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Psoas and Illiacus Static Manual Release

Feel the relief of long-term pain relief in your lower body with the static manual release tutorial. Learn how to correctly identify and release the psoas and illiacus muscles and get back to your body's natural balance.

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Transcript

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.

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