Issue link: https://www.massageandbodyworkdigital.com/i/465652
F r e e m u s i c d o w n l o a d s f o r C e r t i f i e d m e m b e r s : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 95 CLINICAL APPS Alternative position for iliopsoas treatment. Image courtesy Whitney Lowe. 6 to access because of its depth in the hip region and the great number of superfi cial tissues lying over it. There are potential contraindications to the most common treatment method for the iliopsoas muscle, which is to access it in the abdominal region by pressing through the abdominal organs. Applying pressure to the iliopsoas in the abdomen means you are pinning organs, such as the small intestine, between your fi ngers and the muscle. These tissues are usually resilient, but they are not designed to have that type of pressure applied to them. A more serious concern is the proximity of the iliopsoas to the external iliac artery, which branches directly from the aorta (Image 5). Applying pressure in this region could put pressure on the external iliac artery and decrease blood fl ow through that artery. Pressure on this artery could cause a serious adverse event. It is not a common occurrence, but if it happened, it could be a serious injury. An alternative for reducing tightness in the iliopsoas muscle is to perform a facilitated stretching technique (also called proprioceptive neuromuscular facilitation or PNF, muscle energy technique, or active isolated stretching) such as that shown in Image 6. The client drops the leg off the side or end of the table so there is a full range of motion for the hip. The client attempts to fl ex the hip against resistance, and the resistance is held for about four to fi ve seconds. The client is instructed to relax the contraction while the practitioner pushes the hip further into extension, stretching the hip fl exors. This technique is surprisingly effective without the adverse effects of pressure on the abdominal structures. CONCLUSION Michael's case illustrates a common situation with many clients in which there is an underlying soft- tissue dysfunction present for some time but it doesn't seem bad enough to warrant treatment. However, once additional stressors are added, a more serious injury results. Another key issue to remember from our work with Michael is that in many cases the tissue injury may include more than one area, so the evaluation needs to be comprehensive enough to account for all the existing symptoms as much as possible. Proximity of iliopsoas to external iliac artery. Image is from 3D4Medical's Essential Anatomy 5 application. 5 Iliopsoas External iliac artery Whitney Lowe's texts and programs have benefi ted massage professionals and schools for more than 25 years. Learn about Lowe's innovative and engaging online courses and products at www.academyofclinicalmassage.com.