SERIOUS WARNING – If you do any releases to your Psoas or Abs, you MUST READ THIS

2015/01/img_8345.jpgToday, I want to tell you a story of something that happened to a good friend of mine this weekend…but first, some context…

Does this sound familiar?

You roll up to the gym, you grab a roller or ball and start rolling out. After your gym/CrossFit/whatever session, you might be back onto the roller or ball again with some stretches as well.

With the massive increase in “mobility” exercises, drills, and not to mention “things” you can buy to help release muscles, more people than ever are interested in keeping their body in good shape and releasing muscles – This is a good thing.

I have been around the world and there is a disturbing trend – coaches, those who aren’t qualified health professionals, are helping people release by stepping on them (presumably to avoid any accusation of “massaging”) or just helping them “release” their muscles including Psoas.

This is a DANGEROUS thing!

It is up to you whether you want to do this as a coach – is it covered by your insurance? If you are a client, again, it is up to you – what happens if things go wrong? Ideally, you should get a health professional to help you release your muscles, especially in the abdomen… The other joints – I understand. money is an issue, it seems all the same (it isn’t), you can’t be bothered, etc. I am truly ok with people trying to take care of themselves.

What I want you to do is just understand the risks…and then I will treat you like an adult that can make their own decisions.

IMG_8346Karin’s Story

Karin (not her real name) is an old friend of mine. She has had some issues in the past that I have helped with. Karin trains at the local globo gym and has seen other health professionals as well. I personally haven’t treated or seen Karin for ages…literally 8 months ago.

Karin told me she saw someone last week twice and during that time there were lots of “adjustments” and her “Psoas” was released fairly aggressively (Karin’s description). This therapist has a good reputation and is well trained and it could have easily been me, a physio, a chiro, a massage therapist or osteopath (except I don’t go aggressively for Psoas…more on that later). The point is that Karin became unwell after seeing a well qualified therapist…she didn’t just ask a friend to help her…she did the right thing and the therapist did as well.

Anyway, Karin felt unwell after the session and got worse, such that she threw up twice within half an hour. She tried to put up with it (she is a tough girl) but couldn’t get any sleep that night and every time she moved, she had severe pain. She still had the vomiting and now diarrhea. When she contacted me, I told her to go straight to emergency as I thought she had a ruptured appendix.

Basically, she did.

When they operated on her, she they took it out and found it had a small rupture in it.

Now, it could be that it was ready to go and a sneeze could have set it off but she had this pain since straight after the treatment and it only got worse. That is part of the risk of working in the abdomen – whether it is Psoas or Iliacus or whatever deep structure you are going for. There is a lot going on in there.

The following is to help outline some of the reasons – anatomical and philosophical – why I don’t get stuck in like I used to (and was taught to). This is not about someone rupturing an appendix – I think that it might have contributed to the situation but probably wasn’t the only reason.

Why I Don’t Aggressively Release the Psoas

1. RARELY is the Psoas the primary problem or the primary contributing factor. I often find that the psoas is reacting to something and I would rather treat that “something” and then on the retest, the psoas is happier and MUCH LESS pain for the patient

IMG_83522. You can’t effectively get to it in most people without causing lots of pain. When I go looking for it, I start by trying to find the anterior spine (you can feel your spine through your tummy!). A guy my size, forget it! I will hit you before you can get deep enough to feel my spine. Most people have a Psoas that is roughly in line with the front of their spine, maybe a little bit of it anteriorly…but to get any sort of pressure on the muscle, you are going to have to get to at least below the line of the anterior body of the vertebra…not happening in a lot of people…maybe a skinny girl. I have done it before but the pain is significant and causes the patient to tense up so the effect is almost worthless.

 

 

 

 

IMG_82683. I suspect a lot of people need tender spots in their rectus abdominis and obliques worked on. If you are a high level athlete, these muscles can be quite dense – have a look at pork belly. We have a similar abdominal wall. You have to get through all those abdominal muscles and then the internal organs before you get to psoas. Like point 2 above, it is not easy to get to.

 

 

 

 

 

IMG_83504. The Sympathetic Trunk lies right next to the Psoas. If you manage to get to the Psoas, you might irritate these important nerves. These nerves control your internal organs from your heart, lungs, skin, bowels, sexual reproduction organs, etc. Irritating them can make you feel ill, nauseous or sick.

 

 

 

 

 

IMG_83515. The Genitofemoral and Femoral nerves along with the gray rami communicates (small spinal nerves) are also around and through the Psoas muscle…this can cause shooting pains and altered sensations like pins and needles.

 

 

 

 

 

 

IMG_83496. The Abdominal Aorta and Inferior Vena Cava are major blood vessels that run along the spine. These are usually resilient but some people have an abdominal aneurysm. If you poke around looking for the psoas, you can kill someone by rupturing it. The Abdominal Aorta then branches into the Common Iliac Arteries. These arteries lie in front of and next to the Psoas muscles…if you feel a pulse, DON’T RELEASE IT!

 

 

 

 

 

IMG_83487. The intestines are all over the Psoas. They usually just get out of the way but sometimes they can get pinned down. To experienced hands, intenstines feel like hollow sausages and definitely feel different to the psoas muscle. But it is a subtle distinction. In Karin’s case, she probably had a low grade, “grumbling” appendix that got irritated and ruptured from the release. Have a look at the picture. You have to get through the muscles of the abdominal wall and then all of this viscera and then past the blood vessels before you get to the psoas.

