Body Part - Abdomen/Psoas - Techniques

[Twilight Fan]

Hi.

I envision a sticky for this thread in the future (and the other body part threads I'll start!), if this goes well.

We could utilize this sort of like the "Massage Pearls" thread. Anything you find interesting within the MassagePlanetL forums regarding a specific part body and the work surrounding it, could be parked in this thread. Obviously we may end up with some thoughts duplicated from the Massage Pearls, but who cares!!!! The more, the merrier!

In addition, if you'd just be interested in posting some neat techniques you do for this particular body part, that would be wonderful too!

Consider items like:

• Amount of time you generally spend on this body part.
• Amount of time you can spend on this body part.
• Techniques you may use to stretch out a massage while working this body part (example: you need to pass a few minutes to get back on track -- swedish therapists may really appreciate this info).
• How you incorporate other bodyparts at the same time when you are working this area (example: long strokes in working the hip with one hand and the posterior calf with the other -- in unison).
• Techniques for specific problems or patterns.
• Draping/loose draping/non-draping information - the why & why-nots associated with this area.
• Tell us something that just feels good!
• Types of lotions/oils you would use for the technique and why.
• How to perform deeper work or lighter work in the region.
• Case Study Examples from your practice.
• Bonus thoughts that you may have that would be helpful to new and old therapists alike!

Without further ado .... it's all about the abdomen and mighty psoas!!!!

 

[Donna E]

Good thread with good tips! Psoas Release

Have your client scootch to the side of the table you're working on, and dangle his/her leg off of the table, with your hip against the table at his/her hip so the client doesn't fall off. You may need to brace yourself with a hand on the opposite Ilium for support. The edge of the table should be underneath the middle of the back of the leg. Now, press the knee down a little until you get a slight stretch, and after 15 seconds, have your client lift the knee resisting your hand for a brief moment. When the client releases, press the knee further, and continue this pattern until the client's toes touch the floor. This will gently stretch and release the psoas.

Make sure the muscle/s is/are warmed up before doing any stretching. Especially PNF.

I'm not sure if I can explain it well in writing, but have client supine, with knee bent and foot flat on table on the side you are on. Locate psoas by pressing lateral and downward to rectus abdominus and then do a knee jerk to feel muscle contract so you know you have contacted muscle. Then have client lower leg and raise arm above head at same time several times to release muscle, while you keep static pressure on the muscle. I have found this usually releases the psoas quite well.

You can also do the PIR for psoas, which is to have client sitting at edge of table, pull one knee to chest, tuck chin, and roll back onto table, still holding knee to chest. You then press on their extended leg down towards table and hold for 5 seconds while the client is resisting your pressing him to table. Have client relax and you press his leg further towards table. Do this at least 3 times, each time pressing his leg further into extension.

I have never worked with releasing the psoas, but this article describes some excellent self-administered techniques for working with the psoas, and also presents a different way of looking at it too. The authors say that the psoas is an extremely 'emotional' muscle, that is used by the body to protect against trauma, and so releasing it can release a lot of emotional/trauma issues. They recommend that any practitioner should spend a lot of time working with their own psoas, and understanding it, and releasing their own stored tensions there, before they work with a client's, otherwise they could get badly bitten by the counter-transference.

Absolutely an emotional storage tank... especially issues relating to sex & sexuality and/or past trauma/abuse. Be gentle

However, my favorite psoas release is from Ortho-Bionomy and is incredibly gentle and effective.

With the client supine lift the leg of the affected side a few inches off the table, laterally rotate, and abduct a few inches off of center. From this position gently apply pressure into the hip along the long axis of the femur...wait for the release 15-60 seconds. This should not cause pain, but is very relieving to the client. Of course depending on the client you may have to adjust the leg's position slightly for best results. There are also variations that include movement of the ribs and lateral flexion of the trunk. It works very well.

