00:05 - 00:08This is Brent of the Brookbush Institute and in this video we're doing psoas positional isometrics.
00:08 - 00:13The psoas is a crazy muscle. It's one of the very few muscles that has a propensity
00:13 - 00:18both toward over activity, and under activity. So, despite the fact
00:18 - 00:23that you've seen videos from us on manual release techniques for the psoas,
00:23 - 00:28which implies overactivity, lengthening of the psoas, which implies shortening
00:28 - 00:37and overactivity, you also need a little bit of activation, or positional isometric exercise, in your repertoire
00:37 - 00:43for the rare case where the psoas seems to be inhibited. Now, this isn't something
00:43 - 00:49I use all of the time. In fact, I can usually count the amount of times I've used it
00:49 - 00:57over the course of a few months, on one hand. These are the rare individuals who have, maybe, chronic hip
00:57 - 01:03pain. Chronic hip pain, for so long, that it's changed their gait pattern. These
01:03 - 01:07are the individuals who have hypermobility, and hip internal rotation.
01:07 - 01:16Their psoas has become so underactive it'll let somebody go to 55 degrees, or 60 degrees of internal
01:16 - 01:29rotation in supine. This is the individual who has low back pain, but no lordosis, and it seems like they have
01:29 - 01:35an inadequate forward lean. These are the individuals where you might want to
01:35 - 01:39experiment with a little bit of psoas activity, but with all of your techniques,
01:39 - 01:45make sure that you assess, address, and reassess. So, don't just throw this
01:45 - 01:48technique at people, because if you throw at somebody who has a propensity towards
01:48 - 01:53hyperactivity, you will make their compensation worse. I'm going to have my friend, Melissa, come out.
01:53 - 02:00She's going to help me demonstrate this technique. Now, before we start beating up the psoas,
02:00 - 02:04before we start activating the psoas, we try to strengthen the psoas, we have to
02:04 - 02:10know a little bit of kinesiology because I want psoas activation,
02:10 - 02:14I don't want TFL, rectus femoris, iliacus, pectineus, and
02:14 - 02:18brevis activation. That's all of my other hip flexors. So, how do I get hip
02:18 - 02:23flexor strengthening, but only strengthen my psoas? Well, it ends up, as you
02:23 - 02:30get further and further into hip flexion, these muscles, these other hip flexors,
02:30 - 02:38become actively insufficient, or lose their line of pull for hip flexion altogether, so that by the time I get
02:38 - 02:43above 90 degrees, the only two muscles that are left being able to give me a
02:43 - 02:48strong pull are my iliacus and psoas, and in the last 20 degrees of hip flexion,
02:48 - 02:53this is probably above a hundred degrees of hip flexion, it's likely that only my
02:53 - 02:59psoas still has enough length, and enough of a line of pull, to produce any sufficient force.
02:59 - 03:04So guess where we're going to do our positional isometric? In
03:04 - 03:10as high, or in as much hip flexion as we possibly can get. This is why this
03:10 - 03:13activation technique ends up being a little different. Rather than going
03:13 - 03:18through a range of motion, we can't really do that right off the bat with
03:18 - 03:22the psoas, because if we just strengthened hip flexion, there's no
03:22 - 03:27joint actions I can use to reciprocally inhibit the other hip
03:27 - 03:30flexors. Some of them are internal rotators, some of them are external
03:30 - 03:34rotators, one of them crosses the knee, the rest of them don't, it gets a little
03:34 - 03:41complicated. So, what is the protocol for positional isometrics? It's not particularly tough. You want to try to
03:41 - 03:45practice the range of motion without resistance, and then we're going to
03:45 - 03:49gradually increase resistance on that muscle, over the course of several
03:49 - 03:55repetitions as the movement pattern can be performed, or the isometric can be
03:55 - 04:00performed, without deviation or compensation. The grades are generally 0,
04:00 - 04:08as I mentioned, 25, 50, 75, and max. Now, you might have to do somewhere between 1
04:08 - 04:13and 3 reps, at each one of those levels, to ensure that the individual can
04:13 - 04:18produce the force you're looking for, without compensation or deviation. Are you
04:18 - 04:22ready to give this a try? So, the first thing I'm going to have Melissa do, and
04:22 - 04:29it's been my experience that putting the other leg up can be helpful. Sometimes
04:29 - 04:32when somebody has the leg straight down like this, they have a tendency to get this
04:32 - 04:36hamstring really active, they start pressing down into the table, that foot
04:36 - 04:40flares out, and all of a sudden now I'm creating some other compensation on the
04:40 - 04:43other side, that I might have to fix later if they keep reinforcing it over
04:43 - 04:48time. So by putting the foot up like this, it's more like a bridge on this
04:48 - 04:52side, and I don't know about you, but I'm always good with more glute activity.
04:52 - 04:59More glute activity, stronger glutes, always a good thing! Alright, so first
04:59 - 05:03thing I'm going to have Melissa try is, can you just raise this leg into 120
05:03 - 05:07degrees of hip flexion? We'll say that's about there. And notice where I'm standing.
05:07 - 05:12I'm over the top of her. So, I want you to make sure that you keep straight in line,
05:12 - 05:19right, it's going to pass right towards the same side ear. Now, a little external
05:19 - 05:24rotation might be okay, as my psoas is an external rotator, but what you guys want
05:24 - 05:31to look out for is, no internal rotation, no adduction, and definitely no abduction.
