Psoas… release me, let me go!

OK, I’ve relented and decided to write about a topic that was one of the first big online debates I had that soon turned into a heated argument around the down right stupid and completely ridiculous manual therapy technique called ‘Psoas Release’!

Now some of you may remember this argument started when I questioned the plausibility and feasibility of this technique, which got a few therapists really wound up, even causing a couple of deluded sports therapists from a UK based massage teaching organisation to threaten me with legal action for questioning this practice.

So what is my ‘beef’ with Psoas release?

Well first is the word ‘release‘ which is used a lot in manual therapy! Releasing implies we are freeing things up of restrictions, seperating it from being confined. All of which is complete nonsense and totally misleading. This technique should actually be called ‘bloody painful sustained deep stomach prodding‘. 

I see this a lot within the world of manual therapy, techniques having names or descriptions that are implying an action or effect that just doesn’t happen or ever will happen!

Now having had my own psoas ‘released‘ on a course a few years ago, and I am ashamed to say, having inflicted it on a few of my poor patients when I was a young, naive and impressionable physio. I am well aware of what it involves and feels like. 

However for those of you who are fortunate enough never to have had ‘psoas release’ inflicted upon them, let me briefly explain what it involves and feels like.

Imagine you are lying relaxed on a treatment couch, first you feel a therapist pressing on your stomach just inside your pelvic bone, it feels weird, kinda tickly which isn’t so bad I hear you say. 

However, the therapist then starts to push their fingers deeper and deeper down through your guts until they are up to their knuckles in your intestines and it feel like they are trying to perform an appendicectomy with no scalpel or anaesthesia. 

I can assure you this is as uncomfortable as it sounds, it is a truly unpleasant, nauseating, and painful experience, in fact it feels like your internal organs are about to implode.

Psoas release

So what’s the point of this so called ‘therapy’?

Well before we look at the dubious clinical reasoning of why do psoas release, lets first look at the implausibility of how the psoas is supposedly ‘reached’.

The psoas muscle is a deep muscle. A very, very deep muscle within your abdomen and pelvis. It is attached to the side of your lumbar spine and the intervertebral discs. It travels down through the pelvis and inserts onto a bony projection on the femur called the lesser trochanter. It blends with another muscle called the iliacus within the pelvis and so is sometimes referred to as the iliopsoas.

The Iliopsoas (in blue)

However it is covered by a lot of other structures, a hell of a lot of other strucutures, both front and back. At the front it’s mostly the small intestines and the colon, and a little higher up the kidneys and the vascular structures of the external iliac artery and vein which then become the femoral artery and vein as they pass across the inguinal area lower down.

The psoas also has the genitofemoral nerve lying in front of it, and is finally surrounded a by strong dense fascial blanket. To top this all off, all these structures are then covered by three layers of abdominal muscles and then some fatty adipose tissue (some more than others) and skin.

If you where to try and approach the Psoas from the back it is also covered by multiple layers of thick, dense and very strong lumbar spinal muscles, as well as more adipose and skin tissue. So to reach the psoas from either the front or back you have to ‘go through’ a lot of other stuff first!

Now some say they can move this stuff aside as they press down! Which is just bull shit, where exactly do they move this stuff aside to, it’s not as if we have empty zones or reserve spaces in our bodies for pushing things into, do we? 

Ok soft tissues and intestines do mush, slide and glide around a bit, but news flash people your colon and kidneys are very firmly imbedded and attached to the retro peritoneal wall and they do not just slide out of the way. Neither do muscles, tendons or fascial blankets they just get compressed, painfully compressed.

The Iliopsoas (in blue) with abdominal contents on top, abdominal wall removed from one side

So is it possible to touch the Psoas through all this stuff?

Of course its bloody not! 

The Psoas sits so deep and is surrounded by so many layers of other tissue, the only way it is possible to touch or reach it is via surgery, and even then it takes a surgeon about 30 minutes of careful dissecting and moving abdominal stuff out the way first.

