From an upcoming, much longer, post detailing my visit to Stanford University’s Clinical Anatomy Lab, where I worked with cadavers:
Dealing only in pictures the last few years really made me lose appreciation for how deep the psoas muscle is.
We used one cadaver where, besides the skin, everything from the anterior trunk to the posterior trunk was present. Translating this to manual therapy on the psoas, you need to deal with and or go through:
- Skin
- Fat below skin (which can be a lot depending on the person)
- Fascia
- Rectus abdominus
- External obliques
- Internal obliques
- Transverse abdominus
- Large intestine
- Small intestine
- Water and various fluid
To think you’re going to effectively reach this muscle with a foam roller, tennis ball, or theracane, well, good luck. To think a manual therapist can effectively get to this muscle, well, perhaps a few who are very, very skilled.
Even if they can, you can’t do so without working the abdominals. Are you sure your abdominals need the work you have to give them in order to reach the psoas?
Second, I’ve heard some talk about moving other things out of the way in order to reach the muscle. You’re still risking pressing on the organs and other critical structures, and I’m not so sure we should be doing anything dealing with moving or pushing these around. I saw one technique state, “As you press deeper, if you feel pulsing, you’re pressing on the abdominal aorta! In which case you should move your hands laterally.”
Third, this type of work on the psoas is regularly regarded as exceptionally painful. After seeing how deep it is, I think “No shit. It’s like getting punched in the stomach.”
Evolution is pretty smart. Maybe pressing on the psoas and pushing in this area is painful because the psoas needs to be “released.” Or, maybe, you know, the body is crying out to stop because it’s worried about you pressing on the abdominal aorta.
Stupid body. All worried about living and crap.
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Aileen
December 27, 2013
Love it, I had a so called therapist who reckoned my horse, yes my horse had a sore back and she needed to do some massage on his muscles….well after fifteen minutes of massage on my horse and $90 later, she claimed she had released the problem area…..hmmm I was pretty cynical and after reading your article above, I was absolutely correct in being cynical….how big are horses muscles compared to your human cadaver? My vet in fact said the same as you but in reference to horses. Love your website, been reading lots of your facts on hip pain and anterior femoral gliding, due to ongoing hip problems and someone offering to massage my psoas, so a bit of a coincidence that I just came across your latest article when I entered your website today.
reddyb
December 27, 2013
Hey Aileen,
Thanks for the comment.
There’s been some work showing doubts humans can manipulate other human structures. For example, something like the IT band is too strong for a human to actually deform during manual therapy. Considering humans can’t even manipulate certain human structures, I’d say it’s a safe bet they can’t manipulate much of a horse :).
Aileen
December 27, 2013
Yes, I remember reading that the only positive studies ever done were on tendons of white mice, i believe it was in reference to Bowen therapists..Regarding IT band and femoral anterior glide, my IT Band was very painful to palpate, tried foam rollers etc etc, seemed to get some sort of relief at the time, but the next day I was always in pain again. I have been working on your exercise on my knees (pose of a child) in hip flexion and I am having positive results. Can you explain the bio mechanics of how femoral anterior glide would have an effect of tightening the IT band, please? I look at my leg and i have bad alignment all the way from my hip through my knee and down to my ankle. my only reference point is my other leg which is pain free. I feel that my femoral glide is also slightly lateral..is that possible? If I am sitting and put a small cushion under sit bone of my affected side of my , the leg seems to align correctly. I am also working on the way I walk (putting a spring in my step). Until I found your site, I have been stretching the ……out of my hip flexors and psoas!! The other movement that gives me relief is to stand on one leg, bend my trunk forward to around 45 degrees and do small squats, the clicking and clunking, I hear from my hip area is incredible, not painful though. My other hip is free and noisless. I am thinking adhesions? I remember after a knee injury (dislocation of patella) having same sensations when trying to bend knee. I know you cannot give diagnosis without seeing me, but what you are saying really addresses my symptoms. I believe if I can address the cause correctly, I will be on a winner.
reddyb
December 30, 2013
-Femoral anterior glide tightening the IT band:
It can work the opposite way: Issues with the IT band causing femoral anterior glide. The TFL, which inserts into the IT band, can become a dominant hip flexor and rotator. The psoas, another hip flexor, which doesn’t insert into the IT band, often doesn’t work like it should. The psoas also helps keep the femur snug in its socket, helping to prevent anterior glide. If the TFL is dominant over the psoas, you have a particular type of hip flexion without keeping the femur snug = potential anterior glide issues.