05:31 - 05:38These are all kinds of compensation from either, let's say, TFL, TFL this way,
05:38 - 05:43adductors, or if they start doing this thing, you know rectus femoris is
05:43 - 05:48trying to get involved. I want nice, straight hip flexion, all the way up to
05:48 - 05:53120 degrees, and the knee is nice and relaxed. That looks pretty good. You
05:53 - 05:56ready to try a little resistance? -Sure. Alright, so I'm going to have her get
05:56 - 06:00into position here, and all I'm going to do is kind of block her, and say, "okay, I just
06:00 - 06:03want a minimal amount of resistance, just kind of push into my hand a little bit".
06:03 - 06:08I'm going to watch, does she deviate or does she compensate at all, and she looks
06:08 - 06:13pretty good. Alright, so 25% is good,
06:13 - 06:20let's take it up a notch, 50%. Now, as we get into higher amounts of
06:20 - 06:25force, especially if I'm dealing with somebody like Melissa, who's a beast,
06:25 - 06:30she's athletic, she's strong, I'm not going to do this, okay, I'm not trying to
06:30 - 06:34show off how strong my anterior delts are today, alright, I'm not trying to
06:34 - 06:38get a pec workout while I'm working with my patients. I'm going to go ahead and
06:38 - 06:42hold her like this, kind of give her knee a hug, get it nice and close to my
06:42 - 06:47body, use both hands, I'm going to take a staggered stance, I know you can't
06:47 - 06:52see my legs, but my legs are split this way, so at this point any resistance she
06:52 - 06:56gives is maybe a little bit of bicep strength, but more than anything it's my
06:56 - 07:01body that is blocking the resistance here. Alright, so I'm going to have her
07:01 - 07:07go ahead and pull, let's say, half of what you've got. Alright, so nothing too big, I'm
07:07 - 07:11going to hold for 2 to 5 seconds, make sure she doesn't compensate or
07:11 - 07:17deviate at all, and then I'm going to go ahead and have her relax. Good. If I like
07:17 - 07:22the way that looked, I'll go on to 75% percent, if I didn't I can
07:22 - 07:27try a couple more times to see if I can get the same movement pattern, without
07:27 - 07:31compensation deviation. If I can get her up to fifty percent without seeing
07:31 - 07:35abduction, adduction, or internal rotation. So, again, we're going to come up
07:35 - 07:40like this. So this is going to be strong, but not maximum force.
07:40 - 07:45This is the 75% percent. Go ahead and pull up, good.
07:45 - 07:49She might have to push down on this leg a little bit because we're starting to
07:49 - 07:53get to an amount of force that if she doesn't, she's going to flip over,
07:53 - 07:56or I'm going to flip her off the table, or she's going to flip herself off the table, and
07:56 - 08:00none of those sound good. When people fall off the table, they don't come back. Alright,
08:00 - 08:03so that's 75%, for 2 to 5 seconds, and it should start to
08:03 - 08:09feel pretty hard to hold at this point. Good, and relax.
08:09 - 08:15We can go up one more time, this time since she had no deviation, she's well
08:15 - 08:19practiced at this technique, we'll go ahead and go max. You ready? So, up here,
08:19 - 08:25and now I might actually pull. All you've got! I might actually pull back a little bit,
08:25 - 08:31and remember, I'm not pulling with my arms, this is not a row for me, I'm using
08:31 - 08:40my legs to apply a force to her hip flexors. Good stuff. Nice and strong. Now
08:40 - 08:47remember, assess, address, reassess. At this point, I would go back to whatever
08:47 - 08:52assessment I was trying to fix, whether it's internal rotation goniometerry, an
08:52 - 08:58inadequate forward lean, checking the lordosis on the lumbar spine. Maybe I
08:58 - 09:03thought it was related to rotation or something. Whatever your quick test was
09:03 - 09:07that you were trying to fix with this technique, go back to it and see if it
09:07 - 09:14improved. If it didn't improve, what are you going to do? Not this, right? You just
09:14 - 09:17learned something. You might give it a couple more tries, I'm not saying it has
09:17 - 09:22to happen the first time, every time, but if you notice this isn't making change,
09:22 - 09:28then don't do it. If you do notice it's making change, there's a really easy home
09:28 - 09:33exercise version for this technique. Melissa can use her hands as
09:33 - 09:37blocks,
09:38 - 09:43and do the positional isometric just as I did. She's very capable of monitoring
09:43 - 09:50the position of her leg. She can go through the same queus I did, so
09:50 - 09:56start with minimal, I want 2 reps there, and then I want moderate, and
09:56 - 10:01then I want strong but submaximal, and then I want maximal, and she can practice
10:01 - 10:07this technique at home to start getting that psoas to come back in a little bit.
10:07 - 10:15So you have a positional isometric for when your patient or client is with you,
10:15 - 10:20and then, of course, you have their home exercise program, which you can use as
10:20 - 10:25movement prep when they're working out on their own, or as their home exercise
10:25 - 10:30program if this is a client or patient with hip pain. Thank you, Melissa. I hope
10:30 - 10:34you guys enjoyed this technique, once again you're going to use it rarely, but
10:34 - 10:37keep it somewhere in the back of your head, because I guarantee if you're
10:37 - 10:41practicing long enough, if you're practicing as a physical therapist all
10:41 - 10:46you have to do is be practicing often enough, you are going to see somebody who
10:46 - 10:50could use a little bit more psoas activity. I hope you enjoyed the video, if
10:50 - 10:52you have any questions leave them in the comments below, I look forward to hearing
10:52 - 10:55from you.