Now most therapists I talk to about psoas release argue, so what if other stuff is in the way! They argue that it is the pressure we exert through the other structure that causes the release effects.

Well ok, let’s say for the sake of argument that applying pressure through another tissues does do something therapeutic such as ‘release’ a tight muscle, what about the other muscles you have pressed through too are they also released? Why is it only one structure effected. 

Also what about those other more delicate abdominal structures, such as internal organs and neurovascular structures, don’t they get affected? When I question this many therapists just laugh and shrug saying, so what, they squish and move, it’s not a problem. 

This mentality just reflects many manual therapist complete lack of understanding of anatomy. Talk to any surgeon who actually sees and handles internal organs such as intestines and bowels daily for a living, and they will have a very different opinion of how much they can squish and smoosh!

Don’t believe me, have a watch of this video of US surgeon discussing what it involves for her to reach the Psoas muscle but more importantly how she talks about how she handles and respects the intestines and what she thinks of therapists poking around down there.

In my opinion, many therapists understanding of anatomy is full of myths and misconceptions due to them having very little, if no, cadaver or dissection experience. Most rely on text books for anatomy teaching and they don’t get to see it in real life. Most therapists are also taught by other therapists who also have only seen the anatomy in the text books. This leads to the development and snowballing of some ridiculous ideas and implausible manual therapy techniques such as psoas release.

Anatomy dissection

What’s the clinical reasoning for Psoas Release.

The main argument for using this technique I hear is to reduce tightness, spasm, or ‘over activity’ of the psoas, which is often thought to be a cause of pain that can be felt in the back, abdomen, groin or all of these areas.

The other common reason I hear psoas release being used is to ‘excite’, ‘wake up’ or ‘stimulate’ an ‘under active’ psoas back into action when it’s weak or not working optimally in those undertaking sports or exercise.

Before we go any further, could someone please tell me how the hell can one technique be both inhibiting an over active muscle one moment, and then suddenly switch to increasing an under active muscle the next?

And how the hell do you know or test for an over or under active psoas? 

Well I guess you could check its cross-sectional area on MRI scans. There is some research that shows a tenuous link between its size with those suffering low back pain (source), or perhaps you could use fine wire EMG directly into the psoas to record its activity. But these are costly, impractical and potentially unreliable with no robust evidence.

How about good old manual muscle testing to see if the psoas is weak? However the role of the psoas is still debated. Some say it is a hip flexor and external rotator and adductor. Others say it has minimal role in hip action due tinted orientation of its muscle fibres and is more involved in lumbar spine stability and control.

So does pressing on a weak psoas make it stronger?

Of course it bloody doesn’t. Resistance training makes muscles stronger. Poking or rubbing a muscle doesn’t make anything stronger, it doesn’t cause hypertrophy, it doesn’t create endurance.

However, I have had first hand experience of some of those ‘poking makes you stronger’ nonsense courses. On one course a tutor tried to convince me and others in the audience that after he ‘released my psoas’ my strength had miraculously improved!

Well, it might have, as I really wanted to use my poked hip flexors to kick the pretentious prat in the face really hard after he had just inflicted a great deal of pain on me in front of everyone on the course, making me cry out as he ground my guts to mush whilst asking me “is this pain is going to kill you?” to which I quickly replied “no, but it might kill you if it carries on any longer!”

So does psoas release loosen or lengthen the muscle?

I hear many therapists using it for this reason and lots of anecdotes of its susccess. But why does the psoas become tight or over active, and how can we tell?

Many say the psoas gets tight due to extended periods of sitting in hip flexed positions. I question this. Most of us do sit too long, no questioning about that! But even the most sedentary sitter will still spend long periods of time out of hip flexion positions, such as when moving around or in bed (not many curl into fetal positions over the age of 2). Also think about other joints that do the same as the hip, like the elbow a lot of us keep our arm flexed as well at desks, computers etc but our elbows dont suddenly not go straight.