 

 

 

 

 

OLYMPUS DIGITAL CAMERA8. Ovaries, uterus and kidneys are also in the area. You can rupture an ovarian cyst, irritate endometriosis scars, or bruise kidneys, the ureters or bladder. Look at the photo – you have to get through A LOT to get to Psoas.

 

 

So What Should You Do?

1. Use an experienced degree-trained health professional who has experience in knowing about the internal organs and muscles. To be honest, Osteopaths traditionally are taught “visceral manipulation”. Some physios and chiros (like myself) have done courses on how to “listen” and take care of viscera. These courses are often restricted to physios, chiros and osteos…that is not to say your massage therapist isn’t trained, it is just much more unlikely. Hopefully the above list gives you an idea of what I am thinking about when I examine that area. The unfortunate situation is that even experienced therapists doing the right thing might aggravate things. I don’t think Karin’s therapist was negligent but from what Karin has told me, the pain got worse after the treatment. Like I said earlier, it could have been ready to go and anything could have set it off.

IMG_83472. Use a broad-based object like a kettlebell handle, roller or ball to release your abdominals – forget about trying to get the psoas. Honestly, you have to solve why they are getting jacked up, not just try to beat them into submission.

3. The pain should be tolerable, like a 2-3/10. There are usually better things to go hunt down than pounding your abdominal wall. If I do decide to proceed with a painful treatment, it is for a good reason and I explain it and demonstrate using test-retest why it was done. Even if it is for 30secs, I am wary of painful treatments.

4. Proceed with caution. Don’t just let anyone stick their fingers or foot or implement into your guts. If you feel sick, throw up or have diarrhea after treatment, get thee to the hospital ASAP!

Karin’s Story and Conclusion

Karin is recovering in hospital still as I write. She had to stay in a few days with IV antibiotics because the appendix ruptured and leaked into her abdomen. She will make a full recovery and eventually be able to train again but recovering after abdominal surgery means that her training is interrupted for at least 6 weeks. [update – she developed an abscess and now has to have a drain inserted and an extra 5 days in hospital]

We love doing things that “hurt so good”…damaging internal organs shouldn’t be one of them!

Please take care in the future of what you choose to release and why. There are many ways to “release” your psoas… It takes a comprehensive assessment to work out why it wants to lock up. Find someone who knows what they are doing…if you can’t find someone, you can always contact me.

You are an adult – take this information and make an informed decision. Discuss it with your coach and health care team. Make sure that if you are truly interested in taking care of your body, that whatever you do to it and whomever you let “release” your Psoas, knows what they are doing and have taken the above information into account. Even then, as with Karin’s story, treatment can still flare things up.

I would be interested to hear your thoughts on what I have presented above – have you honestly thought about these issues before? Will Karin’s story change your views on what you do to your Psoas?

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About Antony Lo
Antony Lo is an APA Musculoskeletal Physiotherapist based in Sydney. His website is www.MyPhysios.com.au. He specializes in the management, treatment and prevention of pain and dysfunction, particularly of the pelvis and ribcage. His sub-specialties include Crossfit and Exercise Performance Optimization, Ante-Natal and Post-Natal Care and difficult cases that have failed treatment elsewhere.

71 Responses to SERIOUS WARNING – If you do any releases to your Psoas or Abs, you MUST READ THIS

  1. MRPT says:

    Great post A! I hope it will be part of your book:)

    Marianne Ryan PT, OCS MRPT Physical Therapy http://www.mrptny.com Phone: 212-661-2933

    >

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  2. Charles McGrosky says:

    Hi Anthony
    Thanks for your informative and well researched article. I am a massage therapist with 24 years experience with training in Neuromuscular therapy. I would agree completely that the iliopsoas needs a great deal of care and attention while working the area, especially considering all the delicate nerve and venous tissue that is around it. However, I would like to add that I have found that working the Iliopsoas directly very valuable, especially with people who have chronic LBP. I often find trigger points in the muscles and once these are cleared the LBP generally will improve. Like any technique working the area takes practice and it took me years to feel comfortable with it. Now I’m able to go in quickly and gently and with lots of presence of mind, confidently. Thanks again. Charles McGrosky CMT (USA) ps Enjoyed your podcast on the physioedge.

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    • Joyce says:

      I agree with you Charles. I too am an RMT, and treating the psoas happens to be a specialty of mine. The article outlines basically why most massage therapists won’t touch the area. It’s too bad, becuz most people do need treatment. We have become a society in chronic flexion, and the root seems to be in the hip girdle.
      I hope this article doesn’t scare people away from receiving treatment, or make therapists reluctant to do the treatments.

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      • Antony Lo says:

        Hi joyce and charles.

        Sure, it does help some people but have you ever had a client feel worse after your massage? It isnt because they needed to get worse to get better. One very common reason is that you released the lrotective muscle spasm which was protecting them from going into hip extension or posterior pelvic tilt or lumbar flexion.

        Let’s look at it a different way.

