Techniques for hip flexors and rotators?

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Seebs
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Techniques for hip flexors and rotators?

Post by Seebs » Tue Sep 25, 2007 12:00 pm

I have a client who has asked that I concentrate/spend more time on her deep hip muscles, particularly hip flexor and rotators. I did some psoas release work (which she wasn't as impressed with as the other people I've done that work on!), I've done thorough glute work (special attention to lateral hip while working glutes), and did some slow, deep, and specific work along her IT band, which was very tight (she ended up with a bruise :oops:) but she still feels like her area of concern isn't completely addressed. I realize that I don't really have specific techniques for the iliacus and the tensor fasciae latae, which sounds like what she really needs.

One thing that's strange is that this client does Yoga (she's actually a yoga instructor) and so I wouldn't expect her to be so tight. (Tight according to her.) Her hips are indeed very flexible as far as I can tell. Therefore, I haven't had good results from ROM and stretching.

I'm seeing a different client this Friday who said she just completed a weekend of intense yoga training and she, too, is complaining of hip pain. Any ideas on why yoga is so stressful to the hips?

More importantly, any suggestions on specific techniques for working this area?

Ahimsa
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Post by Ahimsa » Tue Sep 25, 2007 1:30 pm

I dunno if this will help, but when it comes to the TFL the best thing to do is just have them turn on their side and dig in. There can be some crazy TP's in there and that seems to be the best angle for both of you to work it.

When you did the psoas did you go in through the belly with the leg bent? I'm surprised you didn't get better results with that since its so rarely touched. As for the Iliacus give it a nice "swooping" motion from top to bottom and don't be afraid to carefully dig in there.

Also have you tried the technique for the rotators where you push in with your hand or elbow on the group (minimus, quad fem, etc) while holding their leg at 90 degrees in the other hand and rocking back and fourth. Thats one of my faves.

Good luck!

Seebs
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Post by Seebs » Tue Sep 25, 2007 4:22 pm

Thanks, Ahimsa!
I'm rather afraid to "dig in" since I've bruised this girl a couple weeks ago. :( But when I get her sidelying, maybe I'll be digging into that TFL (I had to think for a while before I figured out what that was, I'm so bad with acronyms!) and not into something more easily bruised (like farther down on the IT tract.)

The psoas release: yes, I did the one through the belly with leg bent. I was reading some of the posts from this website that turned up on my search, and I'm going to try again, perhaps I wasn't squarely on her muscle. I'll have her leg resist against my pressure to make sure the muscle pops up under my fingers this time. She's so skinny, though, it's not as though there's much there to be in the wrong place!

The rotator one: I think that's one I do. You're talking about client prone, and rotating her bent leg while palpating and doing compressions on glutes, hamstrings, etc, right? I definitely do that one. In my notes I call it the stirring BMT (body mobilization technique.) I thought that would certainly address what my client was asking for, but she wants work more anterior. I guess there's some rotators there, too, just the deeper and harder-to-get-at ones.

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Post by Ahimsa » Tue Sep 25, 2007 7:35 pm

Oh yes those rotators can be hard to get to and uncomfortable for you both! Good luck with that, I'm sorry I don't have many recommendations for that area other than the stretching which you seem to already be doing.

For the TFL thing stand behind her and use your elbow. This should give you enough leverage to get at those trigger points if there are any and not kill yourself at the same time.

Sounds like you are doing the psoas move correctly and if she is skinny like you said there isn't much room for error. It can be hard to find, sometimes I can't believe how deep I have to go just to get to it!

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Post by kathryn » Tue Sep 25, 2007 9:27 pm

Although the psoas can contribute to a lot of dysfunction in the body, the deep spinal muscles (rotators) and quadratus will also cause some hip issues. Usually I'll check for tight psoas by using the Thomas test (if you google it and click on 'images' you will see what it looks like if you don't know). When the psoas is tight, the client's thigh will be above the horizontal and if the rectus femoris is tight the lower leg won't be vertical. A tight rectus femoris can contribute to psoas tightness and even low back/hip pain.

Tightness in the TFL and the gluts can cause the ITB to feel tight.

Before working the QL, it helps to loosen the hamstrings first and then you can work the QL and spinal muscles while client is sidelying. The QL is a really good muscle to check b/c trigger knots here will send satellite knot activity into all the gluts and the piriformis.

The TFL is a good muscle to work, but if its tight this muscle can be very tender and it will not appreciate being dug into. The best way is warm the muscle first and follow with stripping and compressions but within the client comfort. If you know any muscle energy techniques that would also be good. Another way to help it release is have client sidelying and using your forearm on the TFL while they slowly raise their leg, you can count 10 seconds and release (within pain tolerance).

Many yoga instructors have hypermobile joints and this in itself can cause a lot of hip/shouler issues. I would recommend that she do some resistance exercises and if her joints are hypermobile it isn't a good idea for you to stretch any muscles that cross a joint during the massage.

