0:05 This is Brent of the Brookbush Institute and in this video we're doing psoas positional isometrics. 0:08 The psoas is a crazy muscle. It's one of the very few muscles that has a propensity 0:13 both toward over activity, and under activity. So, despite the fact 0:18 that you've seen videos from us on manual release techniques for the psoas, 0:23 which implies overactivity, lengthening of the psoas, which implies shortening 0:28 and overactivity, you also need a little bit of activation, or positional isometric exercise, in your repertoire 0:37 for the rare case where the psoas seems to be inhibited. Now, this isn't something 0:43 I use all of the time. In fact, I can usually count the amount of times I've used it 0:49 over the course of a few months, on one hand. These are the rare individuals who have, maybe, chronic hip 0:57 pain. Chronic hip pain, for so long, that it's changed their gait pattern. These 1:03 are the individuals who have hypermobility, and hip internal rotation. 1:07 Their psoas has become so underactive it'll let somebody go to 55 degrees, or 60 degrees of internal 1:16 rotation in supine. This is the individual who has low back pain, but no lordosis, and it seems like they have 1:29 an inadequate forward lean. These are the individuals where you might want to 1:35 experiment with a little bit of psoas activity, but with all of your techniques, 1:39 make sure that you assess, address, and reassess. So, don't just throw this 1:45 technique at people, because if you throw at somebody who has a propensity towards 1:48 hyperactivity, you will make their compensation worse. I'm going to have my friend, Melissa, come out. 1:53 She's going to help me demonstrate this technique. Now, before we start beating up the psoas, 2:00 before we start activating the psoas, we try to strengthen the psoas, we have to 2:04 know a little bit of kinesiology because I want psoas activation, 2:10 I don't want TFL, rectus femoris, iliacus, pectineus, and 2:14 brevis activation. That's all of my other hip flexors. So, how do I get hip 2:18 flexor strengthening, but only strengthen my psoas? Well, it ends up, as you 2:23 get further and further into hip flexion, these muscles, these other hip flexors, 2:30 become actively insufficient, or lose their line of pull for hip flexion altogether, so that by the time I get 2:38 above 90 degrees, the only two muscles that are left being able to give me a 2:43 strong pull are my iliacus and psoas, and in the last 20 degrees of hip flexion, 2:48 this is probably above a hundred degrees of hip flexion, it's likely that only my 2:53 psoas still has enough length, and enough of a line of pull, to produce any sufficient force. 2:59 So guess where we're going to do our positional isometric? In 3:04 as high, or in as much hip flexion as we possibly can get. This is why this 3:10 activation technique ends up being a little different. Rather than going 3:13 through a range of motion, we can't really do that right off the bat with 3:18 the psoas, because if we just strengthened hip flexion, there's no 3:22 joint actions I can use to reciprocally inhibit the other hip 3:27 flexors. Some of them are internal rotators, some of them are external 3:30 rotators, one of them crosses the knee, the rest of them don't, it gets a little 3:34 complicated. So, what is the protocol for positional isometrics? It's not particularly tough. You want to try to 3:41 practice the range of motion without resistance, and then we're going to 3:45 gradually increase resistance on that muscle, over the course of several 3:49 repetitions as the movement pattern can be performed, or the isometric can be 3:55 performed, without deviation or compensation. The grades are generally 0, 4:00 as I mentioned, 25, 50, 75, and max. Now, you might have to do somewhere between 1 4:08 and 3 reps, at each one of those levels, to ensure that the individual can 4:13 produce the force you're looking for, without compensation or deviation. Are you 4:18 ready to give this a try? So, the first thing I'm going to have Melissa do, and 4:22 it's been my experience that putting the other leg up can be helpful. Sometimes 4:29 when somebody has the leg straight down like this, they have a tendency to get this 4:32 hamstring really active, they start pressing down into the table, that foot 4:36 flares out, and all of a sudden now I'm creating some other compensation on the 4:40 other side, that I might have to fix later if they keep reinforcing it over 4:43 time. So by putting the foot up like this, it's more like a bridge on this 4:48 side, and I don't know about you, but I'm always good with more glute activity. 4:52 More glute activity, stronger glutes, always a good thing! Alright, so first 4:59 thing I'm going to have Melissa try is, can you just raise this leg into 120 5:03 degrees of hip flexion? We'll say that's about there. And notice where I'm standing. 5:07 I'm over the top of her. So, I want you to make sure that you keep straight in line, 5:12 right, it's going to pass right towards the same side ear. Now, a little external 5:19 rotation might be okay, as my psoas is an external rotator, but what you guys want 5:24 to look out for is, no internal rotation, no adduction, and definitely no abduction. 