        They come in and you decide that thomas test is positive. You want to “release” the psoas because it is “tight”. One of 3 things can happen:
        a. It gets better. Can you really add true length to a muscle in an hour? If the muscle is truly shortened and it’s length is a problem causing pain by limiting movement, i would suggest that massage won’t make the muscle longer and the reason why they felt better is because you affected the muscle activity via neurophysiological pathways…which means other methods can also work instead of direct pressure. They can also get better because your massage might have affected an organ or nerve or anything else I listed (or didn’t mention) because there is no truly direct way ti the psoas. At the best, you have to go through the muscles of the abdominal wall – what if you really affected their external oblique which stopped pulling on the ribs which stopped irritating the iliohypogastric nerve via the sinuvertebral nerves which run up to 4 levels above and below vertebral level, which can affect the rami communicans which can affect transversus abdominis which can affect spinal stability which can cause protective muscle spasm of the psoas? That’s just one possibility. I sincerely doubt you lengthened the muscle otherwise massage would fix people with contractures.

        b. It gets worse. I would suggest you may have damaged something (possible but not likely in healthy tissue) or you release protective muscle spasm which allowed the client to move into a position of aggravation.

        c. It stays the same. Despite your best efforts, the psoas wants to stay in that level of activation which means that whatever it is protecting is more important than the stretching, massaging and whatever you did during the session. If you see this, refer straight away to a physio for further assessment because belting away at the muscle won’t solve the problem.

        I am not saying that massage isnt effective. I am saying that it isnt always the answer and sometines when it does help, it isnt for the reasons why we think…and that goes for physio and chiro and osteo techniques too.

        What do you think – happy to discuss it more.

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        • Joyce says:

          Sounds like you really know your stuff Anthony!

          Most often I find there are trigger points in the psoas and iliacus, and when these points are released, the pain decreases (and often disappears), and the client is then able to stretch it. I have encountered tight psoas muscles where when applying some pressure to it will allow the muscle to relax…and it literally melts under my fingertips. Sometimes, it is a trigger point in the obliques, in which case, I address them. I’ve never really thought that treating the psoas would lengthen the muscle, per se, but more of a releasing it from an extreme contracted state. The lengthening happens with stretching…so I will often stretch that while they are on the table, and give them instructions on how to do it at home.
          So whether I am releasing the muscle from a contracted state or affecting neural activity, I don’t know. Most people want relief NOW, so I do what I need to do! I have psoas issues myself, and I only find relief with direct pressure on it. I tend to have lumbar pain when the psoas is in spasm, as do most of my clients. Stretching it is just about impossible, becuz it just hurts!

          In regards to how I treat the psoas and iliacus….some would call it aggressive, becuz I’m digging in there, but it’s done with great care. The approach is slow and communication with the client is imperative. I make sure I don’t push on the colon or intestines (they move out of the way if you go slow) and certainly avoid organs. I start at the bottom of the psoas and work my way up. I have the client positioned with their legs bent at the knee to take tension off the abdominal area. To ensure I’m on psoas, I have them slowly lift their leg a bit. Iliacus is easier to access with less chance of pushing on anything we shouldn’t be…..and I often find that just by getting the triggers on iliacus is enough to remove the pain.

          The only other ways I’ve had mine treated is with muscle energy and contract-relax. Neither worked for me, and I’ve tried the contract-relax with clients with no change.
          But if you look at the bigger picture, a tight iliopsoas often presents with tight glutes, hams or quads…and sometimes all the above. Addressing them all, as well as giving appropriate exercises to the client is necessary. I’ve instructed my clients to adjust their seats in their cars, or work to encourage better posture.

          I’m open to suggestion on other ways to ‘release’ the psoas!

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          • Antony Lo says:

            Trigger points? Tender spots, yes.

            Why would it want to be in an “extreme contracted state?” What would be the purpose?

            Is the Psoas truly short? Or just overactive?

            How would you release a muscle from a contracted state if it is not affecting neural activity?

            I have no doubt you are effective…I just want people to question why what they do works. Quite often, the reasons are not what we think.

            As for your Psoas, why do you think it resists so much to your self treatment and stretching? You say your back is sore when your Psoas is in “spasm” but what if your Psoas is in spasm because your back is sore? Are you treating the right thing?

            As for the bigger picture, I am all for that.

            “Releasing” Psoas is not would I would aim for. I aim to make change to people’s systems – I often think about how to enter their brains via the classical articular system, myofascial system, neural system, visceral system, psychosocial and strategies for technique and function. This model is the integrated systems model and can be found in Diane lee’s book the pelvic girdle.

            I suggest you find the primary contributing factors that are causing the issues you are observing 🙂

            Cheers

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        • Marshall says:

          You just explained my whole dilemma. Just entering school to know more than massage therapy. I want more in the toolbox, but how and where can I learn to be a truly effective bodyworker?

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          • Antony Lo says:

            It is not easy. There are many effective and brilliant therapists/bodyworkers out there who have fantastic practical skills but their theory is simply not consistent with what we know from science.

            Then you can have really smart people who know the science but don’t know how to make it happen to a patient in front of them.

            You need to find at least one of each type of person so you can learn the effective practical skills AND the science and marry the 2 together.

            Ultimately, as I always say, go by the results…you don’t hve to believe the BS story that people (including me) make up about something to explain what happened. Most of the time, we don’t really understand what has happened…we are guessing…but we got a result…that is all a patient really cares about.

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  3. Jordan Lee says:

    Great Post Antony! My preference is to find why its upset and correct that impairment rather than go for the “release” which is temporary, potentially dangerous as pointed out and has no real solid scientific evidence. Thanks for sharing.

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  4. Yes! Thank you for this blog post. It is rare I actually release the psoas, although I feel confident in the anatomy. I actually prefer to release the iliacus portion along the iliac crest. But, just like you said, a tight iliopsoas is a symptom of something else. I have been treating a triathlete who was seeing a PT who (she said) aggressively release her psoas for up to 3 hours! No relief. We found her glutes together and her iliopsoas is 90% better. It’s unfortunate that some professionals are still after “the hurt”. And….my mantra…know what you know and know what you don’t know. Thanks again for a great post!

