hello massage nerds today i'm gonna bring you how to treat the psoas muscle and the
iliacus which combine make up the iliopsoas which is this muscle here that it's a main
hip flexor it flexes your hips and it's also a back stabilizer along with a quadratus lumborum
so if you tilted an anterior tilt that means the iliacus here these fibers are pulling down so
this is really tight if you have a posterior tilt then that means that the fibers of the psoas major
are pulling you really tight so let's start first with the thomas test and i'm just going
to show you something very simple that you can do on your table you know so that you can find
out if it is the psoas i'm going to show you three major trigger points and some anatomy
so while your clients laying supine straight you know flat you ask your client to flex this knee
all the way up grab your grab your leg all the way up pull it as tight as they can and see how
there's quite a bit of space here that means her sauce is you know pulling so it's tight
it's it's quite a bit off the table if it's turning if the the leg is laterally rotated
that means that the iliotibial band is really hypertonic and tight and if it's an interior tilt
then that means that the adductors are pulling and these are hypertonic so this is where you
measure you could see that there's quite a gap here also if there's a gap on her back
which on her it's not if there's a lordic curvature if i could fit if you can fit your arm
underneath if there's a gap that means her psoas is really hypertonic with her which is not on
her it's completely flat some clients it really curves and you can really stick your arm in there
the only place where i see something tight on her is that this leg really came off the table
so that's the thomas test and if you want to learn more about it you can just you know
google that so that's the thomas test so the psoas originates from t12 l12345
on the bodies of the transverse processes on the anterior this muscle goes diagonally so
it's not it doesn't originate here on the anterior part it originates on the
on the back on the posterior right here the lumbar area but it crosses diagonally and it inserts
at the lesser trochanter of the femur and so does the iliacus the iliacus originates on the anterior
part of the ilium bone so i mean i'm sorry the on inside inside so we drew right here the little uh
the little edges of it but it's really on the inside of the ilium so it joins so this is the
psoas major and then it joins with the iliacus is really pretty big so it's on the you know in
the back of this bone and then it joins and they both insert on the lesser trochanter of the femur
so this has three major um trigger points that you're gonna treat and this is the way you're
gonna treat it you're gonna make sure that the client's legs are flat on the that their feet
are flat on the table so bend your knees you want to relax this muscle bend your knees put
your feet flat on the table there you go we want to make sure that that muscle is relaxed you're
going to go to the level of her belly button so you're going to go two inches out at the edge
and then two inches low right here so until you get to the belly of the psoas major now there's
of course you got to go through you know the small intestine and large intestine there so what you're
going to do to treat the belly of it you're going to ask your client to take a deep breath
and on the exhale you're going to do circular motion and go down
and okay do another deep breath again
and on the exhale you go circular motion and go down and you're using the paths of your fingers
not your finger not the tips where you get the finger but see you're treating so you go
two inches out laterally and then two inches about two inches low so you get you're right
on the belly of the psoas major this trigger point right here and if it and i can feel it right there
on her let me see need to keep their knees bent and after she's taking a couple of deep breaths
and you want to make sure that they breathe with her belly not a diaphragm breathe like
take a deep breath with your belly bring your belly up and she's breathing with her diaphragm
breathe with your belly again extend your belly like this
there you go there you go and then on the exhale you go clockwise and i'm right on her so as major
if this is a trigger point it'll trigger they'll feel it in the low back and the lumbar area
so this triggers to the lumbar area and i'm gonna hold this right here up to about 15 to 20 seconds
keeping it at a level of maybe a five or a six what what number is that for you right there
like a six okay so i'm gonna count you know up to about 15 20 seconds which i've already done
since i've been showing you and then that should start releasing she should start feeling that
number going down so now you release gently you don't just want to pop out you release gently
now i'm going to go to her asis which is the anterior superior iliac spine the iliacus is
right underneath there so you're going to want to dig in there and try to find it some people
might be ticklish so be careful you know watch their eyes you know make eye contact
so you can be you know sensitive if if it is too much for them so i'm going right underneath here
and trying to dig my fingers in there you know and trying to feel here's another
trigger point right underneath the asis on the you know on the anterior part of the bone but on the
inside that i can dig in there and she's not going to let me dig in there because it's really hurting
so this right here triggers into the lower part of the abdomen so if there's a trigger point in there
it's good she's going to feel it on the interior part of her abdomen on the lower part and going
down the leg sometimes it goes down the leg right here and they might think it's the rectus femoris
or you know the quads but it's really the psoas the iliacus because now they've you know they've
joined here the iliopsoas have joined right around here so you wanna okay i found okay
something that you have to be real careful if you are on the right side of the body
you have to look out underneath your fingertips that you're not
on the ileocecal valve on the appendix the femoral artery remember if
if you feel a pulse stay off of it because that's that would be the femoral artery or
the inguinal ligament so in order for you to find out if you are on the correct if you're on the so
iliopsoas again you ask them to lift you right underneath here and i'm gonna go in real slowly
and i should feel that muscle okay bend lift up your leg lift your torso okay
no i'm not on it okay right there lift your leg again lift your leg up
right there i felt it right underneath my fingertips i can feel that muscle you want
