Aug 28, 2011

Technique Highlight: The Psoas Release



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.

edit:
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!


6 comments:

Anonymous said...

Ouch.

Braedan@PhysioSurrey said...

Erson,
That's an interesting psoas technique. It seems to be longer duration, lessor ROM version of ART. With a few unique characteristics as well. I have done techniques like this for other body parts, but not for psoas. When/why would you use this technique instead of MFR or ART?

Dr. Erson Religioso III, DPT, MS, FAAOMPT said...

If you haven't for psoas, I suggest you try. The advantages of the movement based release is that it releases faster, the patient can control the stretch, thus making them feel "in control." I don't use MFR, if you're talking "Barnes" MFR, as I don't really believe in it, plus 5 grams of pressure doesn't get deep enough for this muscle. Haven't taken ART, as it's too expensive for what it is. I learned most of the movement/functional releases I teach from the Institute of Physical Art.

Eric Matuszewski,DPT said...

Great expansion on the IPA technique. I recognized the parallel hands/ crossed index fingers right away.
You make very good, focused videos. Definitely a fantastic resource.
I'm learning about FAI/labral tears now. Have you heard that a dysfunctional psoas will allow excessive anterior glide of the femoral head contributing to this?
If this was the case in a pt would you still want to to STM to Psoas? Would this facilitate the Psoas to pull the head back in the acetabulum or would the release cause it to allow it to move fwd?
Thanks

Dr. Erson Religioso III, DPT said...

This is actually a vid I made prior to integrating diaphhragmatic breathing into my practice. Three to four really good diaphragmatic breaths tend to release this and the QL much better than the movements above. In terms of the facilitated psoas, I'm not sure that it would move the femur either way but it would cause dysfunctional movement. That would need to be released and then I would reassess ASLR AROM and strength to see if it needs some corrective ex in the new range.

Jelle Schaegen Bodywork said...

Yes, you do have to go deep! If you would like to experience a state of the art myofascial release session, maybe for any musculoskeletal problem you suffer from, well visit me. It's worth it, and why not combine it with a great stay on the Costa del Sol if possible?

Jelle Schaegen Bodywork. Advanced myofascial release technique. Dutch, 30 years of experience. Skillful and natural treatment of (chronic) complaints of the neck, back, pelvis and extremities. Efficient, fast and safe. Just beats every other method! No exaggeration intended. Marbella, Fuengirola, Mijas Costa, 652 291 224 jschaegen@bodywork.es

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