00:04 - 00:05This is Brent of the Brookbush
00:05 - 00:07Institute and in this video we're going over
00:07 - 00:09static manual release of the psoas and
00:09 - 00:11iliacus. I know a lot of you have been
00:11 - 00:12waiting for this video. But if you are
00:12 - 00:14watching this video, I'm assuming you're
00:14 - 00:16watching it for educational purposes and
00:16 - 00:18that you are a licensed manual therapist
00:18 - 00:20following the laws of scope of practice
00:20 - 00:22in your state. Physical therapists,
00:22 - 00:25athletic trainers, chiropractors, massage
00:25 - 00:28therapists, osteopaths - you're probably all
00:28 - 00:29in the clear and I'm probably forgetting
00:29 - 00:32a couple professions. Personal trainers,
00:32 - 00:34this probably doesn't fall within your
00:34 - 00:36scope, especially this technique which
00:36 - 00:41does pose certain risks. However, you
00:41 - 00:43could possibly use this in a learning
00:43 - 00:46environment with supervision of a manual
00:46 - 00:47therapist to help you with your
00:47 - 00:49functional anatomy knowledge. I'm going to
00:49 - 00:51have my friend Sonja come out. She's
00:51 - 00:52going to go ahead and help me
00:52 - 00:54demonstrate this technique. She's going
00:54 - 00:56to lay on her back here. With the
00:56 - 00:59potential discomfort with this technique
00:59 - 01:00and the fact that it does pose some
01:00 - 01:02risks being close to some sensitive
01:02 - 01:06structures, once again, I want to be 80 to
01:06 - 01:0990% sure that her psoas and
01:09 - 01:12iliacus are involved in the dysfunction
01:12 - 01:13that I've seen or the movement
01:13 - 01:16impairment that I've seen, her complaints
01:16 - 01:19that she's come in with. So, I've
01:19 - 01:21done either an overhead squat assessment,
01:21 - 01:25maybe goniometry, maybe the Thomas
01:25 - 01:27test. This could be related to
01:27 - 01:30things like an excessive lordosis and
01:30 - 01:33asymmetrical weight shift, lumbar spine
01:33 - 01:35pain, a positive Thomas test or hip
01:35 - 01:37extension goniometry all would be
01:37 - 01:40good indicators that maybe I should take
01:40 - 01:43a look at her psoas and iliacus. With
01:43 - 01:45all of our manual release techniques we
01:45 - 01:47follow a very similar protocol which
01:47 - 01:50comes down to palpate and compress but
01:50 - 01:51we do want to get a little bit more
01:51 - 01:53detailed than that. We want to know how to
01:53 - 01:56palpate this muscle, we get some bonus
01:56 - 01:57points for knowing where the trigger
01:57 - 01:58points are. On this video I'm going to
01:58 - 02:00have a harder time showing you this
02:00 - 02:03particular trigger point or its location
02:03 - 02:04compared to some of our other videos
02:04 - 02:07because your psoas and iliacus are deep
02:07 - 02:10to all of your abdominal muscles and
02:10 - 02:12your psoas deep to a lot of viscera.
02:12 - 02:15We have to know what's around these
02:15 - 02:18muscles that we could be potentially
02:18 - 02:22insulting or could potentially disrupt
02:22 - 02:25with pressure. In the case of the psoas
02:25 - 02:28and the iliacus, we do have to consider
02:28 - 02:32that we have our abdominal aorta and
02:32 - 02:34common iliac artery, so if it pulses get
02:34 - 02:37off it. We have our femoral nerve, so if
02:37 - 02:39you start getting any tingling down the
02:39 - 02:42thigh, probably a good idea to move. And
02:42 - 02:43we have to realize that we're on viscera
02:43 - 02:46so we want to be pretty good at
02:46 - 02:47this palpatory technique. It's going to
02:47 - 02:50take a little practice but we don't want
02:50 - 02:53to be moving around a lot in there. We
02:53 - 02:57don't want to be lost, not really
02:57 - 02:58having a good sense of our anatomy
02:58 - 03:01because we still have things like the
03:01 - 03:04small intestines and the ureters and
03:04 - 03:07the kidneys and some other stuff around
03:07 - 03:09the area that maybe we don't want to be
03:09 - 03:13boxing around with pressure. And then
03:13 - 03:15of course, last we have to think about
03:15 - 03:17position which that's going to come down
03:17 - 03:19to patient comfort which I think a lot
03:19 - 03:21of therapists are really good at but
03:21 - 03:24then our comfort. Where should I
03:24 - 03:27be to ensure that I can use my bodyweight
03:27 - 03:31to apply pressure and not use my
03:31 - 03:34hands and my grip strength and put
03:34 - 03:37all these delicate IP joints at risk,
03:37 - 03:40especially over a career. For this
03:40 - 03:41particular technique, I'm going to
03:41 - 03:43show you a couple tricks. I'm going to go
03:43 - 03:46ahead and have Sonja move her hands up.