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    • Antony Lo says:

      Thanks Lori. 3hrs huh? I have a 30secs rule – if it doesn’t help in 30secs, don’t bother…it is protective 🙂

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    • Anonymous says:

      Hi Lori,
      Did you figure out what the other thing was that was causing the right illiopsoas?

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      • Hi. I just saw this comment so sorry for the late reply. It was never an issue of her iliopsoas. Her intrinsic core (TA, int oblique) and glutes were so weak that the area was craving stabilization. So, the iliopsoas thought it would do that job. Once we worked on her ab stabilization and glutes, her iliopsoas chilled out.

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  5. Harrison Dale says:

    Great post Antony cheers for sharing,

    I assume most people will release a psoas for one of a few reasons:
    To increase ROM in hip extension, to decrease lumbar lordosis and anterior pelvic tilt or to increase hip internal rotation. If there’s any other reason I’d love people to share 🙂

    In any case, I find a very non-specific pressure into the first feeling of tone/ resistance with some abdominal breathing will fix all of the above with next to no pain or ruptured organs!

    I really like the technique show by erson religioso shown here: http://www.themanualtherapist.com/2011/08/technique-highlight-psoas-release.html?m=1

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    • Antony Lo says:

      Harry – thanks for that. I still want to know WHY you should decrease the amount of automaic activation in a muscle before you release it.

      RE3 is a nice guy but the hip extension wasn’t very specific and i will contend that he released / decreased activity of the obliques, not his psoas. Also, how does an overactive psoas result in decreased hip flexion?

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  6. Drew Hume says:

    Perfect! Well weighted article. The psoas is somewhat of a hot topic at the moment, being blamed for a lot of things that it’s not responsible for. I hope this information gets out to more people – also with the message that painful massage/release techniques are usually far less effective than pressure techniques that work within pain-free ranges (intensity can be there, as long as the patient can maintain complete relaxation and full breathing cycles).

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  7. I’d also like to add you can’t really release tissues in the way that most clinicians think you can, as in mechanically. We cannot break up adhesions, scar tissue, or fascia. We can change stretch perception and muscle tone. The lighter the better. My rule is that it shouldn’t hurt at all and if so a few diaphragmatic breaths should reduce the tone and thus any accompanying discomfort.

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    • Antony Lo says:

      Yep. Fair point mate. I am going to have to check the research on whether tissues change with manual therapy but i am a big believer that change is neurophysiological.

      We are stuck aren’t we? We know it isn’t a “Psoas Release” but we need to use those terms because people search for them :/

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  8. Nechama Karman says:

    I agree that any release in the abdomen should be performed by a skilled practitioner. The top picture is of me performing the technique (likely lifted from the website of a place I used to work), and I assure you, I was highly trained and developed excellent palpating skills before performing these techniques.

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  9. I enjoyed your blog here on psoas. One thing I like to use myself is the Yamuna balls. They are soft, especially when not inflated all the way. But as with all bodywork, all therapists should layer in gently. Even with Structural Integration, I start superficially and then go deeper. It’s also good to remember that the whole body needs to be treated because the area of pain is not necessarily the main restriction. Thanks for you sharing Anthony. Sharon Hartnett http://www.massageincolumbusohio.com

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  10. Jules Lag, LMT says:

    Thank you for this article. I agree. Most bodyworkers do not have enough real visceral anatomical knowledge to do deep abdominal work. There are too many important structures that could easily get damaged without this knowledge.

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  11. JAGADISH KUMAR SAMAL says:

    very much essential …
    thanks sir….
    keep posting….

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  12. excellent blog my friend Thank you .. I reposted it on my Facebook page… i also own a massage school in the states 24 years now and agree with you.. so thank you… By the way where did you get that one app

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  13. tamarafoxenlmt says:

    This work should be out-of-scope for most massage therapists. The word,”release” of any muscle notes a controversial meaning. I will not have this work performed on me; nor will I “practice to gain experience” on another. Thanks for the article and great photos! Possibly consider adding symptoms indicated to direct one to perform psoas work, along with peer-reviewed data indicating positive outcomes of massaging the psoas.

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  14. HeelingSole says:

    I’m wondering if it’s known which specific barefoot massage technique was involved, or if it was just a random use of a foot by an untrained person: you mentioned that the “coach” stepped on her psoas. This is a very important detail, as the amount of pressure possible from a persons single foot and partial body weight can be deeper than what hands/arms could dish out.

    I’m a nationally certified instructor for an advanced myofascial deep tissue sports massage that uses the feet to massage. Now, our technique doesn’t work in the abdomen for exactly all the reasons you stated- its much more appropriate to use hands from a trained professional in this area. We train and certify our graduates very carefully to work with utmost safety.

    However, there are other styles of barefoot bodywork out there: all broad based, deep tissue, sustained pressure from the foot. I wonder if this coach was even trained to use such a potentially dangerous tool from any recognizable source. A barefoot massage therapists feet can be used for good or evil, based on their intent, and training.

    I hope all barefoot bodyworkers out there take this story very seriously and obtain proper training and certification, and stick to the protocols within that technique.

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    • Antony Lo says:

      Hi.

      I have seen people use feet to massage different muscles.

      This woman had a health professional use fingers into the abdomen, not her feet. Sorry if there was any confusion.

