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