Be careful hanging the leg off the side of the table and doing PNF on someone with an exaggerated anterior pelvic tilt. That technique is great to release psoas with someone who has 0 degrees of anterior tilt or even posterior tilt, which is not very common, but it can actually increase anterior tilt. Remember how many actions the psoas has. The best way I know to release psoas when the person has an exaggerated anterior tilt is this: have the client lie supine with one knee up and foot on the table. To locate the psoas draw a line from the navel to the ASIS. Then place your fingers just medial to that line about half way between the navel and ASIS. Place your elbow on the clients knee and have them gently pull the knee toward the chest. If you feel the muscle push against your fingers you are on it. Then have the client slowly slide the leg down the table and straighten the knee, dorsiflex the foot and laterally rotate the femur, and bring it back to neutral. Then slowly bring the knee back up. To increase the release they can extend the same arm above the head. Then move your fingers distally, find another point and have them do the motion again. You can also use this technique to release the Iliacus and the transverse and obliques.

Psoas work is very rich for both practitioner and client. I hope this helps.

Try having the client lay in supine position, bring leg up with knee bent (ankle parallel with knee), push foot inward toward your client's superior and perform your PNF three times. You can also have client (in same position) bring foot out in opposite direction (laterally) and PNF this as well.

A quote from my thread: My Rolfing Experience

A sample of the "psoas work"

• Client supine (on the spine) with knees bent and soles of feet flat on the table
• Practitioner stands at side of client facing toward the clients head
• Practitioner places the fingers (hands in a knife edge type hold - lateral edge of hand is perpendicular to the floor and fingers are pointed toward the clients head) into the psoas region, firm but not so deep, and the client is asked to raise the sacrum/pelvis toward the ceiling. As the client does this, the therapist is able to go deeper with the fingers into the bilateral psoas and apply pressure. Client lets sacrum down as best possible, which is somewhat prohibited by the locking in of the fingers. (I felt an immediate sense of improvement in my psoas areas.) Practitioner removes fingers by "jiggling" them side to side as they come away from the tissue.

The first thing to remember with the psoas, is that it is surrounded by guts, and neighbor to some large veins and arteries. I'm a believer inusing very light compression and high-intensity energy to gain access to deep tissues any where on the body. Dance with the tissues and you'll waltz your way in. The psoas requires your greatest patients here. Time and tenderness will get you there better than trying to force it. The ab. muscles may tense up to force you out if you use too much force. Likewise, there may be emotional guarding, ticklishness, or smoker's cough keeping you out.

Have you tried putting your client into a sidelying posture? I've had good results with this one when supine hasn't worked out. Not only does it shorten the muscle, but gravity does the job of displacing the internal organs. Gravity also gets excess ab.-fat out of the way, so it is usually the first approach I'll take on a larger client. Some times the client just can't let you in. Try treating the muscle at it's attachment site at the lesser trocanter.

If you can get access to "Basic Clinical Massage Therapy" by, James H. Clay and David M. Pounds, they demonstrate several approaches to the psoas.

(release the Iliacus first)

The Psoas attatches to lumbar vertribri and when tight (sitting, driving, and being in flexion much of the time it is tight on many people) can cause LBP.

I have a notebook with a photocopy from an anatomy book of these muscles and show and explain what I'm going to do and why it's necessary.

Always ask permission to work directly on the skin and work with the breath-- they need to be relaxed.

 

[singer3030]

(copied from a post in the hips/pelvis/glutes thread - this post refers primarily to working with psoas, iliacus, and pectineus)

I love working this area! Don't know exactly how it happened, but I went from feeling kinda ignorant about it to feeling it's now one of my strongest areas to work. The hip flexors especially are rewarding, as I often see dramatic changes in just one or two sessions.

Lately I've taught a few classes (CE provider approval pending) for MTs that focus solely upon the hip flexors. The course was originally intended to be just 3 hours... but I have a good 8-10 hours of material! So we covered just the most critical pieces (assessment, anatomy, and palpatory skills) and surveyed a few basic treatment skills.

