Today, let’s talk about the most controversial but most hyped up technique. ‘Releasing Psoas Muscle Manually’. For those lucky people who are not aware of this technique, this is how it goes.
Imagine you are lying relaxed on a treatment couch, first you feel a therapist pressing on your stomach just inside your pelvic bone, it feels weird, kind of tickly which isn’t so bad. However, the therapist then starts to push their fingers deeper and deeper down through your guts until they are up to their knuckles in your intestines and it feels like they are trying to perform an appendicectomy with no scalpel or anesthesia. I can assure you this is as uncomfortable as it sounds, it is a truly unpleasant, nauseating, and painful experience, in fact, it feels like your internal organs are about to implode.
I am sure my questions are going to open the ‘Can of worms’ and this can be a brutal debate but it is high time we address it and really understand the need for such a technique. So here we go.
Question 1: Are We Really even able to reach THE Psoas Muscle?
The psoas muscle is a very deep muscle. It is attached to the side of your lumbar spine and the intervertebral discs. It travels down through the pelvis and inserts onto a bony projection on the femur called the lesser trochanter. It blends with another muscle called the iliacus within the pelvis and so is sometimes referred to as the iliopsoas.
It is covered by a lot of dense structures all around. In the front, it is small intestines and colon, superior to are Kidneys and vascular structures of the external iliac artery and vein. The psoas also has the genitofemoral nerve lying in front of it and is finally surrounded a by a strong dense fascial blanket. All these structures are then surrounded by three layers of abdominal muscles and then some fatty adipose tissue and skin. Posteriorly, it is covered by multiple layers of thick, dense and very strong lumbar spinal muscles, as well as more adipose and skin tissue. So it practically impossible to reach the Psoas muscle by just pocking one finger. AGREED?
Question 2: What is the Clinical Reasoning for Releasing the Psoas Muscle?
The major reason I came across includes, reduce tightness, spasm or overactivity of psoas muscles which cause pain and lack of mobility. Few groups of physios argued that this technique is being used to excite, wake up or stimulate an underactive muscle.
Firstly, how can the same technique inhibits and excites the same muscles? Secondly, how can we test that? Thirdly releasing or excited the muscle would really strengthen the weak muscles?
There is some research that shows a tenuous link between its size with those suffering low back pain (check the reference below), or perhaps you could use fine wire EMG directly into the psoas to record its activity. But these are costly, impractical and potentially unreliable with no robust evidence.
Question 3: Is there any research which supports this technique?
When it comes to evaluating and critiquing the research and evidence for the psoas release technique that’s easy, there is nothing robust to look at. In fact, there isn’t anything even remotely flimsy to look at just a few very poor case studies. There are many articles mentioning the release of Psoas muscle using various surgical technique but fails to show any evidence for the release when done with one finger.
Basically, there is NO research on its application, its effects nor its results, doesn’t that seem strange for such a widely used and promoted technique?
Psoas release technique is not based on any sound anatomy, not founded on any sound clinical reasoning and not supported by any research. Then my biggest question lies is
Why do Physiotherapist practices such hyped up technique?
By – Dr. Mansi Parikh (PT).