The Thomas Test is often used (see below) to identify tight hip flexors. Now don’t get me wrong I use this test and position often but what information it gives me I take with caution. There is evidence to show that a poor Thomas test with lack of hip extension, doesn’t equal poor hip extension in other positions (source) and there is also evidence to show that even if you do improve hip extension by ‘releasing’ the psoas or stretching in the Thomas position it doesn’t translate into increased movement in other positions and tasks (source).

A tight hip flexor as seen in a Thomas Test, this is actually done on a Tom, the Running-Physio.com Tom Goom

What about the evidence?

When it comes to evaluating and critiquing the research and evidence for the psoas release technique that’s easy, there is nothing robust to look at. In fact there isn’t anything even remotely flimsy to look at just a few very poor case studies.

If you go on Pubmed and search ‘psoas release‘ you get 202 articles, but they are all related to surgical techniques that involve actual cutting or tenotomising the muscle, such as for contractures suffered in those with cerebral palsy or for true psoas muscle impingement’s after hip replacements. If you search Pubmed for ‘psoas +/- manual therapy‘ this time you only get 16 papers and only those few limited single case studies!

Search on Google Scholar and the same thing a few papers on psoas cross sectional area size in those with low back pain, and the same few case studies. The rest is just references to chapters in books and manuals on teaching the technique!

Basically there is NO research on its application, its effects nor it’s results, doesn’t that seem strange for such a widely used and promoted technique?

In summary psoas release techniques are not based in ANY sound anatomy, not founded on ANY sound clinical reasoning and are usually not practised by ANY sound therapist.

As always, I welcome the debate and discussion my blogs can create, and I think this one may cause a bit, so please comment below, but keep it civil and please leave the ad hominem attacks or legal threats out as they simply don’t work, just like psoas release!

Thanks for reading

Adam

 

 

 

 

 

 

94 thoughts on “Psoas… release me, let me go!

  1. Great post! I used to “release the psoas” back in my early massage training but there was always something that grated about the theory and practice. When people learn to move and feel their whole body differently, psoas obviously has to change too. For me, “releasing psoas” isolates a part of anatomy out of the context of the whole and elevates it as a magic button to be pressed. It’s also too easy for client and practitioner alike to fall into the notion that change will only happen where the practitioner touches. Psoas comes up all the time in clinic, but so does the rest of the body and I don’t have to physically touch everything to help my clients.

    • I realize that I am extremely late to this conversation. I was searching for some information on the psoas and stumbled upon this post…. Having acknowledged that this was discussed long ago, I am hoping that you may just feel like continuing this topic for me. I am a massage therapist and, for clients that need the work, I do manual therapy on the psoas. I think this post raises some good points that need to be heard but I also very much believe in the benefit of working the psoas.
      Having a healthy understanding that there is much I do not know, I ask: As a massage therapist, what (within my scope of practice) would you suggest is the most effective way to help localize the psoas and get some movement/flexibility in the area to help reduce low back pain? I apologize for the novel. I just wanted to respond, explain and pose my question…. If anyone is still paying attention after all this time passed, I would very much appreciate any thoughts on what I may be able to do to help my client or any suggestions I could make for him to be doing on his own to help alleviate some of his low back pain…. Thank you
      I have already done my troubleshooting and history with my client to determine that the psoas is the most likely root to the pain. Now I am left with determining where to go from there. I have my own problems with the ‘psoas release technique’ that I was taught. I have never had the results I learned I would in school. Having said that, I have had positive results in manipulating the muscle to help gain some movement in the hips and in turn relieve much of the pressure causing pain.

  2. Hi Adam,

    I thought the words of Engelbert should be expanded upon as he has a bit to say on the topic. His message could be applied to a few other topics as well.

    “Please release me, can’t you see
    You’d be a fool to cling to me
    To live our lives would bring us pain
    So release me and let me love again”

    Cheers,

    Aran

    • Haha, very good Aran… But didn’t Engelbert also sing

      You’d be like heaven to touch
      I wanna hold you so much
      At long last love has arrived
      And I thank God I’m alive
      You’re just too good to be true…

      He truly does have a lot to say on manual therapy, who knew!!!