03:46 - 03:49Can you bring your shirt up to belly
03:49 - 03:52level? Chances are I could probably
03:52 - 03:55palpate through a thin shirt like
03:55 - 03:58Sonja's got on but if things are a
03:58 - 03:59little thicker it's just going to make
03:59 - 04:02it that much harder to get in. Can I move
04:02 - 04:04this? I'm going to move
04:04 - 04:06Sonja's waistband just a little bit down
04:06 - 04:10here because I want to find the top of
04:10 - 04:13her ASIS. The two landmarks
04:13 - 04:15we're going to use to really help us
04:15 - 04:17with this palpation are going to be her
04:17 - 04:21ASIS, her semilunar lines, which are those
04:21 - 04:24lines that that give the rectus
04:24 - 04:25abdominus its
04:25 - 04:27shape, they're kind of in between the
04:27 - 04:29external obiques and the rectus abdominus.
04:29 - 04:31That's a good good place to start our
04:31 - 04:34palpation. And of course we want to know
04:34 - 04:37where the umbilicus is. The psoas, a
04:37 - 04:39lot of people make the mistake of going
04:39 - 04:43"Oh let me go after the ASIS, that's where
04:43 - 04:45the psoas is." That's actually not true,
04:45 - 04:48your psoas goes from lumbar spine to
04:48 - 04:49lesser trochanter
04:49 - 04:51which means when you place your fingers
04:51 - 04:53down on the semilunar lines they're
04:53 - 04:55actually going to be pointing towards
04:55 - 05:00the lumbar spine. If I start with my
05:00 - 05:03fingers here and I'm actually going
05:03 - 05:04to have her start in a hip flexed
05:04 - 05:06position so I take her a little bit into
05:06 - 05:09a posterior pelvic tilt, take some of the
05:09 - 05:11tension off of her abdominal wall here.
05:11 - 05:15Then I have her take a deep breath
05:15 - 05:20for me and I start my pressure inward as
05:20 - 05:22she breathes out. This will be a lot more
05:22 - 05:25comfortable for her.
05:25 - 05:28After she takes that big breath, she'll
05:28 - 05:31go back to taking normal breaths and
05:31 - 05:33maybe even a little shallower breath than
05:33 - 05:36normal, still within comfort because I
05:36 - 05:38don't want her to take deep breaths and
05:38 - 05:43keep pushing me out of her abdomen.
05:43 - 05:46To check whether I'm on her psoas
05:46 - 05:48of course I'm looking for something
05:48 - 05:51that's that's fairly vertically aligned.
05:51 - 05:53I'm looking for something that feels
05:53 - 05:56fairly tube shaped under my fingers.
05:56 - 06:01I know that the psoas is moderately
06:01 - 06:03thick, I guess maybe about this the
06:03 - 06:06thickness of somebody's wrists.
06:06 - 06:08So I'm searching for something that's
06:08 - 06:09shaped like that but so I don't go
06:09 - 06:11searching all over her abdominal cavity,
06:11 - 06:14what I'll usually do is I'll get in this
06:14 - 06:15position where I have this hand applying
06:15 - 06:18pressure and then I can use these
06:18 - 06:21fingertips to actually apply the
06:21 - 06:23pressure. I started with these guys
06:23 - 06:25applying pressure now I'm going to relax
06:25 - 06:27this hand and let this hand do most of
06:27 - 06:29the work. And then if I put my
06:29 - 06:32arm down over Sonja's knee, I can
06:32 - 06:35ask her, "Hey, can you push your
06:35 - 06:37knee into my arm, pull up into hip
06:37 - 06:40flexion?" and her psoas will pop right
06:40 - 06:41into my fingers. If I don't feel it, then
06:41 - 06:45I can move either medial or lateral, have
06:45 - 06:46her go again
06:46 - 06:51a little harder, there we go.
