I would release the tension and the iliacus with my hands, that those patients who are also doing things with their diet, and this supplementation and other things, were actually making much better progress. And symptomatically, whether it was like they were having pain, or they were having issues with their bowel movements, they would notice a direct connection with changes and improvement in that. On those days, when they would work on their iliacus, they’d come back to my office and be like, “Oh my gosh! I actually had a bowel movement and I haven’t had one in like a week.” as a result of that tension. So I think there’s a lot more to explore with that, but there’s a definite there’s a definite connection there.

Brianne Grogan 21:48

I couldn’t agree more. I’m completely obsessed with digestive health. And this has been a long standing issue for me. I think I had it fro