      Cheers

      Adam

  3. Hi Adam
    Very thought provoking. I use the technique and always thought I could palpate it lower down and have had good results. It is not a technique I use on a daily basis though. The results could be neurophysiological though. I also use light touch fascial work that I was taught in 1998 which again may work due to effects on the nervous system. I have attended one of Julians dissection workshops which was excellent but at that time we just dissected the cadaver in prone so did not explore frontal anatomy. Maybe I need to revisit this. Very well put together argument though and will be interested to see Tom Myers reply.

  4. In my opinion the late Louis Gifford had it right by looking at the body from an evolutionary perspective. After thousands and thousands of years of evolution, has natural selection failed us so badly that we are prone to developing tight psoas’s? I don’t think so. It is just another anatomically driven theory that some numpty came up with, and for some reason the bandwagon has been jumped on (just like it did with core stability) and it has permeated its way into our practice. How about everyone just leaves the psoas alone, starting from now.

  5. Great post Adam. @Pete Grey I don’t think 1000’s of years of evolution prepared our bodies to be sat at desk and laptops for hours on end either. If you don’t routinely move your hips into EOR extension you could argue that this may habitually reduce hip flexor ROM and “tighten” the hip flexors.

    I think the argument of a therapeutic ‘release’ is a semantic one (what/how are we releasing?) as these kind of manual techniques only ‘permeate’ into our practice when there has been repeatable, experiential success/proof in treating people’s pain and/or loss of function.

    For what its worth; I’ve had good, immediate resolution of symptoms of many hip and some LBP complaints using Soft Tissue Release techniques on distal attachment of ilopsoas/adductors around the lesser trochanter. As Tom Myers said I would never use a force or pressure that causes sustained pain in the abdominals (or any other region for that matter). Improvements can be maintained with an exercise programme as described by Adam above.

    p.s.
    Surely if anyone expresses any opinion or argument about manual therapy you are guilty of confirmation bias…?

    • Hi Mark

      Thanks for your comments, you make some interesting points. The notion of modern man sitting for extended periods causing hip flexor tightness is an argument I’ve heard lots before and I don’t think it holds water, man has always sat, even when chasing wooly mammoths around I still bet we sat for ‘extended’ periods afterwards!

      And does extended sitting habitually cause tightness, I don’t think so I see inflexibility and flexibility in all types of people from all different backgrounds and occupations lifestyles etc etc, sitting it seems to be a nice convenient scapegoat to blame!

      With regards to my confirmation bias, you maybe right, but I do use manual therapy daily, I just don’t believe the mechanical anatomical nonsense that surrounds it, so my confirmation bias isn’t against manual therapy rather against the unevidenced and outlandish claims surrounding it. More of my thoughts can be heard here http://www.strengthphysio.com/archives/770

      Thanks again for your comments

      Regards

      Adam

    • re: “If you donโ€™t routinely move your hips into EOR extension you could argue that this may habitually reduce hip flexor ROM and โ€œtightenโ€ the hip flexors.”…It would seem that this is a very ‘western’ viewpoint. By the same logic, one could argue that eastern cultures (who will often rest in a squatting posture/position) would be more inclined to experience such tightness, no? I have never seen any evidence to support such a conclusion.

      Very nice posting, btw, Adam.

  6. Adam,

    Great post. “Hip flexor tightness, activation, inactivation, dysfunction, flexibility, inflexibility more than likely comes from an “infinite” ability of the human body to COMPENSATE motions in all our movements ( especially Gait ). The million dollar question is which motion compensations are feeding into the hip flexor dysfunction ? I.E. Lack of Dorsi flex In back leg in gait or lack of IR in opposite side hip ???? But, if one understands the principles of AFS ( Applied Functional Science) the one can discover CAUSES of the dysfunction. Because most importantly, in probably NOT the hip flexor’s Fault, it’s the symptom. There for most manual therapy is just treating the symptom rather than the causes of the dysfunctional Part ( hip flexor )

    Kerry

  7. I can’t believe there isn’t any research to back such a widely used and taught technique! I will still ask my massage therapies to release my psoas when my back is feeling stiff! Good read, thanks!