to make sure that you are on the muscle and not and not on any of those you know other
you know like the the artery or the nerve or the ileocecal valve or somebody has a flared
up appendix they're going to feel pain and the way you distinguish that is that you make sure
that she lifts her leg up and then puts it back down and you can feel that muscle because it
lifts your leg up this this muscle brings you into hip flexion so this is the the the motion of the
psoas major and the iliacus and together they form the iliopsoas so it's two muscles combined in one
okay so once you're right here and you're sure that you're on the iliopsoas you know right by the
ilium you might want to do some uh string counter strain so what i'm gonna do and she's not gonna do
so much of the movement it's going to be passive movement you know i'm going to lift up her leg
myself so it can relax even more and you might you know my fingers underneath are just moving
you know and holding i'm holding this up a little bit you can also rotate it in you know medially
or rotate it out you know laterally so this also helps loosen up that tendon attachment and the
iliopsoas and this is really good like when you're holding that trigger point you can hold it right
here for about 15 to 20 seconds while you're holding that trigger point and then you let
the leg down slowly you want to be able to engage some of those same movements so that it'll start
releasing now the third trigger point that you're gonna treat is okay you may put your legs down
we are gonna go down to the insertion so they come comes here and it inserts at the lesser trochanter
the tendon the tendon of the iliacus and the sauce major combines and it comes into the
lesser trochanter of the femur and you can feel it you know and don't use too much pressure
because this is a very sensitive area you might feel the femoral artery here so make sure again
that you're on the tendon and one of the ways that you can make sure is by asking her to
bend her knee towards her okay right there i felt that right away underneath my fingertips again you
ask your client to to breathe two or three times you ask her what level like what level of pain is
it right there no pain so she doesn't have pain in the insertion however she had pain on the belly of
the muscle more than she did here and right here on the uh you know this is the other so this is
the first trigger point second trigger point third trigger point she doesn't have any pain here which
is a good sign it's a good sign that it's not the insertion however if it did hurt again you would
only hold it for about 15 seconds half a beat breathe through it and don't go above a five
or a six so this is the strongest hip flexor and the strongest hip okay this is the strongest hip
flexor and the strongest hip extensor is the glutes so you always want to check the glutes
because a lot of times the glutes are hypertonic and you know and are pulling you into a posterior
you know tilt and this one after you've treated you want to make sure that they're balanced you
know muscles get out of line because they're not balanced so you want to make sure and treat the
also the the gluteus maximus oh i'm going to show you sideline because actually that's one of my
favorites so let's turn her on her side that's another way to reach the psoas major and the
iliacus okay so when you turn your client sideways you always want to support the top leg the bottom
leg is straight and support the cervicals make sure her back is straight but right here it's a
excellent way to reach the psoas and the iliacus because the abdominals kind of fall you know
gravity pulls them towards the table so it's they're easier to access again you find where
their belly button is two inches out two inches down you're going to get to the belly of it so you
want to do circular motions and ask your client to take a deep breath and then on the exhale
you push down a little bit until and you can do this a couple of times okay one more deep breath
and then on the exhale i go down just a little bit more see if i can feel it is it as tender
as it was is it still a six like it was when you were supine no it went down so now it's
a five so this is good and like i said you just you know let her breathe through it you hold it
you know static pressure until it starts releasing so this is a great way to get again
to the uh to the psoas major now you release slowly and remember you want to use the pads not
the fingertip not the fingertips now to get to the iliacus this is an excellent way because here's
the asis the the most anterior superior ilic spine of the illeg now i can dig in oh i'm sorry
is that cold be real gentle but i'm going i'm cupping i'm cupping really getting to
the iliacus right there oh and i can feel i'm on it is that is that hurt it tickles no no
it's tense and yeah i can i can really feel this is
right there i can feel it and again this one moves it the you know the ileocecal valve and
you know the appendix out of the way because it's being pulled by gravity towards the table
so this is probably an easier access for you guys not to if you're not sure if you're on
the ileocecal valve or the appendix this might be better you're finding the the bony part the asis
and you're going underneath and you always want to go in on the exhale okay this is an excellent way
and all i'm doing is back and forth you know superior inferior medial and lateral movements
just really trying to get to the you know in the back of the ilium here
and you can also do some some movements
yeah this is intense work guys you know people that have low back pain
a lot of times it's not the quadratus lumborum it is the psoas and remember the psoas
crosses diagonally from the you know from the lumbars it crosses diagonally to insert
on the you know lesser trochanter or the femur so it crosses diagonally and it it's difficult
to palpate it's a real difficult muscle to get to so be careful be gentle another thing that i want
you to teach your clients is that when they get up especially if they're on the supine position
they should never get straight back up because that will strain that muscle you want to show
them to roll over and get up from bed on the you know from the sideline or from your table
sideline position the tight iliacus is very common with runners with dancers with gymnasts
with uh women you know pregnant women that carry you know that weight of the baby it puts pressure
on the inguinal ligament so you want to treat this muscle for people especially you know that run
because in that motion when they're running and lifting their leg it'll you know get
hypertonic so this is a great way to treat those three trigger points sideline and uh supine
and i hope that this will help you and until the next time create a great day
you