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Psoas Activation (Positional Isometric)

Learn how to properly activate the psoas muscles, which play an important role in maintaining postural stability. In this video, you will learn positional isometric techniques to safely target the psoas, promote healthy mobility, and reduce the risk of injury.

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Transcript

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.

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