  8. Thank you for this article, is was very interesting and I pretty good read.

    Mine is a layman’s point of view. I’ve never had my Psoas ‘released’ by a physio, but instead I use a lacrosse ball and lie with my stomach down on it and I push my stomach against in while inspiring and then I let it sink into my gut as I exhale and relax.

    When I first learned about the technique, I thought “nonsense, no way your can reach the Psoas!”, but when I used it, my low back pain disappeared. It was impressive. And not that painful. 2-3 minutes on side are enough. You know when it’s enough because you stop feeling pain when applying pressure. Once a week. Tried it more than once, and it didn’t make any difference.

    Not always I get results as impressive as that first time. But for the little time it takes, this manouver pays huge dividends. And who knows what am I “releasing”, probably not the psoas. But it damn works.

  9. Hey Adam,

    I’m glad you left the blood vessels on the anatomy diagram … OUCH!

    Interestingly extravascular surgical release of the fascial tissue surrounding the common iliac artery and external iliac artery, is one of the SURGICAL methods of dealing with arterial flow problems in young athletes. http://www.ncbi.nlm.nih.gov/pubmed/22186674

    They could have saved a lot of money and got PT’s to do it … I NAYSAY to that!

    Cheers

    Alan

  10. Hi Adam,

    Good article, thanks for sharing. I very much agree with you on your main points. Reading through the comments has been so fun seeing people share their (very strong!) opinions, which are coming from their personal beliefs/experience. I think at least engaging in conversations like these shows that everyone involved is at least willing to look at their beliefs and at least entertain a new way of thinking.

    I think questioning what we each do as therapists (I’m a postural alignment therapist, not manual therapist or physical therapist) is one of the most important things we can do. Why do we use a certain technique? What does it really do? How do I know it does that? Is this correcting the dysfunction/cause of the problem or just treating the symptom/compensation? Just because they feel better now, does that mean they will be better tomorrow or next year? Will the pain or tightness or whatever come back? Why? Is there a better way to achieve the desired result? These questions are the only way we get better at what we do and how the profession of manual therapy or physical therapy or whatever gets better. When clients/patients come in to see me one of the first things we do together is talk about what therapies they have tried, what those therapists told them the problem was, what treatments they did, how did those treatments affect the problem, did it work, etc. When having these conversations it blows me away how many clients/patients were never told what the cause of the pain/problem was, how the treatments would affect that cause, and show the common sense connections between those things.

    I love to hear how others think, because we can learn so much from each other, so I am wondering how many of the therapists commenting on here know that a psoas needs to be released? Do you do functional tests? Manual muscle testing? Evaluate gait? Postural assessment? Palpation?

    Do you think about whether the “tight” psoas is the dysfunction or just a compensation? How do you test this?

    Then do you retest after treatment? What changes?

    Depending on what the retest results tell you, where do you go next? Does it matter?

    I like to hear how people connect the dots and make common sense out of it all. That at least is always my goal. Thanks for any continued conversation!

  11. Really well written points. I haven’t used a deep tissue “release” technique like that in a long long time. Found MET to be much more effective and less invasive. Going to revisit this ‘comments’ section when I have some more time to take in all the different approaches. Great stuff on here- thanks!

  12. Hello Adam,
    Thanks for your post. I found it fascinating.
    I came across your blog by searching ‘psoas release’ as I am wondering whether psoas release surgery might give me some relief from chronic pain (I had a THR of that hip almost two years ago and the groin/hip pain started about 9 months later). The surgical release seems to be a very imprecise solution (at least when it is conducted because of positioning of the prosthesis and the tendon rubbing over it). I’ve also read some article suggesting the tendon can tighten up again.
    What, if anything, is your experience with surgical release of the tendon and long-term recovery? I understand if you’re too busy to write a response, but perhaps you could provide a link or two to some helpful studies?
    Thanks,
    Kate

    • Hi

      Thanks for your comment, im afraid I have not had any personal experience of this issue you describe, although in my searching for evidence for the other type of psoas release I did come across lots of journals and papers on this type of surgery for this type of problem, so I am sure there is info and people who can help, just not me Im afraid

      Sorry

  13. I find it interesting that you choose to compare the theory of psoas tightness to the elbow, and not the shoulders. The reason that the current thinking on adaptive shortening of the psoas with new world postures is more directly relatable to the pectorals major & minor, is it not? As they have a tendency to shortening that is plainly visible.