06:51 - 06:55Found it. Now once I find it, I
06:55 - 06:59can go and look for the the densest
06:59 - 07:03portion of that muscle and then again
07:03 - 07:05just like all of our other techniques,
07:05 - 07:07I'm going to get nice and comfortable
07:07 - 07:10here. Try to use my bodyweight and wait
07:10 - 07:13for a release. Generally that takes about
07:13 - 07:1630 seconds to 2 minutes. Hopefully
07:16 - 07:18they're pretty good at relaxing, you
07:18 - 07:19don't have to stay in there for two
07:19 - 07:22minutes to get a good release.
07:22 - 07:26How you doing? As soon as I feel a
07:26 - 07:30reduction in tissue density, that release
07:30 - 07:32that we're looking for, I'm done with
07:32 - 07:35this technique. And then I could go on to
07:35 - 07:38reassessment. Being that this particular
07:38 - 07:41technique can cause some discomfort, I
07:41 - 07:45would definitely do some level of
07:45 - 07:47reassessment right after this
07:47 - 07:49intervention. You should be doing
07:49 - 07:51reassessment after many of your
07:51 - 07:52interventions to test if they were the
07:52 - 07:54appropriate technique for that
07:54 - 07:56individual but specifically with this
07:56 - 07:58technique if it didn't do anything to
07:58 - 08:01improve her movement, I'm not going to do
08:01 - 08:02it again. I don't want to do things that
08:02 - 08:04are uncomfortable and ineffective. I'm
08:04 - 08:06okay with a certain level of
08:06 - 08:08uncomfortable and effective but
08:08 - 08:11uncomfortable and ineffective, never
08:11 - 08:14okay. The iliacus is a little tricky,
08:14 - 08:16actually kind of trickier than the psoas.
08:16 - 08:18I'm going to use the same technique but
08:18 - 08:23my iliacus runs along the face of my
08:23 - 08:25ilium. If you palpate
08:25 - 08:30their iliac crest, you can get a good
08:30 - 08:32idea of where your fingers should be
08:32 - 08:35headed. I'm going to find her ASIS,
08:35 - 08:38have her do the same deep breath
08:38 - 08:42and breathe out and the reason why I say
08:42 - 08:45that the iliacus is a little rougher is
08:45 - 08:47because despite it being really easy to
08:47 - 08:51find initially, you really can only get
08:51 - 08:54to the most anterior fibers. You start
08:54 - 08:56pulling up so much tissue and you start
08:56 - 08:58getting so much tissue stretch and so
08:58 - 09:00much stretch from all those
09:00 - 09:02abdominal muscles: your external obliques,
09:02 - 09:04your internal obliques, your transverse
09:04 - 09:07abdominus that you really don't get to
09:07 - 09:10access that much. You can gather up
09:10 - 09:13some tissue from the midline to try to
09:13 - 09:17get a little deeper but I think you
09:17 - 09:20will find that my best guess is you're
09:20 - 09:23probably getting about halfway maybe to
09:23 - 09:26the the middle of the iliac crest that
09:26 - 09:27you're probably not going to be able to
09:27 - 09:29hit any of those fibers on the posterior
09:29 - 09:32iliac crest. Nonetheless, if you find
09:32 - 09:36dense tissue, you're going to go ahead
09:36 - 09:40and hold and wait for a release.
09:43 - 09:47And again once I finish with this
09:47 - 09:48release technique, let's say she had a
09:48 - 09:51really positive modified Thomas test,
09:51 - 09:53it's real easy for me to go back and go
09:53 - 09:57"okay go ahead and hold, did that get
09:57 - 10:00better?" If it didn't then maybe this is
10:00 - 10:02one of those techniques that I don't
10:02 - 10:05actually need to help correct the
10:05 - 10:06movement impairment she's going to be
10:06 - 10:09complaining about. We'll move on to
10:09 - 10:11our close-up recap. For a close-up
10:11 - 10:13recap of psoas and iliacus release, a
10:13 - 10:15couple landmarks we need to keep in mind.
