Psoas and Illiacus Static Manual Release

The Psoas and Illiacus Static Manual Release is a deep-tissue massage technique to target tightness in the lower back and hip area. This technique involves the therapist gently massaging the muscles of the psoas and illiacus, and simultaneously applying pressure on them to break up any built-up tension. By using this technique, the therapist can manually release the tension, restoring lumbar mobility and easing the pain and discomfort in the region. Also, depending on

Transcript

00:00:0400:00:05
This is Brent of the Brookbush
00:00:0400:00:05
...blank
00:00:0500:00:07
Institute and in this video we're going over
00:00:0700:00:09
static manual release of the psoas and
00:00:0900:00:11
iliacus. I know a lot of you have been
00:00:1100:00:12
waiting for this video. But if you are
00:00:1200:00:14
watching this video, I'm assuming you're
00:00:1400:00:16
watching it for educational purposes and
00:00:1600:00:18
that you are a licensed manual therapist
00:00:1800:00:20
following the laws of scope of practice
00:00:2000:00:22
in your state. Physical therapists,
00:00:2200:00:25
athletic trainers, chiropractors, massage
00:00:2500:00:28
therapists, osteopaths - you're probably all
00:00:2800:00:29
in the clear and I'm probably forgetting
00:00:2900:00:32
a couple professions. Personal trainers,
00:00:3200:00:34
this probably doesn't fall within your
00:00:3400:00:36
scope, especially this technique which
00:00:3600:00:41
does pose certain risks. However, you
00:00:4100:00:43
could possibly use this in a learning
00:00:4300:00:46
environment with supervision of a manual
00:00:4600:00:47
therapist to help you with your
00:00:4700:00:49
functional anatomy knowledge. I'm going to
00:00:4900:00:51
have my friend Sonja come out. She's
00:00:5100:00:52
going to go ahead and help me
00:00:5200:00:54
demonstrate this technique. She's going
00:00:5400:00:56
to lay on her back here. With the
00:00:5600:00:59
potential discomfort with this technique
00:00:5900:01:00
and the fact that it does pose some
00:01:0000:01:02
risks being close to some sensitive
00:01:0200:01:06
structures, once again, I want to be 80 to
00:01:0600:01:09
90% sure that her psoas and
00:01:0900:01:12
iliacus are involved in the dysfunction
00:01:1200:01:13
that I've seen or the movement
00:01:1300:01:16
impairment that I've seen, her complaints
00:01:1600:01:19
that she's come in with. So, I've
00:01:1900:01:21
done either an overhead squat assessment,
00:01:2100:01:25
maybe goniometry, maybe the Thomas
00:01:2500:01:27
test. This could be related to
00:01:2700:01:30
things like an excessive lordosis and
00:01:3000:01:33
asymmetrical weight shift, lumbar spine
00:01:3300:01:35
pain, a positive Thomas test or hip
00:01:3500:01:37
extension goniometry all would be
00:01:3700:01:40
good indicators that maybe I should take
00:01:4000:01:43
a look at her psoas and iliacus. With
00:01:4300:01:45
all of our manual release techniques we
00:01:4500:01:47
follow a very similar protocol which
00:01:4700:01:50
comes down to palpate and compress but
00:01:5000:01:51
we do want to get a little bit more
00:01:5100:01:53
detailed than that. We want to know how to
00:01:5300:01:56
palpate this muscle, we get some bonus
00:01:5600:01:57
points for knowing where the trigger
00:01:5700:01:58
points are. On this video I'm going to
00:01:5800:02:00
have a harder time showing you this
00:02:0000:02:03
particular trigger point or its location
00:02:0300:02:04
compared to some of our other videos
00:02:0400:02:07
because your psoas and iliacus are deep
00:02:0700:02:10
to all of your abdominal muscles and
00:02:1000:02:12
your psoas deep to a lot of viscera.