    Do you not believe that the “rounded shoulders” posture commonly seen in those that sit at a desk (either work, hobby, student, etc) falls under the same category? If not, I’m curious as to what your thinking is on tight pecs and what causes it, as well as how this could not relate to the iliopsoas.

    Especially when you take into account the lower and upper cross syndromes, and hyperlordosis. It’s hard to ignore the biggest of the hip flexors when it comes to obvious bad posture (especially if you perform Ely’s and RecFem isn’t the one that is tight).

    I believe you shouldn’t dismiss a likely condition just because you think the technique being used is ridiculous. I have to admit you’ve swayed me to not use this type of psoas release to directly access the psoas, as to not cause harm to the overlying structures. However, if someone comes to me with a posterior pelvic tilt and hyperlordosis, as well as a Thomas test that is positive for an anteriorly pulled spine, I am going to treat psoas.

    I usually put them in sidelying and pin the iliacus (after warming the area) and then passively move their leg into extension to stretch out the fascia and underlying muscle. The same can be done in prone by pinning below the organs on the lower part of psoas (and granted the abs aswell) and slowly straightening the legs. This one is harder to do, of course.

    Either way, I find myofascial as a good approach to treating the psoas (and surrounding area), and then once it has been loosened, the client can be instructed on neutral pelvis, and TA & glute strengthening as well as iliopsoas stretching.

    However I did enjoy your post, it made me question a lot of things and determine my stance on the subject. So thankyou.

    – Caitlin

    (p.s. I made an account on here just to comment. I am really curious about your stance on rounded shoulders that I mentioned in the start)

    (p.s.s. I think one of the things Tom was saying is that you denied that therapists have an effect on tissue and fascia, and only the NS. Or at least it appeared that way via your comments. But, it’s been proven that massage has circulatory effects so clearly it’s not all neurological. And a properly trained therapist can lengthen fascia. I have performed and had myofascial release done to me and the effects are still lasting. If the problems reoccur within a year, a lot of the time it is due to not being educated on corrective posture habits, or lack of participation in performing remex, meaning the root issue hasn’t been corrected. At least that’s what I’ve learned.)

  14. Adam. you conclude by saying that psoas release – “doesn’t work”….heres how you got to that argument…

    a. there are too many bodily structures/organs in the way to reach the psoas (this may be correct – I accept that)
    b. most clinicians/pt’s don’t use it (likely true)
    c. therefore it doesn’t work…ergo provides not benefit and those practicing it are incorrect in doing so

    You can failed to consider that perhaps it is not the “psoas” that it receiving the benefit. Suggesting that the “technique” provides patients no benefit also suggests that you have somewhat of a superior understanding of the inner workings of the human body. This is where science tries to get ahead of itself by forming conclusions before it has properly investigating its own hypothesis…Your using some scientific reasoning to disprove the existence of a phenomena, however you also haven’t investigated it fully. What you need to understand is that observation is key, and that one observation cannot simply to used to disprove other observations. You reasoning in (a) and (b) above is inadequate to draw the conclusions you have.

    I would suggest that your conclusion would be better left at …”it is very unlikely that the psoas technique is directly manipulating the psoas muscle in most patients”. This is all your evidence can conclude.

