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Assessment & Self-Massage for the Hip-Flexors!

One of the key muscular areas in the body that gets negatively affected from our modern sit-happy society is the hip-flexors. Specifically, I’m talking about the iliopsoas group which can be broken down into the psoas major, psoas minor, and the iliacus respectively. Also important but not discussed in this blog post are the secondary hip-flexors including the rectus femoris, tensor fascia latae, and the sartorius. I want to discuss the importance of this muscle group and its wide spread connections in the human body and then show how to do some self -massage on this area since not all people have access to competent manual therapy or soft-tissue release  in their area or can maybe not afford to pay for the work.

A little anatomy review reveals the attachments points of these muscles as follows (I don’t like using the origin/insertion designations since the definition of the terms origin and insertion do not always reveal true muscular function):

Psoas Major: Has proximal attachments from the verterbral bodies, transverse processes, and intervertebral disks of T-12 thru L-4 and a distal attachment on the lesser trochanter of femur.

Psoas Minor: (only present in about 50 % of population) Has proximal attachment on vertebral bodies of T-12 and L-1 (maybe L-2) and merges with Psoas Major and Iliacus to attach distally on lesser trochanter of femur.

Iliacus: From the iliac fossa of the iliac bone, the must then merges in with Psoas muscles to form the “iliopsoas” which then attaches on to the lesser trochanter of the femur.

 The Ilio-psoas group!

A Broader Perspective!

Since muscles never operate in isolation, I’m going to borrow some ideas for the work of famous Rolfer and bodyworker Thomas Myers and his Anatomy Trains or “Myofascial Meridians” concept. With regards to the hip-flexor musculature, we find that they belong to a very important myofascial line called the “Deep Front Line.”

The All Important “Deep Front Line” 

According to Myers,

the deep front line comprises the body’s myofascial “core”. Beginning from the bottom, the line starts deep in the underside of the foot, passing up just behind the bones of the lower leg and behind the knee to the inside of thigh. From here the major track passes in front of the hip joint, pelvis, and lumbar spine, while an alternate track passes up the back of the thigh to the pelvic floor and rejoins the first at the lumbar spine. From the psoas-diaphragm interface, the DFL continues up through the rib cage along several alternate paths around and through the thoracic viscera, ending on the underside of both the neuro-cranium and viscerocranium.” (Anatomy Trains, 2nd Edition, pg 179).

Tom Myers knows the body!

So in essence, the deep front line is almost the “glue” which binds all of the other myofascial lines. For those who’ve never been introduced to Myers’ conceptual framework of myofacsial meridians or trains, please visit his site or buy his book!

 

 A must-have text for therapists and movements specialists!

Assessment For the Hip-Flexor Group

There are many structural and functional problems that can ensue from dysfunctions in the deep front line but I am going to focus on possibly the most significant one: disruption of pelvic mechanics and the associated body wide influences. Problems with the pelvis and lower spine will almost always involve the ilio-psoas musculature (and others). In a healthy or relatively “balanced” pelvis, we should find a more or less neutral pelvic position with balanced length and tone amongst the hip-flexors and hip-extensors.  Although research linking pelvic tilt to pain is lacking, it is still a valid concept to at least explore since the pelvis has such a strong influence on structures above and below.

Balanced Postural Alignment (whatever that means!)

At either of extreme of this we have:

1) The anterior pelvic tilt (aka “Janda’s Lower-Crossed Syndrome, called “locked short” in Myofasical speak)

Janda’s Lower-Crossed Syndrome 

   Professor Vladimir Janda was one smart dude!

and

2) The posterior pelvic tilt (called “locked long” in Myofasical speak)

Ideal compared to Flat back posture 

Muscle length tests such as the modified Thomas test are a quick and easy way to determine the resting tonus of the various hip-flexor muscles that may locked short (excessively toned) or locked-long (hypotonic).  

As pictured above, the man performing the test has adequate length in his psoas muscles with possibly  shortened Rectus femoris muscles and possibly tensor fascia latae and the external hip-rotator involvement. The key here is to keep the back flat on the table to ensure adequate stabilization of the pelvis and to look at both the angle shown above as well as a straight-on view to look for ab and add-uction problems as well as rotations.

Self- Massage for Psoas with small ball release!

So lets just assume for a moment that we are working with someone with a positive Thomas test and we are going to teach them how to perform some self-treatment methods using small balls to push through the abdomen area and intestines (psoas muscles lie behind the intestines and visceral tissue and are on the front of the spine). Before I show the release here some contraindications for any kind of abdominal release work and especially deep-abdominal work such as psoas-release:

1) Any kind of fresh surgery and scar

2) Preganancy or any hint of pregnancy

3) Inflammatory gut syndrome or condition

4 ) Any hint of Aortic aneurysm

5) Pelvic inflammatory disease

6) Any  type of stomach or intestinal/visceral cancer

When in doubt…don’t do this release and always check with a compotent medical advisor before attmepting any self-massage release techniques such as this!

To perform this release you will need a special type of massage ball that goes under the name “small-ball” massage. Here are a couple of links for Fitballs, or other small-balls.

Here’s the video!

Thanks for reading and watching my blog! Feel free to pass this on to anyone you feel may benefit from the information and please leave any questions and comments you may have…

Keats (ksnideman@gmail.com)

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