00:02:1200:02:15
We have to know what's around these
00:02:1500:02:18
muscles that we could be potentially
00:02:1800:02:22
insulting or could potentially disrupt
00:02:2200:02:25
with pressure. In the case of the psoas
00:02:2500:02:28
and the iliacus, we do have to consider
00:02:2800:02:32
that we have our abdominal aorta and
00:02:3200:02:34
common iliac artery, so if it pulses get
00:02:3400:02:37
off it. We have our femoral nerve, so if
00:02:3700:02:39
you start getting any tingling down the
00:02:3900:02:42
thigh, probably a good idea to move. And
00:02:4200:02:43
we have to realize that we're on viscera
00:02:4300:02:46
so we want to be pretty good at
00:02:4600:02:47
this palpatory technique. It's going to
00:02:4700:02:50
take a little practice but we don't want
00:02:5000:02:53
to be moving around a lot in there. We
00:02:5300:02:57
don't want to be lost, not really
00:02:5700:02:58
having a good sense of our anatomy
00:02:5800:03:01
because we still have things like the
00:03:0100:03:04
small intestines and the ureters and
00:03:0400:03:07
the kidneys and some other stuff around
00:03:0700:03:09
the area that maybe we don't want to be
00:03:0900:03:13
boxing around with pressure. And then
00:03:1300:03:15
of course, last we have to think about
00:03:1500:03:17
position which that's going to come down
00:03:1700:03:19
to patient comfort which I think a lot
00:03:1900:03:21
of therapists are really good at but
00:03:2100:03:24
then our comfort. Where should I
00:03:2400:03:27
be to ensure that I can use my bodyweight
00:03:2700:03:31
to apply pressure and not use my
00:03:3100:03:34
hands and my grip strength and put
00:03:3400:03:37
all these delicate IP joints at risk,
00:03:3700:03:40
especially over a career. For this
00:03:4000:03:41
particular technique, I'm going to
00:03:4100:03:43
show you a couple tricks. I'm going to go
00:03:4300:03:46
ahead and have Sonja move her hands up.
00:03:4600:03:49
Can you bring your shirt up to belly
00:03:4900:03:52
level? Chances are I could probably
00:03:5200:03:55
palpate through a thin shirt like
00:03:5500:03:58
Sonja's got on but if things are a
00:03:5800:03:59
little thicker it's just going to make
00:03:5900:04:02
it that much harder to get in. Can I move
00:04:0200:04:04
this? I'm going to move
00:04:0400:04:06
Sonja's waistband just a little bit down
00:04:0600:04:10
here because I want to find the top of
00:04:1000:04:13
her ASIS. The two landmarks
00:04:1300:04:15
we're going to use to really help us
00:04:1500:04:17
with this palpation are going to be her
00:04:1700:04:21
ASIS, her semilunar lines, which are those
00:04:2100:04:24
lines that that give the rectus
00:04:2400:04:25
abdominus its
00:04:2500:04:27
shape, they're kind of in between the
00:04:2700:04:29
external obiques and the rectus abdominus.
00:04:2900:04:31
That's a good good place to start our
00:04:3100:04:34
palpation. And of course we want to know
00:04:3400:04:37
where the umbilicus is. The psoas, a
00:04:3700:04:39
lot of people make the mistake of going
00:04:3900:04:43
"Oh let me go after the ASIS, that's where
00:04:4300:04:45
the psoas is." That's actually not true,
00:04:4500:04:48
your psoas goes from lumbar spine to
00:04:4800:04:49
lesser trochanter
00:04:4900:04:51
which means when you place your fingers
00:04:5100:04:53
down on the semilunar lines they're
00:04:5300:04:55
actually going to be pointing towards
00:04:5500:05:00
the lumbar spine. If I start with my
00:05:0000:05:03
fingers here and I'm actually going
00:05:0300:05:04
to have her start in a hip flexed
00:05:0400:05:06
position so I take her a little bit into
00:05:0600:05:09
a posterior pelvic tilt, take some of the
00:05:0900:05:11
tension off of her abdominal wall here.