    • Hi Markus

      Thank you for your comments, you are quite right I can not truly say that this psoas release technique ‘doesn’t work’ in helping people with musculoskeletal issues

      However, what I am suggesting and what I thought I had made clear in this blog, I guess not clear enough, is that it this technique doesn’t work under the premise of reaching the psoas muscle and releasing it, as the name of the technique implies, and it doesn’t work in helping those I have used it on in the past, or those who have told me they have had it done to them.

      Your assumption that I haven’t considered other possible mechanisms for effect, is not correct. I am well aware of the neuromodulation effects of ALL manual therapy and these effects may or may not have a positive effect.

      But the intention of this blog was not to discuss these effects, rather explain the stupidity and absurdity of those therapists doing psoas release, pressing through abdomens in a belief they are reaching the psoas, its bloody stupid and ridiculous, almost borderline abuse and so I argue should be stopped being practiced immediately

      If neuromodulatory effects are wished to be achieved then there are simply much safer, much friendlier, much more pleasant means to achieve these.

      Regards

      Adam

  15. Hi Adam,

    I recently started reading a few blogs and found myself agreeing with your thoughts on a range of topics. I read this one and it was in stark contrast to my clinical experience and after a few days musing over the conflicts, I would appreciate your thoughts on the points which are troubling me.

    Anatomically –
    I am a Physio and I predominately work in a young and sporting population with age ranges from 14-25. When I first saw this technique while I was training I considered it an anatomical impossibility in a lot of the population but it is a technique I would consider is possible in the population I work in with levels of discomfort taken into consideration when applying the technique. You certainly can feel a pulse from the Abdominal Artery on the left and I believe both are located at a similar depth in the abdomen.

    Palpation and symptom reproduction –
    **Firstly, I am very aware of palpation limitations and if this was my only point of contention, I wouldn’t bother writing a reply.**
    My belief on why I consider palpation is possible stems from palpation which elicits the clients direct symptoms, often Lx or groin pain if it is a technique I would then choose to implement. My head is happy with that theoretical link. In the lower portion of the muscle I believe that you can certainly palpate the difference between an active and relaxed muscle when the client is asked the lift their knee from a crook lying position. I struggle to think of another structure in that vicinity which is causing their mechanically patterned pain.

    Treatment progression-
    In instances where I get a favourable response during and between treatments for Lx or groin pain, a treatment progression I have used is Dry Needling the Iliospoas at the lesser trochanter (in the circumstance that palpating this portion of the muscle does also elicit their symptoms). I have had this treatment progression favourably improve symptoms on re-assessment. The same symptoms which were initially improved by treating the Psoas with my hands. I have deduced that this makes sense because I am treating he same structure, just in a different way.

    Symptoms Resolution-
    I agree with a number of replies to this blog, that treating Iliopsoas is addressing a symptoms, with out treating the problem. I do how ever have one patient in mind who was a snow boarder, 3 weeks post a hyper extension injury to his back. Once vertebral fractures were ruled out, my assessment ticked the theoretical boxes for Psoas contributing to his pain. After two isolated Psoas treatments with hands, no needles, his Lx AROM and combined movements were pain free and were what he considered normal. He returned to boarding for the season with no aggravation. I know that is just one case study, similar to the ones you can find online and I know you can find the same type of stories about K-tape and all sorts of other crap out there, but what ever I did in isolation to his stomach considerably improved his level of function. My mind runs with other situation where Psoas treatment in isolation has considerably improved someone’s between treatment re-assessment. To date, I believe it was a useful technique in their management.

    From my experience, they are the sticking points in my mind about this one. Currently, I find it a difficult one to just throw out of my tool box of interventions.