10:15 - 10:17I've actually pulled the waistband of
10:17 - 10:20Sonja's shorts here right down to the
10:20 - 10:22top of the ASIS so I know where that is.
10:22 - 10:24And then Sonja, go ahead and give
10:24 - 10:27me a little contraction of your abs.
10:27 - 10:29You see this little dark shadow right
10:29 - 10:31here, this is her semilunar lines. It's a
10:31 - 10:33good place for us to start sinking our
10:33 - 10:36fingers in towards the lumbar spine.
10:36 - 10:38Remember, our psoas goes from lumbar spine
10:38 - 10:42to lesser trochanter of the femur. To
10:42 - 10:45get to the psoas, what I usually have my
10:45 - 10:47clients do is try to relax the best they
10:47 - 10:50can and then I'll have them take a nice
10:50 - 10:54deep breath for me. And then as they
10:54 - 10:57breathe out, I'll just let my fingers
10:57 - 11:00sink in towards their lumbar spine.
11:00 - 11:04Notice I'm going in that direction.
11:04 - 11:08I'm going to feel something kind of
11:08 - 11:10tubular shaped, it's going to
11:10 - 11:13be kind of a thick tube, the psoas is. The
11:13 - 11:15way I'm going to check that as I
11:15 - 11:16mentioned in the previous videos, I'm
11:16 - 11:18going to go ahead and have Sonja pull
11:18 - 11:22her or lift her knee into my armpit or
11:22 - 11:25elbow and I should feel that psoas
11:25 - 11:27contract pretty good.
11:27 - 11:30Alright, good right there. Once
11:30 - 11:35I found that, I can then go a little
11:35 - 11:38proximal to distal here to find
11:38 - 11:42the most tender point. Once I've found it
11:42 - 11:43I'm going to make sure she's totally
11:43 - 11:46relaxed, she's just trying to breathe
11:46 - 11:48normally maybe a little shallower than
11:48 - 11:50normal because big deep breaths aren't
11:50 - 11:52going to feel real great but we're just
11:52 - 11:55going to wait for that release to happen.
11:55 - 12:00Do remember, the psoas is very close to a
12:00 - 12:02lot of sensitive tissues. If you
12:02 - 12:05feel a pulse, get off it. There's no
12:05 - 12:07need to compress something with a pulse,
12:07 - 12:10that's an artery. If Sonja started
12:10 - 12:12complaining about tingling through her
12:12 - 12:16leg, her thigh, the bottom of her foot,
12:16 - 12:20we need to move, we need to
12:20 - 12:22get off that nerve. This is very
12:22 - 12:26close to the femoral nerve. We also need
12:26 - 12:28to consider that we're pretty close to
12:28 - 12:30some internal organs so if we have any
12:30 - 12:34other weird sensations. For example, all
12:34 - 12:36of a sudden needing to use the restroom,
12:36 - 12:39again we need to probably reset and
12:39 - 12:43move. Once we feel a release happen
12:43 - 12:46though, we should be good and then we'd
12:46 - 12:49retest. I was just using
12:49 - 12:53one hand here. Compared to Sonja, I'm
12:53 - 12:56a pretty large guy, you could go finger
12:56 - 12:58tip over finger, just be careful not to
12:58 - 13:02double the breadth of your contact
13:02 - 13:03surface because then you're just
13:03 - 13:05stretching out all of that abdominal
13:05 - 13:08musculature, all of the skin over her psoas
13:08 - 13:10that much more and it's going to be
13:10 - 13:12that much more uncomfortable. I would
13:12 - 13:15start with one hand and then place your
13:15 - 13:16fingers over the others to add a little
13:16 - 13:19bit of pressure. For the iliacus, the
13:19 - 13:22iliacus is really easy to find, not very
13:22 - 13:25easy to release, unfortunately. The
13:25 - 13:28iliacus is going to be against the face
13:28 - 13:30of our ilium, so all we need to do
13:30 - 13:33is come right over the ASIS and then
13:33 - 13:36curve around. I'm going to have Sonja
13:36 - 13:39take a nice deep breath for me. As she
13:39 - 13:41breathes out, I'm going to go ahead and
13:41 - 13:44sink in. The big problem with the iliacus
13:44 - 13:47is because of the tension in her skin
13:47 - 13:49and her transverse abdominis and the
13:49 - 13:52abdominal fascia and her external and
13:52 - 13:54internal obliques and all that stuff
13:54 - 13:56that we're having to palpate through, I
13:56 - 13:58just can't get to very much of her
13:58 - 14:01iliacus. It's not like I'm going to get
14:01 - 14:03down to the posterior wall. I'm probably
14:03 - 14:05just going to mostly affect
14:05 - 14:11the fibers closest to her ASIS. How's that
14:11 - 14:16feel? Feels good. As we mentioned in
14:16 - 14:18previous videos Sonja is kind of a
14:18 - 14:22masochist, she kind of likes pain.
