Issue link: https://www.massageandbodyworkdigital.com/i/530196
F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 107 true or false, I'll make some simple and practical suggestions for working with the psoas. My suggestions are based on my own clinical, teaching, and supervising experience, and though admittedly biased by my own training, style, and proclivities, my views are tempered by my in-depth readings and study of many others' reports, opinions, and approaches. PSOAS ANATOMY The term psoas is usually shorthand for the psoas major, a pair of layered muscles deep in the abdomen. The psoas' posterior layer attaches to the transverse processes of the five lumbar vertebrae, and its anterior layer to the side (lateral aspect) of the vertebral bodies and intervertebral disks of T12–L5. The psoas major joins with the iliacus muscle in a common tendon at the lesser trochanter of the femur to form the iliopsoas complex, which is surrounded by the thin, tough iliac fascia (Image 1). The left and right psoae, together with the left and right spinal erector groups, are arrayed around the spinal column like four guy-wires around a mast. In sitting or standing, the two psoae work bilaterally to stabilize the vertical spine. In sidebending and twisting, they work unilaterally to exert powerful torques on the spine. Because of their role in twisting the trunk, surgically severing the short psoas was at one time thought to improve severe scoliosis, until this extreme measure was thankfully deemed ineffective. 9 The psoas is extremely sensitive. This is likely related to its proprioceptive function in upright postures. If we think of the psoas as a proprioceptive sensor, sending information about spinal position The psoas major (green) and quadratus lumborum (red). Image courtesy Primal Pictures, used by permission. 2 and movement to the central nervous system, rather than solely as a motoric muscle, it'll help us approach it with the sensitivity and subtlety it needs. The psoas' sensitivity is also due to the numerous nerves that pass around, within, and through its muscle mass (Image 2). Lying alongside the spinal nerve exits, the psoas' front and back layers sandwich the nerves of the lumbar plexus. These nerve trunks, which give rise to the obturator, genitofemoral, sciatic, and other nerves, pass right though the psoas' belly. This unique anatomy gives the psoas a potential role in certain types of nerve entrapment pain, such as groin pain, sciatic pain, or femoral nerve pain. 10 In my practice, I have observed a clear improvement in many clients' axial sciatic pain after careful work with and around the psoas (see "Assessing Sciatic Pain," Massage & Bodywork, July/August 2011, page 110). IS PSOAS WORK SAFE? Many critics of direct manual therapy with the psoas are concerned about the risk of internal damage. They do have a point—the psoas is indeed surrounded by structures more delicate than the muscles and dense connective tissue that most bodyworkers are accustomed to working, stretching, and releasing. Without a doubt, insensitive, painful, or strong work around these structures of the abdomen is ill advised and could even be dangerous. Fortunately, injuries from psoas work seem to be rare. Although my reasonably extensive Internet searches found just one account of client injury associated with psoas techniques in myofascial, massage, structural integration, manual therapy, or physical therapy (and that single report being an uninvolved party's social media account of a practitioner apparently stepping on a client's psoas), the potential for client injury from insensitive abdominal work is real. 11 But strong pressure is rarely (if ever) needed in our approach to the psoas— its delicate, proprioceptive nature means it responds quickly and easily to gentle touch. This gentle touch, especially when used with the necessary sensitivity and communication with the client, is (in my opinion and experience) unlikely to damage or disrupt the surrounding structures. BENEFITS OF PSOAS WORK In our Advanced Myofascial Techniques trainings, we include gentle, direct work with the psoas in our repertory, as we have seen clear benefits that are not easily accomplished by other means. However, we do so with extreme respect, caution, and reverence for the unique sensitivity and potency of the psoas. Many other practitioners and their clients find benefits from careful psoas work, for a wide variety of reasons. 12 Watch Til Luchau's technique videos and read his past articles in Massage & Bodywork's digital edition. The link is available at www.massageandbodywork.com, www.abmp.com, and on Advanced-Trainings.com's Facebook page. "Working with the Psoas"