How Massage Therapists Can Remove Discomfort From Psoas Treatments

It can be painful and uncomfortable.

It is one of the more sensitive areas a Massage Therapist can treat.

Getting in and working on the psoas is a skill in itself. It takes practice and some clear communication with your patient.

Over the years I have had some great success with it and even have some people who request specifically to have it treated.

There is also a lot of debate over whether it should be treated manually or not. But if you take care with it, the treatment and learn some different modifications the benefit can outweigh the discomfort.

This post has some great tips on how you can treat this sensitive area and make it more comfortable for your patients.

How Massage Therapists Can Help By Treating Psoas

I want to share a technique that is as useful as it is uncomfortable, this is the way I used to do it.

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 hypermobility, plus an inhibition of hip abductor/extensors)
Older patients with stenosis (lack of hip extension causes lumbar hyperextension, further closing the stenosis)
Hip capsular patterns – will improve hip external rotation
Posteriorly rotated ilium
Pt’s with diffuse anteriolateral thigh complaints from compression of femoral nerve
Pt’s with spondylolisthesis, may help in conjunction with soft tissue work to the paraspinals
And a stabilization program

Have your patient lay supine with knees and hips flexed. Use an even finger grip, both 3rd and 4th fingertips with your elbows flared out so that your fingertips have even contact. Start about 2-3″ laterally to the umbilicus and slowly move from superficial to deep 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?

Here are two signs to make sure:

It’s not pulsing, if it is, go more lateral as you’re on the descending aorta!
Ask the patient to slightly flex their hip; as soon as they do, you should feel it contract under your fingertips

Start with oscillations, and you can progress to functional release movements starting with heelslide (you push proximally as patient slides heel distally), ipsilateral upper extremity elevation, combination upper extremity elevation and heelslide, then anterior pelvic tilts.

The last is the most uncomfortable, and maybe even the first time you can get a patient to posteriorly 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 patient had a restricted psoas to begin with.

Techniques For Massage Therapists To Work Psoas Pain Free

Let’s be clear, you are no where near the psoas when doing a release, but this is the new way I do it.

I am just targeting the area around and above, and am very general to release lower quarter tone anteriorly, that’s about it.

Why you should use this

it doesn’t hurt
it rapidly improves hip and lumbar motion
- if a patient needs sidegliding in standing for an ipsilateral lower quadrant issue, but is unable to move without discomfort

Patient:

supine, in hooklying
at least the involved lower extremity needs to be bent at the hip and knee

MT:

standing on the involved side
use either the pads of digits 3-4 of both hands or even easier, an EDGE Mobility Ball (any ball will do)
assess resistance to superficial to deep pressure lateral to the umbilicus on one side versus the other
the side with increased resistance is the side you should treat

Technique:

lightly apply superficial to deep pressure, it SHOULD NOT cause any pain
at the point of resistance that is highest, have the patient complete 3-5 diaphragmatic breaths
make sure they exhale fully
the exhalation will help reduce tone autonomically

re-test the limited hip and/or lumbar motion

As it is with so many other techniques in Massage Therapy communication and consent is key. Make sure when attempting this treatment that if you feel the pulse, you move off of it quickly as you do not want to compress the descending aorta. Whether you’re helping someone with stenosis, spondylolisthesis or just SI issues treating the psoas can give you and your patients greater success in treatment. Use both videos as a guide to help you with the treatment and see which one works best for your patients.

Erson Religioso

Dr. Erson Religioso III, DPT, MS, MTC, CertMDT, CFC, CSCS, FMS, FMT, FAAOMPT, graduated from D’Youville College in 1998 with a dual Bachelor’s of Science and Master’s of Science in Physical Therapy. His interests in Orthopaedics and Manual Therapy lead him to pursue a Doctor of Physical Therapy degree from the University of St. Augustine. Studying under Stanley Paris, Ph.D, PT, internationally known for his manual skills and knowledge of the spine as well as his distinguished faculty, Dr. Religioso earned his DPT and Manual Therapy Certification in 2000. He later became credentialed in Mechanical Diagnosis and Treatment of the Spine in 2000. Erson also operates several websites dedicated to Manual Therapy, www.themanualtherapist.com, www.modernmanualtherapy.com as well as www.edgemobilitysystem.com