      Liked by 1 person

      • HeelingSole says:

        Ok….. it was this line “helping people release by stepping on them (presumably to avoid any accusation of “massaging”)” and this line “Don’t just let anyone stick their fingers or foot or implement into your guts” that led me to think that some form of barefoot massage was used in this case. I’m glad it wasn’t, but I’m sorry this even happened to anyone in the 1st place.

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  15. sue says:

    I totally agree with your views in this article. I am level 5 trained sports and remedial soft tissue therapist and was taught to work on psoas but don’t because of the reasons you outline. The abdominal aorta is particularly vulnerable in my opinion. I also find that most people can strengthen or stretch this muscle without such an invasive technique. Thank you for pointing out the dangers here.

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  16. Laura says:

    I find the timing of this article to be impeccable. I’ve been suffering with abdominal pain for over a year. I’ve had weekly massages, chiro visits, foam rolled, stretched twice a day, and nothing seemed to help. Last week I got so desperate that I ordered a DVD set I found online for releasing your psoas. I will approach this with care now. Maybe I will even return them. I need to find the cause of my discomfort and tightness. Who should I go to? My primary care doctor?

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    • Antony Lo says:

      Yes Laura. Please see your doctor to clear all the possible nedical reasons first. If they are ok, find someone who can sort through a holistic view of your body to find the cause of your pain, bot just the synptoms. I hope abd pray you get some answers.

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  17. Sarah says:

    Hi, I’m a female crossfitter and had a laparoscopic appendectomy almost 8 weeks ago. Recovering from the surgery and sitting out of CF for 6 weeks was diffucult and lonely. I was cleared by my surgeon to go back to CF, and have been for 2 weeks now. I haven’t found any articles/blogs/advice etc on how to scale movements and weights to get back into WODs after abdominal surgery or what it feels like emotionally and physically . I’m guessing Karin and others may also experience similar feelings and questions…..

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    • Antony Lo says:

      It is certainly a fair point Sarah.

      I guess it is too dangerous for those of us that provide information because every person is a bit different.

      For instance, in general, a laparoscopic appendectomy should be fairly routine but scarring does occur.

      The best is obviously to go see someone who understands CrossFit, the operation you had and the effects of post surgical scarring.

      Scaling – if it were me, i would go slowly and test things out slowly. It will be heavy movements that require you to hold your breath or the extension part of a kip that will be a danger.

      Go slowly and gradually build up. Get confidence in the movements.

      I always tell crossfitters to go to the gym even post-surgically and attend your regular class times. The reason is that crossfit is not just exercise, it is a social part of your life.

      I had one patient who attended in the morning, did the warm up (scaled), did her rehab program i wrote for her and she finished in time for the cool down. For her, she would rather her arm drop off than stop training because she loves it and her “family”…so she kept going and was happy to have something useful to do while she recovered. Even sitting on the bike or walking laps of the gym is useful 🙂

      Cheers

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  18. Anonymous says:

    I’m UK trained osteopath and sports therapist and I do use active release techniques on Psoas as I do believe while not the primary cause of patients issues, they can be a maintaining factor as well as contributing cause of abdominal imbalance, which ultimately can lead to back and pelvic issues. One reason for this is the incorrect use of the Psoas in abdominal exercise work and the fact that we spend too long siting which I believe can cause reduction in flexibility of this muscle. I have found that in the case of over use or spasmodic tension that I can get a good level of release by addressing the muscle close to its insertion at the lesser trochanter. This is an intimate area so a full explanation of the technique to the patient is imperative as well a full communication during the process.

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    • Ben Jordan says:

      I agree with the above post. I am a massage therapist in the US trained in a school where I did learn all of the things you describe. I treat the muscles in the iliopsoas group fairly regularly in people who have low back pain, laterally rotated femurs, or lateral torso flexion to name just the most common instances. That being said the techniques I was taught do not entail large scale pain, are used usually near the hip crest or below that (but above the pelvic bone) where I can access the muscle with minimal interference from other muscles, and do involved a strong neurophysiological component in place of deeper pressure.

      I agree that aggressive treatment through the rectus abdominus is perhaps a poor way to go about treatment and you can access the muscle without needing to push through that.

      The pain relief you can get for clients who have any kind of lateral leg turn out (hockey or soccer players, people who lock their knees and laterally rotate femurs as a result, etc.) is quite remarkable and if lower spinal erectors and quadratus lumborum are contracted (anterior hip tilt) iliopsoas is almost always a player since it is forced to work in a lengthened position.

      So while I think a simpler approach is better I would hesitate to scare people away from treating this muscle group. In general the core abdominal muscles are one of the areas that get work the least often but often need it.

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  19. Pingback: Barefoot Massage and the Belly… | Ashiatsu DeepFeet Bar Therapy's Blog

  20. A good read, and useful cautions.

    One correction, though, the “anterior spine” (in point 2 of the article) shouldnt relate to the actual spine. I think the author has got confused. It relates to the Anterior Superior Iliac Spine, which is the bony nobble at the front of your ‘hips’, on the ilium bone. You defo shouldnt be trying to feel your actual spine through your tummy.

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    • Antony Lo says:

      Hi Matthew. The anterior spine can be felt and as I wrote in the article, care must be taken because of the abdominal aorta, inferior vena cava and associated nerves. I also mention that it is only easily felt in small, thin people.

      The ASIS was not was I referring to and I wasn’t confused. The point of the blogpost was that if you are going for Psoas anteriorly, then you have to get to at least the level of the anterior vertebral body before you contact Psoas directly.

