I want to share a technique that is as useful as it is uncomfortable. The psoas has spinal attachments, and is more than just a hip flexor. Some studies think it functions as a stabilizer. Since it attaches to the spine, the only way to release it manually is to go DEEP.
This technique will help:
- Female runners with SI problems (lack of hip extension causing SI and lumbar
hypermoiblity, plus an inhibition of hip abductor/extensors)
- Older patients with stenosis (lack of hip extension causes lumbar hypertextension,
further closing the stenosis)
- hip capsular patterns - will improve hip ER
- posteriorly rotated ilium
- pt's with diffuse anteriolateral thigh complaints from compression of femoral nerve
- pt's with spondylolisthesis, may help in conjunction with ST work to the paraspinals
and a stabilization program
The pt is supine with knees and hips flexed. Use an even finger grip, both 3rd and 4th fingertips with arms abducted so that your fingertips have even contact. Start about 2-3" laterally to the umbilicus and slowly move anterior to posterior until you can't move any further. The abdominal contents will move out of the way. If you move too quickly, you will activate the rectus abdominus and the contraction will push you out. How do you know you're on it? 1) it's not pulsing, if it is, go more lateral as you're on the descending aorta! 2) Ask the pt to slightly flex their hip; as soon as they do, you should feel it contract under your fingertips. Start with oscillations, and you can the progress to functional release movements starting with heelslide (you push proximally as pt slides heel distally), ipsilateral UE elevation, combination UE elevation and heelslide, then anterior pelvic tilts. The last is the most uncomfortable, and maybe even the first time you can get a pt to posterioly pelvic tilt correctly, as they want to move away from your hands! Perform for 5-7 minutes or until you feel a change. Reassess function, ROM, special test, or however you came to the conclusion the pt had a restricted psoas to begin with.
Here is a link for the HEP for psoas stretching.
This post is still one of the top posts as of 2013, almost two years after being written. Here is the updated psoas release I now instruct, it's much faster and more comfortable!