5:31 These are all kinds of compensation from either, let's say, TFL, TFL this way, 5:38 adductors, or if they start doing this thing, you know rectus femoris is 5:43 trying to get involved. I want nice, straight hip flexion, all the way up to 5:48 120 degrees, and the knee is nice and relaxed. That looks pretty good. You 5:53 ready to try a little resistance? -Sure. Alright, so I'm going to have her get 5:56 into position here, and all I'm going to do is kind of block her, and say, "okay, I just 6:00 want a minimal amount of resistance, just kind of push into my hand a little bit". 6:03 I'm going to watch, does she deviate or does she compensate at all, and she looks 6:08 pretty good. Alright, so 25% is good, 6:13 let's take it up a notch, 50%. Now, as we get into higher amounts of 6:20 force, especially if I'm dealing with somebody like Melissa, who's a beast, 6:25 she's athletic, she's strong, I'm not going to do this, okay, I'm not trying to 6:30 show off how strong my anterior delts are today, alright, I'm not trying to 6:34 get a pec workout while I'm working with my patients. I'm going to go ahead and 6:38 hold her like this, kind of give her knee a hug, get it nice and close to my 6:42 body, use both hands, I'm going to take a staggered stance, I know you can't 6:47 see my legs, but my legs are split this way, so at this point any resistance she 6:52 gives is maybe a little bit of bicep strength, but more than anything it's my 6:56 body that is blocking the resistance here. Alright, so I'm going to have her 7:01 go ahead and pull, let's say, half of what you've got. Alright, so nothing too big, I'm 7:07 going to hold for 2 to 5 seconds, make sure she doesn't compensate or 7:11 deviate at all, and then I'm going to go ahead and have her relax. Good. If I like 7:17 the way that looked, I'll go on to 75% percent, if I didn't I can 7:22 try a couple more times to see if I can get the same movement pattern, without 7:27 compensation deviation. If I can get her up to fifty percent without seeing 7:31 abduction, adduction, or internal rotation. So, again, we're going to come up 7:35 like this. So this is going to be strong, but not maximum force. 7:40 This is the 75% percent. Go ahead and pull up, good. 7:45 She might have to push down on this leg a little bit because we're starting to 7:49 get to an amount of force that if she doesn't, she's going to flip over, 7:53 or I'm going to flip her off the table, or she's going to flip herself off the table, and 7:56 none of those sound good. When people fall off the table, they don't come back. Alright, 8:00 so that's 75%, for 2 to 5 seconds, and it should start to 8:03 feel pretty hard to hold at this point. Good, and relax. 8:09 We can go up one more time, this time since she had no deviation, she's well 8:15 practiced at this technique, we'll go ahead and go max. You ready? So, up here, 8:19 and now I might actually pull. All you've got! I might actually pull back a little bit, 8:25 and remember, I'm not pulling with my arms, this is not a row for me, I'm using 8:31 my legs to apply a force to her hip flexors. Good stuff. Nice and strong. Now 8:40 remember, assess, address, reassess. At this point, I would go back to whatever 8:47 assessment I was trying to fix, whether it's internal rotation goniometerry, an 8:52 inadequate forward lean, checking the lordosis on the lumbar spine. Maybe I 8:58 thought it was related to rotation or something. Whatever your quick test was 9:03 that you were trying to fix with this technique, go back to it and see if it 9:07 improved. If it didn't improve, what are you going to do? Not this, right? You just 9:14 learned something. You might give it a couple more tries, I'm not saying it has 9:17 to happen the first time, every time, but if you notice this isn't making change, 9:22 then don't do it. If you do notice it's making change, there's a really easy home 9:28 exercise version for this technique. Melissa can use her hands as 9:33 blocks, 9:38 and do the positional isometric just as I did. She's very capable of monitoring 9:43 the position of her leg. She can go through the same queus I did, so 9:50 start with minimal, I want 2 reps there, and then I want moderate, and 9:56 then I want strong but submaximal, and then I want maximal, and she can practice 10:01 this technique at home to start getting that psoas to come back in a little bit. 10:07 So you have a positional isometric for when your patient or client is with you, 10:15 and then, of course, you have their home exercise program, which you can use as 10:20 movement prep when they're working out on their own, or as their home exercise 10:25 program if this is a client or patient with hip pain. Thank you, Melissa. I hope 10:30 you guys enjoyed this technique, once again you're going to use it rarely, but 10:34 keep it somewhere in the back of your head, because I guarantee if you're 10:37 practicing long enough, if you're practicing as a physical therapist all 10:41 you have to do is be practicing often enough, you are going to see somebody who 10:46 could use a little bit more psoas activity. I hope you enjoyed the video, if 10:50 you have any questions leave them in the comments below, I look forward to hearing 10:52 from you.