For simplicity, I roughly divide treatment skills into two broad categories that each have two broad subcategories:

A. Passive Techniques - basically anything you do where the client passively allows you to manipulate their tissues. These I divide into two categories: Indirect and Direct.

1. Indirect Techniques - basically techniques that don't require putting force directly into the tissue. These include fascia work, positional release, some forms of stretching, and so forth.

2. Direct Techniques - basically techniques that apply direct pressure to the tissues. These include trigger point, cross fiber friction, etc.

B. Active Techniques - basically anything you do in which the client actively participates in moving or manipulating their body. These I divide into two categories: Stretching and Exercising.

1. Stretching - Here I teach active stretching methods like Active Isolated Stretching and PNF stretching. There are others, but I prefer these for ease of use, effectiveness, and because clients learn them fairly easily.

2. Exercising - This could run the gamut of somatic education, personal training, etc... and it's far outside the scope of practice of most MTs. I limit my course material to emphasizing the importance of knowing practice limits and referring clients to the appropriate experts. MTs should not mess around with exercising clients or making recommendations regarding a client's exercise program unless they have real credentials and some actual training experience.

I believe MTs should have a good grasp of how to assess for hip flexor issues. This includes observation of posture and movement in addition to the verbal intake. It's also critical that the MT establish good solid boundaries and a connection of trust before working the area. Communication, in short, is key.

An MT should also really know what they are looking for, how to find it, and what to beware of. There's a lot of important stuff around the inguinal ligament, so you don't want to be aimlessly poking about. Even on very large clients, it's easy to figure out where you are once you find the ASIS and use it as a landmark.

I prefer to start with indirect techniques, especially if the client's anterior hip fascia is thick and doesn't move easily. Also, indirect techniques tend to be more easily tolerated if those areas are very tender and/or ticklish.

Direct techniques usually follow indirect ones, at which point the tissues should be well prepared. I teach a gentle approach to applying direct pressure, to make it easy on both client and MT. No sense in either one feeling real pain during or after the work!

Active stretching is something I would normally do last, to get the body to use the tissues we just released. This is critical for motor education, and clients can learn and practice these skills for faster progress between sessions.

Though the hip flexor course I've put together focuses on the psoas, iliacus, and pectineus, it's important to also look at them in relation to the glutes, TFL, quads, adductors, etc. The whole pelvic area is fascinating, and I hope to see more MTs take an active interest in working it!

 

[Cutie001]

For anyone who didn't get much training on working the abdomen, this gal on YouTube really goes to town. I have no idea what country this is from (I am guessing Brazil), but it gives you a good look at how things are done somewhere other than the US, and it is a long abdominal sequence: 10 minutes

 

[rockin_robin07]

We were taught to warm up the stomach...asking first if they recently ate or need to go to the bathroom...but then we proceeded to move in a clockwise direction. Not too deep at first but then eventually hitting the "4 corners" of the midsection.

In Thai massage, we learned Thai internal organ massage...DEEP...DEEP.. almost down to the spine...lol...It was uncomfortable at first but after a while, we got used to it.

I know some modalities really work the abs, like shiatsu and lomi, but its an aquired technique and alot of clients feel too vunerable in the abs...since we hold alot of emotions there...

 

[Pompal 09.]

Our Shiatsu ab routine was done through clothing, and involved palpating lightly each area from the end of the ribcage to the ASIS' corresponding to a reflex map of the meridians. Further work was done from there; it was very light and energy-based.

The Swedish routine started with one hand on top of the other over the navel, just resting, and then proceeded to a kind of compression which lead into "sun & moon" strokes on the belly. That entire opening is something like a spiral. Then the two hands come back together and move as one still going clockwise around the navel but pulling from the far side and pushing from the close side. Dunno if that makes any sense, this stuff isn't so easy to describe We also did a thumb glide under the rib cage, going around the table for the other side, to address the diaphraghm. Closing was the opening in reverse.