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      • Anonymous says:

        I hadn’t realised that. Thanks and sorry that i misunderstood. I find it a lot easier to find psoas by going just medial of the ASIS and asking the client to slowly raise their leg a little. This avoids the need to “find the anterior spine”.

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  21. Catriona St. George, BCMT says:

    Iliopsoas can be effectively and comfortably released using Contract-Relax techniques followed by specific psoas stretching. Can be done prone or supine. No need to press blindly/painfully into anyone’s abdomen.
    C. St. George, BCMT
    Newport, Rhode Island

    Like

  22. jesspreale says:

    Fantastic post! I think well intending physios, massage therapists etc. press on structures without truly knowing what they are pressing on! Great points- couldn’t have said it better myself!

    ~Jessica Reale, PT, DPT, WCS
    http://www.jessicarealept.com

    Like

  23. eddieteran says:

    Reblogged this on Eddie Teran, CMT and commented:
    Thanks for writing this. I’ve been doing a fair amount of abdominal scar tissue work the last few months, always have to take it slow!

    Favorite line, “We love to do things that ‘hurt so good!’… damaging internal organs shouldn’t be one of them!”

    Like

  24. Pat says:

    This article is very misleading and directed towards fear-mongering. A single incident or saying, ‘this happens more often,’ is not empirical data or statistics. Your subjective opinion is biased due to a somewhat personal experience. This is the equivalent of race baiting, by using hysteria and mis-information. I am a LMT that specializes with athletes, specifically fighters. With this premised, I will explain my disagreement to your main points.

    Firstly, the deep tissues of the body often hold complex hypertension and are often neglected due to the more technical stretching and therapy they need to release them. It is a blanket statement to evoke that most issues arise from other sources of ailment, and generalizing at that. In many occupations the hip flexors suffer from chronic sitting patterns ranging from transportation to the office. As an athlete, and work on them, the hip flexors can make or break events if not fine tuned. The mobility of hip flexors and their subsequent ROM are key to full performance, in an office or in the ring.

    Secondly, the therapy and body work on hip flexors vastly vary in techniques, effectiveness, ease, and ‘safety.’ Modalities including deep tissue to advanced kinetic stretching have profound effects on the hip flexors. To avoid treatment because of an isolated incident is childish. PNF stretching tools that utilize inhibitors and nerves like contract-relax and post isometric relaxation are great and easy to use, and without serious hazards. PNF techniques are also great pre and post events. In relaxed settings; slow, cautious, and well executed deep tissue techniques can be used to release trigger and tender points as well as chronic hypertonic issues. I have not once ever experienced a problem performing hip flexor releases, including athletic to heavy clients. Show us the stats that explicitly illustrate that these techniques should not be used.

    Thirdly, the idea of aggressively working on a soft tissue ailment is inteslf ridiculous. What do yo mean, aggressively stabbing into the abdominal region or an aggressive plan? You are using fear mongering terminology to establish you hysteria. Here is a idea for you, you lay the client on their side and allow gravity to assist with shifting the internal tissues that are layered on top of the hip flexors out of the way. You can also flex the hip while carefully and gradually sinking deeper to the targeted muscle. I understand the inherent risk with working with layers, but you simple relax the superficial tissues prior and that’s not a problem. As far as organ and neural tissues, you can safely work around them as well, by staying lateral and close to the hip while by-passing other tissues. The pain can also come from the hypertonic tissues itself, not explicitly from surrounding nerve and organ tissues (as pain will only originate from here if the techniques are executed in a sloppy fashion or without restraint from obvious indicators like a steady pulse). YES, if you lack the sensitivity to know what you are pressing on, don’t do it.

    “The sympathetic trunk”? Good god, how medial are you working?

    “Most people have a Psoas that is roughly in line with the front of their spine, maybe a little bit of it anteriorly…” You don’t say.

    Kidneys? If a therapist was palpating the kidneys then why do they have a license? Muscular tissue and organ tissue feel, lets just say, ‘slightly’ different.

    “These courses are often restricted to physios, chiros and osteos…that is not to say your massage therapist isn’t trained, it is just much more unlikely.”
    Massage Therapists come in many variations, finding one with a specialty for a specific ailment is the general idea. I am not going to go to a spa for therapeutic hip flexor releases. To generalize that massage therapists are not as qualified, hence more dangerous is misguiding and again fear mongering. Are you really stating that soft tissue professionals will be incompetent, what in comparison with physios? Specialty training and advancing your body work education obviously enhances therapist performance. To generalize all LMT is profoundly stupid.

    I could say the same about CrossFit: CrossFit is a quasi real sport in that people that do CrossFit do it for CrossFit. CrossFit should therefor not use Olympic or power lifts as they do not actually enhance said fields. Repetitive and speed power lifting is an oxymoron, as such that the techniques used would also GENERALLY not pass in an Olympic program. However, to say that all CrossFit groupies have no lifting ability in an olympic or power event is profoundly stupid, as they do have gained speed, power, and strength. Therapists have the ability to safely work on the hip flexors, despite the field they are in. You cannot summarize the general abilities as you cannot assume where ailments come from without a proper client intake and interview. It is a fact that the lumbar attachments of hypertonic hip flexors directly, and mostly cause lower back pain in many clients including postural distortions.

    I find this article, mis-flavored to say the least.

    Like

    • Pat, you make some great points, and really interesting reading. Perhaps you could edit ur post as it comes across as very aggressive and reactive rather than helpful and professional.