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OffIce
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Post by OffIce » Wed Sep 26, 2007 3:43 am

Sounds like their hips are in fact weak, not tight, the muscles are fatigueing causing muscular pain. Address the strength issue...Never work directly on the ITB as it has the tendency to the complete opposite, which is contract without releasing. Work the quads and hammies and mobilize the ITB..

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techniques for hip flexors/rotators

Post by Rubmyster » Wed Sep 26, 2007 7:28 am

This is a challenging problem for me, too. I was taught last year by the esteemed Whitney Lowe that it is not helpful to manually release the psoas.If you look at a Netter anatomy text, you'll see nerves, blood vessels, intestines near the muscle. It's also very close to the abdominal aorta. :shock:
I've struggled with this info and tried to stretch the psoas instead.
My psoas horror story: I was in a NMT class years ago and my trade partner couldn't palpate the psoas. So an instructor came by and drove his hands in so fast and deep that I blacked out for a few moments. :shock: :cry: I am more respectful with this muscle now.
Cheers,
Rubmyster
jody

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Post by WaltFritz » Wed Sep 26, 2007 10:07 am

"Releasing" the psoas takes on different meaning under different treatment approaches. Deep, invasive approaches to the psoas, called "releases" can indeed be traumatizing with little if any therapuetic value. Gentle sustained releases of the psoas can have profound effects, both in lengthening as well as opening up the entire region, with no ill effects such as you described. I can recall when I first took MFR1, one of the lab assistants apparently felt that my partner was not going deep enough into my psoas when we were practicing the soft tisuue mobilization approach. While I did not respond by blacking out, my end reaction was similar. I learned early on that this approach did not work for me. Once we learned the proper form of MFR to the psoas, tolerance was much better and results were positive as well.
Walt Fritz, PT Pain Relief Center, Rochester, NY
http://www.myofascialresource.com
For therapists: MFRmail Newsletter (patient focused newsletter also available)
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Seebs
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Post by Seebs » Wed Sep 26, 2007 7:05 pm

OffIce wrote:Sounds like their hips are in fact weak, not tight, the muscles are fatigueing causing muscular pain. Address the strength issue.
Hmm, interesting! Is there something in a massage session I can do to "address the strength issue" or is it more something I should tell my client to do outside my office? Should I look up hip strengthening resistance exercises for her to do?
OffIce wrote: ..Never work directly on the ITB as it has the tendency to the complete opposite, which is contract without releasing. Work the quads and hammies and mobilize the ITB...
Mobilize it? Doesn't it just kind of lay there for things (as in muscles) to insert into it?
kathryn wrote: Many yoga instructors have hypermobile joints and this in itself can cause a lot of hip/shouler issues. I would recommend that she do some resistance exercises and if her joints are hypermobile it isn't a good idea for you to stretch any muscles that cross a joint during the massage.
Why is that? Doesn't doing yoga help with strengthening?

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kathryn
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Post by kathryn » Wed Sep 26, 2007 8:21 pm

Yes, yoga does help to build endurance and strength by working all the muscle groups of the body, but there is also a chance of overstretching the tendons of muscles that cross a joint and this is when there can be problems. It's hard to say with your client without seeing her myself, but yoga instructors in particular are more likely to overstretch, especially if they spend a lot of time in difficult poses.

Vladamir Janda is known for his research in muscle imbalances, he discovered the 'upper crossed' and 'lower crossed' syndrome. In which certain muscles are tight while others are over-stretched and weak. In the lower crossed syndrome the psoas, rectus femoris, hamstrings, tfl, adductors, piriformis and ql will be tight while the weak muscles are the rectus abdominis, glutes, vastus medialis, vastus lateralis, transversus and abdominis.

In either of the upper or lower crossed syndromes, it is important to loosen the tight muscles first, when this happens then worry about stregthening the weak inhibited muscles. Resistance strengthening is very effective and best done with a professional so you can refer out for that.

A good muscle energy technique for the psoas is have client sidelying (ex: on their left side) with both legs bent in 90 degree angle-- have them bend left leg up to chest then grasp the ankle of right leg with your right hand and your left hand goes on clients sacral area while standing facing clients back (not good if they have knee issues) and gently pull right leg back until you feel resistance. Then have them try and bring their knee forward using about 20% of their total strength while you resist their action. After each time, you will find you can bring the leg back just a little further and repeat. Each side only needs about three or four times.

Also the psoas will release well if you are sure to also work the rectus femoris.

Hopefully, that made any kind of sense. I use this often along with the Barnes method of myofascial release and it works really well. The client always feels their hips have opened afterwards.

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Post by nybor7 » Tue Oct 02, 2007 4:06 pm

I'll have to go find it but I think I remmeber a TFL demo on the freebie DVD given away from Biofreeze.

I found this link (it is old) about getting the freebie DVD. May be sorth a shot.

Robyn
r e l a x - South Carolina

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