00:05:1100:05:15
Then I have her take a deep breath
00:05:1500:05:20
for me and I start my pressure inward as
00:05:2000:05:22
she breathes out. This will be a lot more
00:05:2200:05:25
comfortable for her.
00:05:2500:05:28
After she takes that big breath, she'll
00:05:2800:05:31
go back to taking normal breaths and
00:05:3100:05:33
maybe even a little shallower breath than
00:05:3300:05:36
normal, still within comfort because I
00:05:3600:05:38
don't want her to take deep breaths and
00:05:3800:05:43
keep pushing me out of her abdomen.
00:05:4300:05:46
To check whether I'm on her psoas
00:05:4600:05:48
of course I'm looking for something
00:05:4800:05:51
that's that's fairly vertically aligned.
00:05:5100:05:53
I'm looking for something that feels
00:05:5300:05:56
fairly tube shaped under my fingers.
00:05:5600:06:01
I know that the psoas is moderately
00:06:0100:06:03
thick, I guess maybe about this the
00:06:0300:06:06
thickness of somebody's wrists.
00:06:0600:06:08
So I'm searching for something that's
00:06:0800:06:09
shaped like that but so I don't go
00:06:0900:06:11
searching all over her abdominal cavity,
00:06:1100:06:14
what I'll usually do is I'll get in this
00:06:1400:06:15
position where I have this hand applying
00:06:1500:06:18
pressure and then I can use these
00:06:1800:06:21
fingertips to actually apply the
00:06:2100:06:23
pressure. I started with these guys
00:06:2300:06:25
applying pressure now I'm going to relax
00:06:2500:06:27
this hand and let this hand do most of
00:06:2700:06:29
the work. And then if I put my
00:06:2900:06:32
arm down over Sonja's knee, I can
00:06:3200:06:35
ask her, "Hey, can you push your
00:06:3500:06:37
knee into my arm, pull up into hip
00:06:3700:06:40
flexion?" and her psoas will pop right
00:06:4000:06:41
into my fingers. If I don't feel it, then
00:06:4100:06:45
I can move either medial or lateral, have
00:06:4500:06:46
her go again
00:06:4600:06:51
a little harder, there we go.
00:06:5100:06:55
Found it. Now once I find it, I
00:06:5500:06:59
can go and look for the the densest
00:06:5900:07:03
portion of that muscle and then again
00:07:0300:07:05
just like all of our other techniques,
00:07:0500:07:07
I'm going to get nice and comfortable
00:07:0700:07:10
here. Try to use my bodyweight and wait
00:07:1000:07:13
for a release. Generally that takes about
00:07:1300:07:16
30 seconds to 2 minutes. Hopefully
00:07:1600:07:18
they're pretty good at relaxing, you
00:07:1800:07:19
don't have to stay in there for two
00:07:1900:07:22
minutes to get a good release.
00:07:2200:07:26
How you doing? As soon as I feel a
00:07:2600:07:30
reduction in tissue density, that release
00:07:3000:07:32
that we're looking for, I'm done with
00:07:3200:07:35
this technique. And then I could go on to
00:07:3500:07:38
reassessment. Being that this particular
00:07:3800:07:41
technique can cause some discomfort, I
00:07:4100:07:45
would definitely do some level of
00:07:4500:07:47
reassessment right after this
00:07:4700:07:49
intervention. You should be doing
00:07:4900:07:51
reassessment after many of your
00:07:5100:07:52
interventions to test if they were the
00:07:5200:07:54
appropriate technique for that
00:07:5400:07:56
individual but specifically with this
00:07:5600:07:58
technique if it didn't do anything to
00:07:5800:08:01
improve her movement, I'm not going to do
00:08:0100:08:02
it again. I don't want to do things that
00:08:0200:08:04
are uncomfortable and ineffective. I'm
00:08:0400:08:06
okay with a certain level of
00:08:0600:08:08
uncomfortable and effective but
00:08:0800:08:11
uncomfortable and ineffective, never
00:08:1100:08:14
okay. The iliacus is a little tricky,
00:08:1400:08:16
actually kind of trickier than the psoas.