      Like

    • Antony Lo says:

      Hi pat.

      Thanks for your comment.

      Firstly, you accuse me of writing based on my subjective opinion and yet you claim you have never had problems…that is “your subjective opinion” and “biased due to a somewhat worst album experience”. In other words, no different to mine. Where are your studies?

      The purpose of the article is to just let people know why I think trying to get at your Psoas is not as simple as looking on a muscle chart.

      You say “the deep tissues of the body hold complex hypertension etc etc etc”…you make the claim. Where is your evidence?

      Your claim that hip flexors are a problem – so, is there a difference between overactive hip flexors and physically shortened hip flexors? What about adaptively activated / protective hip flexor activity? What about pain-induced inhibition or activation? What about peripherally mediated or centrally mediated pain? What about referred pain? What about plain old simple psychological problems?

      And then what if what you consider to be “releasing” hip flexors (whatever that means – what are they released from?) is actually just affecting the body a different way? Are you willing to consider that what you claim is happening might not be actually happening?

      Yes, I generalize and say that “muscular tension” is often for other causes…that is because it generally is. Let’s examine why. Muscles are dumb. They only do what the nerves tell them to. Therefore massaging the muscles leaves you with only one way to access the neural system. Any change is muscle activity is via a neural mechanism. You are hoping that the primary contributing factor to that activity is based in the muscle itself. Muscles work without you thinking about them. The greatest and longest lasting effects are to teach someone how to move better and use their body differently…which is not good for LMT or PTs who do lots of passive treatment. Stretching is more neurally based than physical as most people don’t hold it long enough and passive sustained stretching isn’t as good as movement. And then protective muscle spasm is usually in response to something else…and that’s why I generalize.

      What does “mobility” mean? Do you mean flexibility? ROM? Activity? Ease of movement? How do you deal with that? Massaging is not the only way.

      On your second point, which I address some things above, I don’t say not to treat hip flexors, I say to find the real reason why they are a problem. Are LMTs where you are from allowed to diagnose? They aren’t in Australia. Therefore, how do you legally tell where the problem is from? You are guessing at best (legally). If you are not licensed to diagnose, your training won’t teach you how either.

      As you are the one challenging my position, show me the stats that say I should use these techniques over others? Here, read some of this. Go search pubmed for the effectiveness of our techniques. As for you never having experienced a problem, n=1 is a small sample. I also mention that this problem is rare.

      For your third point, I have seen plenty of aggressive techniques advocated in person as well as on the Internet. I know how to work deeply. I am merely asking people to question how much training their therapist has had and to ensure if they understand the risks. Of course it can be done safely.

      How many people do you think know where the sympathetic trunk is? Have you never had someone tell you they felt a bit sick or nauseated after your massage to the psoas?

      Having a go at me because I am trying to educate lay people about the structure of the psoas? Nice.

      Kidneys are there. Just reminding people.

      Visceral manipulation courses are often limited to those professions. What was wrong with that statement? I acknowledge that your massage therapist might be trained in it…it is just unlikely.

      I don’t generalize all LMT…I am merely stating the truth. I didn’t say they were incompetent, just asking people to check the qualifications of those who are working with you. Is there anything wrong with that? If you are qualified, you should be proud and happy to answer the question.

      “…you cannot assume where ailments come from without a proper client intake and interview”…so, I take up to 45-60mins to do my assessments BEFORE commencing treatment. I am licensed to diagnose. Are you? Massage therapists, in my experience, are not able to diagnose. Therefore, I can generalize that a massage therapist’s ability to diagnose is going to be significantly less than someone trained to diagnose. If you don’t like that statement or the system, then do a degree in something that allows you to diagnose.

      “It is a fact that the lumbar attachments of hypertonic hip flexors directly, and mostly cause lower back pain in many clients including postural distortions”. A fact huh? Produce our evidence. A pain producing structure? Yes. A primary contributing factor? Sure. Most cause lower back pain? Nope. You know how I know? Because the research tells us that 85% of low back pain is NON-specific low back pain. That means it ISNT the muscle. But hey, why let the facts get in the way of a good rant 😜

      Bottom line, read the post again. The main message is that you should ensure you are careful when letting someone dig around there. A highly experienced therapist probably irritated an already inflamed appendix. Just be careful and consider other options. Is there something wrong with that?

      Like

    • Anonymous says:

      Thank you you are so very much the voice of reason here and the previous article definitely is in the neighborhood of fear mongering…..has he even considered that before approaching the psoas the small and large intestine should be worked on and released so the access to deeper structures like the psoas is much less invasive or traumatic?

      Like

      • Antony Lo says:

        Hi Someone – are you referring to me or Pat? Did you read my reply?

        Am I fear-mongering? No. Don’t want people to consider their insides? Yes.

        “…before approaching the psoas the small and large intestine should be released…” – released from what exactly?

        It sounds like you have experience in this area. So did the therapist that caused the flare up.

        As I state in the article, normal tissue doesn’t react like this. I also say it could have happened to me.

        The moral of this story is that you need to be careful as a therapist about what you do and need to be careful about who you let in there. 😁

        Cheers 🙂

        Like

  25. lisa says:

    infact, Liz Koch speaks, after over 40 yrs of experience, to NOT get into the psoas, and yes, find out why it is out of whack. check out her site, books and such – easy info to digest and integrate on RELEASING the psoas, and move correctly to not engage it when not necessary. Also, Katy Bowman.