The deep tissue routine included skin rolling to warm up the fascia (not across the linea alba though), ab work, including attachments on the ribs, more diaphraghm, etc, and could lead into iliopsoas work.

I just checked a book out from the library, Unwinding the Belly on work which has its origins in Chi Nei Tsang. Very interesting to me.

 

[leelou]

We learned a very typical Swedish ab routine, going clockwise in the direction of the intestines...as not to back anything up (yipes, that would be ugly! ). The one part of the technqiue that I think is special, is the approach and end to the stroke sequence.

As your warmed hands approach the belly, you hover just above the naval and wait for an inhale (getting in sync with the breath). Then, as the belly rises with inhalation it gently and flawlessly touches your hands, your hands then sort of melt into the belly. At the end, after full ab work, your hands wait for an exhalation to disconnect. I have found it to be very nurturing.

 

[dieownhi5x3]

An awful lot of stress is held in the abdomen. Many people are reluctant to try it, but once it is done, it is no trouble the next time. Warming and working the abs allows access to the psoas, which is important for low back troubles.

We learned a myofascial technique that works very well to address psoas only without warming abs first! Simply locate the point one third distant from the navel on a line with asis, and gently apply pressure, increasing only as the tissues release. It can take up to 10 minutes per side! If you feel pulsing, back off, and relocate, it could be the abdominal aorta. Works quite well, but advise client to be near the facilities for awhile!

 

[Poop]

We learnt around six strokes to make up a 5-10 mins abs routine. Starting with two-handed effleurage, from low on the rectus abdominus, and going up, then up and out to the sides a little, then up and right round the sides. Then some light kneeding/petrissage in a clockwise circle, then some knuckling in a clockwise circle, then some light tapotement like hacking but with very soft loose fingers (this one is really nice ;-) ) then some top to bottom firm effleurage, starting at the centre just under the ribs and going down and outwards round the sides, then pulling from the sides, in and down. Finally, if you have really rendered the clients abs to mush, place hands above and below the navel in parallel, and start some gentle rocking. Gradually increase the pressure and tempo, and flex your hands, so that you end up having hold of the whole rectus abdominus, so that you can pull it up and stretch it away from the body as you rock (this one feels totally amazing if you have let yourself go to the point where you can let someone do this to you!). Then slow down the rocking til it's imperceptible, and gradually transfer to energetic rocking, so that the client doesn't know that your hand has disconnected, and so that you retain an energetic connection to their abdomen.

Just one other element that I had forgotten here, that you might like. That is, doing a 'round' (clockwise round the belly) of finger snapping. This is hard to describe, but if you make lobster claws from your hands, and gently snap your thumbs and fingers together, as though you are catching something in your claws, you get the idea - doing this with lubrication, and pinching against the skin of the abs can feel a little ticklish if it's too light, but is nice if you are firm and fast, and the client is very relaxed there.

 

[Brrrrrrin]

Another thing... tension in the abs can prevent neck work from being as effective as it otherwise would.

My chiropractor has been doing soft tissue work for my abs before adjusting my neck, and then at the SF gathering Monday night, the Somatics instructor recommended working from the center out, also emphasizing the importance of relaxing the abdominals, and not just rectus.

 

[Bill L]

i have a fairly extensive intake form, and part of it includes a brief description of the possible benefits from abdominal massage, followed by a yes/no option as to whether the client would like it included.

i've found this works best in my practice, as i have a pretty equal mix of relaxation and deep work clientele...along with a surprisingly high number of 'first massage ever' folks. makes it clear that i'm happy to provide ab massage without freaking anyone out. cuz yes, some people ~viscerally~ recoil at the suggestion. this way, they can quietly circle "no" or happily circle "yes!" ...or ask questions, if they've never been offered before.

as a professional, i'm happy to give abdominal massage, but on a personal level, can't tolerate receiving it.

no way am i letting anyone into my solar plexus, i've put too much time and energy into establishing my shields! which is a whole 'nother topic :wink: