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