    Like

  26. hi,

    LMT here for over 20 yrs.

    this is a great post- i abandoned aggressive methods years ago after testing out some MET techniques. it was because of a post similar to this one that i decided to change it up- there ARE better ways (if a shortened psoas is the culprit). try it out- actively engaging/firing the psoas is much more effective (and works a lot faster) at lengthening it than smooshing around in someone’s guts. no one likes their guts smooshed. pain does not equal gain.

    too often we tend to take it personally when someone points out that what we may be doing may not be the best way to do things. getting defensive gets in the way of progress- methods evolve and improve. if they didn’t, lobotomies would still be a norm.

    in no way do i feel this author is “talking down” massage therapists. he’s just shedding light on an issue in bodywork, proper training, and sharing ideas to improve practices across a range of professions.

    Like

    • Antony Lo says:

      Thanks Tania.

      MET and similar contract and relax type therapies are nicer in general…just try to solve WHY the psoas feels it needs to be increased in activity.

      In a healthy abdomen, deep work shouldn’t be a problem – I do mention that…I merely wrote this to highlight that things can get worse when a perfect storm of circumstances occur.

      Like

  27. Anonymous says:

    I think about the same things!!! I usually avoid abdominal work on clients unless absolutely necessary. There is so much going on and there are so many GI inflammatory issues. I work as slow as possible and work with the body and never too aggressive. The body is capable of healing itself as for myself a massage therapist I am only able to assist in that healing process. I believe that that abdominal region houses so much of ones emotions that if you were to even go to a trained person that has done this many times that it should be with someone you trust.

    Like

  28. D says:

    You know bones, I know muscles, attachments, nerves, viscera etc… sounds like there is a bit of animosity about massage therapists and a scare tactic going on, maybe to get more business? Im sorry you feel that way, we could be such good allys in natural health care, but we “massage therapists” are trained in releasing nearly all the muscles of the body as long as we went to a good school, also our liability insurance rate comparatively reflects the damage incurred by MTs compared to Osteos and Chiros. And don’t even get me started on Physical therapists and how they are trying to become acupuncturists on 24 hours of study when it takes a minimum of 3000 to become an acupuncturist, how much was your liability insurance annually? Less than 2% of people are harmed by massage therapy and this is typically done by men who entered the field for the wrong reasons! I would have to say that our training remains in the “non harming” area of work comparatively and is very effective. Please don’t be afraid of Massage therapists based on this blog as this is a complete fluke.

    Like

    • Antony Lo says:

      Hmm. I know bones, muscles, nerves, viscera etc etc.

      There is no animosity.

      I explained that it could happen to anyone including me.

      The level of education for physiotherapists / chiropractors and osteopaths fairly standard as they are university degree courses. The education level for massage therapists (at least in Australia) varies in quality quite widely. So the caution to ensure your therapist (any therapist) knows their anatomy is fair.

      As usual, simply choose your therapist carefully.

      Like

  29. Hi Anthony, thank you for this, I am the author of The Vital Psoas Muscle and teach workshops all over the world, always re-iterating the psoas major needs relaxation, not pressing!
    Jo Ann Staugaard-Jones

    Like

  30. Jason says:

    You don’t feel nauseous, you feel nauseated. Most doctors say it wrong, too, but it’s worth pointing out. Something that is nauseous makes you feel nauseated.

    Like

    • Antony Lo says:

      Hi Jason. You are indeed technically correct. However, it might be possible in this day and age to argue that the word has evolved to mean feeling nauseated 😉 Some dictionaries carry both definitions for “nauseous” but I do indeed acknowledge the older meaning and “misuse” here!

      Like

  31. Kryss says:

    Very informative article, thank you. I very rarely ever try to work on the psoas, I just don’t think I need to be in there stirring the pot up, so to speak. I much prefer to introduce stretches to my client and find out what they are doing that could be contributing and things that they can do to help change it. It most instances, proper stretching and changing of certain sitting habits has done wonders.

    Like

  32. Reblogged this on Aquarian Age Massage and commented:
    This type of treatment seems to be trending right now. Here are some reasons to avoid seeking psoas release.

    Like

  33. Pingback: Elite Chiropractic – Does Sitting Cause Your Hips To Get Tight?

  34. Hi Anthony,
    Nice stuff! Can not agree more!! On that note… I also found out that most hip flexor problems unless there is trauma could be caused by digestive system.. Over and over clients come with back/hip/ breathing issues.. Well guess what: ask what they eat/drink, and how much-have they been to toilet regularly.. Look at their abdomen.. Hmm rather swollen or wobbly… Gently massage around abdominal area get them to breath into abdomen-then into ribs-once into chest-and repeat ribs-abdominal breathing few more times…. Suddenly the pain leasened- (as it is-generally the point of release in right area of abdomen is oleo exam valve that is inflamed and its direct key to our amazing right hip flexor)
    Once that eases I’m
    Happy to head to TFL/glut med/QL/longitudes.. whatever needed.. And it’s working….then give them idea about work ergonomics, posture, food and inflammation and off they should go to Physio for restructuring alignments!! I think gentle is the way to go around abdominal region no question!!!
    I’m only masseur-sport and injury specific-I used to be sports specific personal trainer-then went to injury specific-I have been trained with physics-osteopaths and chiros-now I’m doing degree in nutritional medicine.. And it all sure making more sense more I learn!!! I think next thing is neuroscience for me.. Lol…
    I’m saving your article I really like it!!!
    Cheer Irena.
    Ps: hope your friend is not all good:)

    Like

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