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December 13, 2007
The Walking Puzzle
A client calls for an appointment reporting that they are having trouble walking. Following their morning run, they began dragging their leg. I immediately thought about the psoas muscle because it is the primary hip flexor. After a few more questions, I spoke to my client about how we walk, with reference to my muscle poster and a demonstration of how a psoas in spasm would make walking more comfortable bent over. They laughed saying that the only way they could pick up their leg was to bend their body at a 45 degree angle, a perfect mimic of my demonstration.
So I began our session with a psoas release technique. Before I got started, my client told me they observed a bump in their abdomen that was tender and I confirmed through palpation that it was the psoas in a contracted state. I also demonstrated for the the proper technique for psoas stretch that involved a lunge position. Then I did PNF activation of the psoas muscle and the dysfunctional side exhibited considerable weakness compared to the healthy side. Clearly, we needed to do more work.
They also reported having a problem with extra tight quads asking if that would affect the low back. I said yes, demonstrating how tight quadricep muscles will tilt the pelvic bowl forward. Then I did a myofascial release of the quadricep muscle. It was at this point, again talking about the anatomy, that we discovered the iliacus muscle which lined the inside of the pelvis was also in spasm. I worked to release that.
Then I asked if the leg on the affected side felt as though it was too tight in the socket. The client said yes, like the whole leg just needed to be pulled out of the socket. This indicated that work needed to be done at the lesser trochanter insertion of the psoas. Clearly, I was having to pull out all of the stops and use all of my psoas and low back techniques.
I got the client to lay up on their side and assisted them with a full body stretch that had me anchoring them from the arm, stretching through their shoulder and rib cage, down through the low back and down the iliotibial band of their leg as it hung off of the table. I also engaged the client in another PNF technique that activated the twisting muscles of the torso.
I had the client turn onto their back and they pointed to their sacroiliac (SI) joint as also having a problem. I wasn't surprised because I have learned that there is often pain in the SI joint when the psoas on the affected side is dysfunctional. I softened the quadratus lumborum muscles on the affected side and massaged the balance muscles, gluteus medius and gluteus minimus on the opposite side. I then mobilized the fiberous connective tissue of the SI joint with a gentle PNF technique.
I checked the hamstring muscles and their attachments at the ischial tuberosity. They felt like they were in good shape, which makes sense considering the quadracep muscles were so tight. I palpated the rest of the gluteal muscles and low back muscles. I told the client this was just about all the places I could think to work as we were almost out of time, except for the tensor fascia latae muscle, which I pressed in on as I said this. The client almost came off the table. Clearly, their body was not ready to let me wrap us the session with such a strong reaction. I gently worked that muscle until it calmed down and the client had much less of a reaction upon palpation.
Whew! That was one session where I earned my living. I put all of my years of experience and knowledge to use to solve a problem. I'm sure there are tons more techniques out there to help with psoas and low back problems. If you want to share your techniques, feel free to leave a comment down below and thank you for sharing to help make us all better therapists.
tags: massage massagetherapy wellness massage therapy bodywork health
Posted by linda at December 13, 2007 7:43 AM