14:22 - 14:23Since these techniques are so
14:23 - 14:26uncomfortable, they are a little
14:26 - 14:27different than some of the other
14:27 - 14:28techniques as we're having to push
14:28 - 14:31through viscera and we're having to push
14:31 - 14:34through that sensitive abdominal area
14:34 - 14:35and there's tends to be a little bit
14:35 - 14:37more skin stretch with these techniques.
14:37 - 14:39Make sure you're doing your reassessment,
14:39 - 14:40I mean you should be always doing
14:40 - 14:42reassessment between interventions but
14:42 - 14:46especially in this case. If you did not
14:46 - 14:48get a result from releasing the psoas or
14:48 - 14:50releasing the iliacus manually, for
14:50 - 14:53example, an increase in hip extension, a
14:53 - 14:56decrease in excessive lumbar lordosis
14:56 - 14:58during an overhead squat assessment,
14:58 - 15:01don't do the technique again. It's that
15:01 - 15:04simple. If it's effective, I'll take a
15:04 - 15:07little uncomfortable for effective
15:07 - 15:10outcomes. What I won't take is
15:10 - 15:12ineffective and uncomfortable.
15:12 - 15:14There you have it. Static manual release
15:14 - 15:16of the psoas and iliacus. I think the
15:16 - 15:18most important thing to remember with
15:18 - 15:20this particular technique is you are in
15:20 - 15:23close proximity to some very sensitive
15:23 - 15:26tissues when you do this technique. That
15:26 - 15:28means several things. Number one, you must
15:28 - 15:32assess before you do manual techniques.
15:32 - 15:36You need to be certain that the
15:36 - 15:40technique itself is worth whatever risk
15:40 - 15:43it imposes. You also need to be aware of
15:43 - 15:46those structures, things like the femoral
15:46 - 15:49nerve, the abdominal aorta and common
15:49 - 15:51iliac artery, the viscera, even the
15:51 - 15:53small intestines that are in there. They
15:53 - 15:59all have the potential of being insulted,
15:59 - 16:01we'll say, by pressure and moving around.
16:01 - 16:04If you feel something pulse,
16:04 - 16:07get off it. If you start causing tingling
16:07 - 16:09down somebody's thigh, that's not a good
16:09 - 16:12thing. Move. Make sure you're testing your
16:12 - 16:15position with that little hip flexion
16:15 - 16:17trick I showed you so that you know you
16:17 - 16:20are on the psoas itself and you don't
16:20 - 16:22spend a lot of time rummaging around
16:22 - 16:25potentially releasing something like the
16:25 - 16:28small intestine. And of course,
16:28 - 16:31last, make sure you practice this on some
16:31 - 16:35colleagues before you move in to doing
16:35 - 16:37this with a patient. and if at all possible,
16:38 - 16:41grab somebody who has experience with
16:41 - 16:44this particular technique so that you
16:44 - 16:46can do it on them and a manual
16:46 - 16:49therapists can give you feedback. It's
16:49 - 16:52the best education you can get for all
16:52 - 16:54of the manual techniques which we show. I
16:54 - 16:57hope you get great outcomes with
16:57 - 16:59this technique, I hope it does fill a big
16:59 - 17:02gap of psoas an iliacus release that
17:02 - 17:05maybe you couldn't do before but knew and
17:05 - 17:07some patients needed to be done. I look
17:07 - 17:09forward to seeing your comments. I'll
17:09 - 17:11talk with you soon.