00:08:1600:08:18
I'm going to use the same technique but
00:08:1800:08:23
my iliacus runs along the face of my
00:08:2300:08:25
ilium. If you palpate
00:08:2500:08:30
their iliac crest, you can get a good
00:08:3000:08:32
idea of where your fingers should be
00:08:3200:08:35
headed. I'm going to find her ASIS,
00:08:3500:08:38
have her do the same deep breath
00:08:3800:08:42
and breathe out and the reason why I say
00:08:4200:08:45
that the iliacus is a little rougher is
00:08:4500:08:47
because despite it being really easy to
00:08:4700:08:51
find initially, you really can only get
00:08:5100:08:54
to the most anterior fibers. You start
00:08:5400:08:56
pulling up so much tissue and you start
00:08:5600:08:58
getting so much tissue stretch and so
00:08:5800:09:00
much stretch from all those
00:09:0000:09:02
abdominal muscles: your external obliques,
00:09:0200:09:04
your internal obliques, your transverse
00:09:0400:09:07
abdominus that you really don't get to
00:09:0700:09:10
access that much. You can gather up
00:09:1000:09:13
some tissue from the midline to try to
00:09:1300:09:17
get a little deeper but I think you
00:09:1700:09:20
will find that my best guess is you're
00:09:2000:09:23
probably getting about halfway maybe to
00:09:2300:09:26
the the middle of the iliac crest that
00:09:2600:09:27
you're probably not going to be able to
00:09:2700:09:29
hit any of those fibers on the posterior
00:09:2900:09:32
iliac crest. Nonetheless, if you find
00:09:3200:09:36
dense tissue, you're going to go ahead
00:09:3600:09:40
and hold and wait for a release.
00:09:4300:09:47
And again once I finish with this
00:09:4700:09:48
release technique, let's say she had a
00:09:4800:09:51
really positive modified Thomas test,
00:09:5100:09:53
it's real easy for me to go back and go
00:09:5300:09:57
"okay go ahead and hold, did that get
00:09:5700:10:00
better?" If it didn't then maybe this is
00:10:0000:10:02
one of those techniques that I don't
00:10:0200:10:05
actually need to help correct the
00:10:0500:10:06
movement impairment she's going to be
00:10:0600:10:09
complaining about. We'll move on to
00:10:0900:10:11
our close-up recap. For a close-up
00:10:1100:10:13
recap of psoas and iliacus release, a
00:10:1300:10:15
couple landmarks we need to keep in mind.
00:10:1500:10:17
I've actually pulled the waistband of
00:10:1700:10:20
Sonja's shorts here right down to the
00:10:2000:10:22
top of the ASIS so I know where that is.
00:10:2200:10:24
And then Sonja, go ahead and give
00:10:2400:10:27
me a little contraction of your abs.
00:10:2700:10:29
You see this little dark shadow right
00:10:2900:10:31
here, this is her semilunar lines. It's a
00:10:3100:10:33
good place for us to start sinking our
00:10:3300:10:36
fingers in towards the lumbar spine.
00:10:3600:10:38
Remember, our psoas goes from lumbar spine
00:10:3800:10:42
to lesser trochanter of the femur. To
00:10:4200:10:45
get to the psoas, what I usually have my
00:10:4500:10:47
clients do is try to relax the best they
00:10:4700:10:50
can and then I'll have them take a nice
00:10:5000:10:54
deep breath for me. And then as they
00:10:5400:10:57
breathe out, I'll just let my fingers
00:10:5700:11:00
sink in towards their lumbar spine.
00:11:0000:11:04
Notice I'm going in that direction.