That is, because the TFL attaches on the pelvis, you may be pulling the pelvis down (TFL action), but not pulling the femur backwards (psoas action).
This is why you tend to see anterior glide issues accompanied with internal rotation issues: The TFL also internally rotates the hip (and the psoas has some lateral rotation). Dominant TFL with dormant psoas = potential anterior glide and femoral internal rotation issues.
-Regarding how you sit:
Usually adding butt support is not helpful. Doing this tends to put the knees below the hips, giving a propensity for pushing the femur forwards / upwards. What you want is a soft surface, with the knees in line with or slightly above the hips. I go over the relationship between the hips and knees in stance in this post: http://b-reddy.org/2013/12/09/cueing-people-out-of-hip-extension-while-standing/
The same rules in stance apply to sitting: Knees slightly in front / above hips.
Aileen
January 1, 2014
HAPPY NEW YEAR and thank you for your reply…..for the past week I have had a much lesser degree of pain or no pain in my hip. Basically I have stopped stretching my hip flexors. I am now focusing on strengthening my psoas and watching out for hip extension when i am standing. Regarding TFL, if I continue to focus on strengthening my psoas, will TFL naturally give up some of the work and therefore loosen or should I return to active stretches at some point.? If I understand my own body correctly, it seems that my psoas weakness has caused tight TFL leading to femoral and anterior glide as well as some tibial torsion, so my whole leg and foot have been affected due to the weak psoas. I like to ride my horse and was finding, I could not throw my painful leg over the saddle, I tried mounting from the other side, but using my painful leg as the standing leg was just as problematic. So I have been avoiding riding as I can’t do an emergency dismount quick enough…..I have stopped many other physical activities which I have been doing for decades, due to the same problems….jogging, skipping, dance, karate etc so Brian, it looks like you are giving me my old life back again and I can’t thank you enough. I am in my late 50’s and my impression has been that some young physical therapists in my area seem to think I should be grateful that I can stand at my age and that if I stretch my hip flexors, I would be fine! I have recommended your website to many of my friends and they love it.
reddyb
January 3, 2014
Sounds like you’re on the right track now.
-Regarding loosening the TFL:
In this context, I avoid hip extension for a long period of time. (Months at a minimum.) There are too many other ways to loosen the TFL. There’s a lot on this in my “6 exercises to loosen the IT band” manual: http://b-reddy.org/2013/08/20/6-exercises-to-loosen-the-it-band/
5 of the 6 exercises are hip friendly (I go over which one isn’t), and one of those 5 is explicitly for the psoas, for issues like we’re talking about.
So, I’d work on the psoas and loosening the TFL at the same time, but without putting the hip into extension.
Great to hear you’ve found things useful! Thanks for the nice words and recommending the site. I really appreciate it.
Aileen
January 3, 2014
Thank you, I have just purchased (purchased seems the wrong word as it is more like a small donation) your Manual on Exercises regard IT band. Just glancing through, I know its just what I need. I shall get back to you in a couple of months and let you know the outcome. Don’t get me wrong there are really good therapists out there, but I need to have detailed explanations as to why and how and this website ticks all the boxes. If you are ever lecturing in Australia, i would make an effort to attend.
reddyb
January 3, 2014
Thanks for the purchase! Hope you find it helpful.
No plans on lecturing any time soon. Although it’s something I plan to do in the future.
jpdanna
February 22, 2014
YES! That would add to my reasons for coming back to SoCal for a long awaited visit! Will be buying that manual now too! I am so grateful for your knowledge.