    Lastly and more generally, your point about there being no research for such a widely used technique perplexed me. Now, I am not a researcher and have no experience in the area but I expect that there would be a number of things that therapists all over the country do with in the scope of our “evidenced based profession”, which have not been rigorously researched to categorically deem them effective treatments. Treating Pec Minor for shoulder pain, Flexor Digitorum Longus for medial ankle pain or MTSS, fibularis brevis for poster-lateral ankle pain following inversion sprain, Tib Ant for anterior ankle pain in competitive walkers etc. etc. Certainly quick Google Scholar searches of these topics yield nothing but these are interventions that I admit to having used and each one of these examples I have seen positive post treatment effects with in, and between treatments. As a profession we are proud to have our practice based in science and evidence and I value that greatly, but the application of research to our practice is very difficult. As an example, just because I know a study on eccentric exercises for an Achilles Tendinopathy was completed in a demographic of 18-30 year old men and I have a 35 year old female in my treatment room, it doesn’t mean I am not going to use my clinical reasoning and implement that program if I deem it appropriate. Likewise, the patient who comes to me with Lx or groin pain which I believe has a symptom relationship to the Psoas muscle, has not had a RCT conducted on them, so I assess, treat and then re-assess to know if I am correct. That’s my research and evidence.

    Thanks for taking the time to read and hopefully discuss my points. I am very aware that in 5,10,15 years time I will be a totally different Physio to the one that I am now and perhaps treating the Psoas is something I will one day laugh about…

    • Hi Brent

      Many thanks for your detailed comments. I don’t want to spend too long going over everything as I have talked about this technique for way too long.

      First just because you can feel a pulse of the abdominal artery doesn’t mean your are close to it, I can feel my heart beating through my chest but I cant palpate it.

      Next you simply can not reach the psoas with palpation, the depth of most of it and the other structures in the way just make is impossible

      Even if you could, using palpation techniques to decide if something is tight, tense, soft,relaxed etc are all prone to confirmation bias of the palpater, ie you feel what you want to believe you feel. When blinded to patients symptoms and history, palpation is no better than guess work.

      You’re right the evidence base is lacking for a lot of things therapists do to patients, should we stop everything, no! If there is no risk of harm and plausible rationale reasons for doing a treatment or technique, then we can continue. However digging around someones abdomen as I mentioned is not without risks and and stretches levels of plausibility beyond any sane persons levels of common sense, so yes we should stop psoas releasing

      Kind Regards

      Adam

  16. At age 37 I was diagnosed with 3rd stage breast cancer. I opted for a tram flap reconstruction instead of a implant. You don’t hear much about this procedure anymore as it is extremely painful and recovery time is extra long. I was cut open hip bone to hip bone and they used my vertical oblique muscles to reconstruct the breast which was removed. I am a LMT, CMMP and MTI. Trust me their is no way possible to reach the psoas to release it. I hear other therapist and theachers saying your hip is higher on one side and your psoas is so tight that is the cause for the symptoms.

    After watching my own surgery on video and working on women who use to get old fashion tummy tucks. Even using MFR, palpitations, & stretching. You are no where close to reaching the actual psoas without surgery being involved. Yes, patients will even tell me “my psoas is out” (many are Bikram yoga students). I’m in no way putting down Bikram Yoga even though I do disagree with them using the same routine ever session and it is unhealthy for the body to not diserfy when doing any kind of exercise. I suggest using postural and muscle testing the MFR, ART and sidelining and the release of hip flexors will loosen up and you possibly might get a gentle release which allows the body to self align which then causes the lower back, hip flexors and other ares to let go and you cause the patient little to no pain. Their out of pain and strengthening exercises given to ones who will do them and those areas will stop pulling everything out of alignment.

    But you are not getting anywhere close to their psoas. This is my out look on it and sole opinion. No complaints about how much better the patient feels when they leave after 21 years of practice.

    If you ever want to talk about Lymphedema their is another area that in the US has been treating people wrong for so long.

    Great discussion. Changeling my mind is always good for me and helps keep me young and on my toes while I teach others.

    Thank You!

    Healthy (90% ok 80%) of the time. It is the holiday season. ๐Ÿค”๐Ÿ™ƒ๐Ÿค—๐Ÿค—๐Ÿค—๐Ÿค—

  17. So, what CAN I do to get my psoas to release? I’ve been struggling with hip/leg pain for almost two years now and I have to take something for it daily. I’ve been for massage, acupuncture and to an osteopath with no relief. Any help?

Please leave your comments here...

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s