00:11:0400:11:08
I'm going to feel something kind of
00:11:0800:11:10
tubular shaped, it's going to
00:11:1000:11:13
be kind of a thick tube, the psoas is. The
00:11:1300:11:15
way I'm going to check that as I
00:11:1500:11:16
mentioned in the previous videos, I'm
00:11:1600:11:18
going to go ahead and have Sonja pull
00:11:1800:11:22
her or lift her knee into my armpit or
00:11:2200:11:25
elbow and I should feel that psoas
00:11:2500:11:27
contract pretty good.
00:11:2700:11:30
Alright, good right there. Once
00:11:3000:11:35
I found that, I can then go a little
00:11:3500:11:38
proximal to distal here to find
00:11:3800:11:42
the most tender point. Once I've found it
00:11:4200:11:43
I'm going to make sure she's totally
00:11:4300:11:46
relaxed, she's just trying to breathe
00:11:4600:11:48
normally maybe a little shallower than
00:11:4800:11:50
normal because big deep breaths aren't
00:11:5000:11:52
going to feel real great but we're just
00:11:5200:11:55
going to wait for that release to happen.
00:11:5500:12:00
Do remember, the psoas is very close to a
00:12:0000:12:02
lot of sensitive tissues. If you
00:12:0200:12:05
feel a pulse, get off it. There's no
00:12:0500:12:07
need to compress something with a pulse,
00:12:0700:12:10
that's an artery. If Sonja started
00:12:1000:12:12
complaining about tingling through her
00:12:1200:12:16
leg, her thigh, the bottom of her foot,
00:12:1600:12:20
we need to move, we need to
00:12:2000:12:22
get off that nerve. This is very
00:12:2200:12:26
close to the femoral nerve. We also need
00:12:2600:12:28
to consider that we're pretty close to
00:12:2800:12:30
some internal organs so if we have any
00:12:3000:12:34
other weird sensations. For example, all
00:12:3400:12:36
of a sudden needing to use the restroom,
00:12:3600:12:39
again we need to probably reset and
00:12:3900:12:43
move. Once we feel a release happen
00:12:4300:12:46
though, we should be good and then we'd
00:12:4600:12:49
retest. I was just using
00:12:4900:12:53
one hand here. Compared to Sonja, I'm
00:12:5300:12:56
a pretty large guy, you could go finger
00:12:5600:12:58
tip over finger, just be careful not to
00:12:5800:13:02
double the breadth of your contact
00:13:0200:13:03
surface because then you're just
00:13:0300:13:05
stretching out all of that abdominal
00:13:0500:13:08
musculature, all of the skin over her psoas
00:13:0800:13:10
that much more and it's going to be
00:13:1000:13:12
that much more uncomfortable. I would
00:13:1200:13:15
start with one hand and then place your
00:13:1500:13:16
fingers over the others to add a little
00:13:1600:13:19
bit of pressure. For the iliacus, the
00:13:1900:13:22
iliacus is really easy to find, not very
00:13:2200:13:25
easy to release, unfortunately. The
00:13:2500:13:28
iliacus is going to be against the face
00:13:2800:13:30
of our ilium, so all we need to do
00:13:3000:13:33
is come right over the ASIS and then
00:13:3300:13:36
curve around. I'm going to have Sonja
00:13:3600:13:39
take a nice deep breath for me. As she
00:13:3900:13:41
breathes out, I'm going to go ahead and
00:13:4100:13:44
sink in. The big problem with the iliacus
00:13:4400:13:47
is because of the tension in her skin
00:13:4700:13:49
and her transverse abdominis and the
00:13:4900:13:52
abdominal fascia and her external and
00:13:5200:13:54
internal obliques and all that stuff
00:13:5400:13:56
that we're having to palpate through, I
00:13:5600:13:58
just can't get to very much of her
00:13:5800:14:01
iliacus. It's not like I'm going to get
00:14:0100:14:03
down to the posterior wall. I'm probably
00:14:0300:14:05
just going to mostly affect
00:14:0500:14:11
the fibers closest to her ASIS. How's that
00:14:1100:14:16
feel? Feels good. As we mentioned in
00:14:1600:14:18
previous videos Sonja is kind of a
00:14:1800:14:22
masochist, she kind of likes pain.
00:14:2200:14:23
Since these techniques are so
00:14:2300:14:26
uncomfortable, they are a little
00:14:2600:14:27
different than some of the other
00:14:2700:14:28
techniques as we're having to push
00:14:2800:14:31
through viscera and we're having to push
00:14:3100:14:34
through that sensitive abdominal area
00:14:3400:14:35
and there's tends to be a little bit
00:14:3500:14:37
more skin stretch with these techniques.
00:14:3700:14:39
Make sure you're doing your reassessment,
00:14:3900:14:40
I mean you should be always doing
00:14:4000:14:42
reassessment between interventions but
00:14:4200:14:46
especially in this case. If you did not
00:14:4600:14:48
get a result from releasing the psoas or
00:14:4800:14:50
releasing the iliacus manually, for
00:14:5000:14:53
example, an increase in hip extension, a
00:14:5300:14:56
decrease in excessive lumbar lordosis
00:14:5600:14:58
during an overhead squat assessment,
00:14:5800:15:01
don't do the technique again. It's that
00:15:0100:15:04
simple. If it's effective, I'll take a
00:15:0400:15:07
little uncomfortable for effective
00:15:0700:15:10
outcomes. What I won't take is
00:15:1000:15:12
ineffective and uncomfortable.
00:15:1200:15:14
There you have it. Static manual release
00:15:1400:15:16
of the psoas and iliacus. I think the
00:15:1600:15:18
most important thing to remember with
00:15:1800:15:20
this particular technique is you are in
00:15:2000:15:23
close proximity to some very sensitive
00:15:2300:15:26
tissues when you do this technique. That
00:15:2600:15:28
means several things. Number one, you must
00:15:2800:15:32
assess before you do manual techniques.
00:15:3200:15:36
You need to be certain that the
00:15:3600:15:40
technique itself is worth whatever risk
00:15:4000:15:43
it imposes. You also need to be aware of
00:15:4300:15:46
those structures, things like the femoral
00:15:4600:15:49
nerve, the abdominal aorta and common
00:15:4900:15:51
iliac artery, the viscera, even the
00:15:5100:15:53
small intestines that are in there. They
00:15:5300:15:59
all have the potential of being insulted,
00:15:5900:16:01
we'll say, by pressure and moving around.
00:16:0100:16:04
If you feel something pulse,
00:16:0400:16:07
get off it. If you start causing tingling
00:16:0700:16:09
down somebody's thigh, that's not a good
00:16:0900:16:12
thing. Move. Make sure you're testing your
00:16:1200:16:15
position with that little hip flexion
00:16:1500:16:17
trick I showed you so that you know you
00:16:1700:16:20
are on the psoas itself and you don't
00:16:2000:16:22
spend a lot of time rummaging around
00:16:2200:16:25
potentially releasing something like the
00:16:2500:16:28
small intestine. And of course,
00:16:2800:16:31
last, make sure you practice this on some
00:16:3100:16:35
colleagues before you move in to doing
00:16:3500:16:37
this with a patient. and if at all possible,
00:16:3800:16:41
grab somebody who has experience with
00:16:4100:16:44
this particular technique so that you
00:16:4400:16:46
can do it on them and a manual
00:16:4600:16:49
therapists can give you feedback. It's
00:16:4900:16:52
the best education you can get for all
00:16:5200:16:54
of the manual techniques which we show. I
00:16:5400:16:57
hope you get great outcomes with
00:16:5700:16:59
this technique, I hope it does fill a big
00:16:5900:17:02
gap of psoas an iliacus release that
00:17:0200:17:05
maybe you couldn't do before but knew and
00:17:0500:17:07
some patients needed to be done. I look
00:17:0700:17:09
forward to seeing your comments. I'll