Ep 147 - Old Man Psoas:"The Rebel MT"with Allison Denney

0:00:00.0 Speaker 1: Anatomy Trains is delighted to announce a brand new dissection live stream specialty class on September 18th. Lumbopelvic stability: A one-day layer dissection with Anatomy Trains' author, Tom Myers, and master dissector Todd Garcia. The early bird price of $150 is held until September 10th. After September 10th, the price is $250. Come see the body's actual core for yourself. This course will be provided over Zoom webinar with multiple camera views, live chat, and Q and A. Visit anatomytrains.com to sign up.

0:00:34.7 Speaker 2: This episode is brought to you by the Massage Mentor Institute. Diane Matkowski, also known as the massage mentor, and Allison Denney, also known as rebel massage, have teamed up to bring you the Massage Mentor Institute. MMI is a collection of teachings and education opportunities from industry leaders around the world. Because your continuing education experience should be whatever you want it to be, they are building community one body part at a time, and they want you to be a part of it. Head over to themassagementorinstitute.com today, to see more, learn more and do more.

0:01:20.9 Allison Denney: Hi, my name is Allison Denney, and this is The Rebel MT podcast, where you'll hear me forcibly colliding the worlds of anatomical jargon and humor. I believe that when you know your anatomy, the what, and you know your physiology, the how, the techniques will follow. But the loads of Latin and the gobs of Greek can make a cranium convulse. It is a little overwhelming to dip your toe into the sea of anatomical knowledge, only to find that it is a bottomless ocean. You are smart, but this is intimidating. You will get there eventually. In the meantime, let's look at things differently so that you will actually want to take a swim, or at least hop on a boat and take a peek at what's under the surface. There are two things to think about when working with the psoas muscle, and they are not the umbilicus and the ASIS, they are not anatomical parts or physiological constructs, they are not even mechanical basics or constructive techniques, they are daisies and the color purple. No, just kidding. They are nervousness and urgency. More specifically, the ideas that first and foremost, it is entirely too easy to feel overly nervous when working in this area, and second, calming that sense of urgency you might have to get through this as quickly as possible, is fundamental.

0:02:45.4 AD: Neither of these asks are necessarily easy. We live in a world, as I am sure you are well aware, that both urgency and nervousness abound. There are, it is true, many aspects of life that call upon either our nerves or our sense of immediacy, like perhaps when you see a rattlesnake while you're out hiking, or maybe if a car in front of you on the freeway slams on its breaks. But there are also facets of life that poke at these feelings without a real need to act. Those, I believe, have become problematic on a very different scale. Let's say for example, that you have a phone. Let's also say that it is smart, it has a pretty screen and lots of enticing buttons. It lights up and makes funky sounds, and it connects you to everything and everyone.

0:03:31.2 AD: Everything you could possibly know, every person you could possibly talk to, every event that is possibly happening right now is right there on your phone. How cool is that? Incredibly cool, I think. But then let's say that you get a text, and that text is a group text that you have set up with a bunch of your besties, and one of your besties just pinged the group about the latest Hollywood romance that went bust, or the political scandal that is unravelling right now, or the current disease-carrying cabbage that has been pulled off the shelves of a grocery store you might shop at occasionally. There is nothing about any of this that can be handled with indifference, you have got to act right now, you better start Googling all the things so that you can have something smart and unique to contribute to the conversation so that you aren't out of the loop and possibly seen as not completely entrenched in current events. If you can feel the anxiousness stirring in you just listening to that anecdote, you are not alone.

0:04:36.2 AD: Big breaking news stories about health scares and environmental crises are undoubtedly something to fear and react to with some urgency, but they have become so frequent and impossibly prolific that our adrenals are all but shot, our nerves are on the frets, our sense of urgency is operating at such high alert that it has forgotten how to turn off, which makes approaching something that is not as dramatic, a little difficult. If everything contains elements of something to fear, and our ability to distinguish which of these is serious and which of these is misleading, has blown a gasket, how do we then relax around something that should elicit a little awareness, but not a full-blown heart attack? How do we hear a text ping and not pick it up right away to respond? How do we read a news story and not believe that the world is about to end? How do we approach a muscle that has so many red flags around it that we don't jump out of our skin and run away? These are awesome questions. I'm so happy you asked. Psoas dysfunctions press all of these buttons. They are the financial scandal of human biology, the political unrest of anatomical parts, the tsunami of muscle pain.

0:05:52.9 AD: Let me rephrase that. They are the tsunami warning of muscle pain, they lie waiting under the surface hidden from view, and could strike at any moment. We can have all the usual suspects lined up for a day of typical body work, shin splints, sciatica, tendinitis, and all the vague yet chronic pains of the neck, shoulders and low back. And then with barely a warning, in walks a psoas issue. The persistent hip pain or low back tension or leg weakness proves in fact to be the symptom of something lurking in the psoas. It crashes onto the shore and wreaks havoc for the unsuspecting massage therapist who was enjoying their day at the beach, thank you very much. You've been warned about this and you were given all the tools about how to survive a psoas tsunami, but here it is right in front of you, and all of those survival skills, they just flew right out the window.

0:06:48.6 AD: So let's go back to those two important rules I mentioned earlier. First, acknowledge your nerves, take a deep breath and decide that those are nerves of excitement, not fear. And then second, recognize your urgency, take an even deeper breath and channel your inner sloth, your snail spirit, your tortoise essence. Hit the breaks and slow everything down. Easier said than done, you might be thinking, and I agree. But it doesn't mean we can't try. I'll start with the excitement part. I don't know how to get you excited about anatomy, other than standing on the corner like one of those guys tax companies hire at taxis, and just spin huge arrows pointing towards the incredible deals they have to offer. Here I am with that cardboard arrow, spinning it with one hand, flashing a thumbs up with my other hand, holding a ridiculous grin on my face, and kicking one foot in the air. The psoas is an incredibly cool muscle. Located in the deep core, the psoas major originates on the transverse processes and the bodies of the lumbar vertebrae, crosses over the front of the pelvic bone and inserts itself at the lesser trochanter of the femur. What all of this means is that it anchors onto the front part of your low back spine, makes its way under the lower organs, kidneys, bladder, etcetera, and latches itself onto the very upper part of the inside of your thigh bone. See? So cool.

0:08:07.3 AD: As for the breaks part, think about it this way, the psoas itself is like an old man who has found comfort in isolation. It lurks deep in the dark, under the skin, under the abdominal muscles, under the small intestine, and all the omentum elements that make up the viscera. It sleeps quietly at the back corners of its cabin in the woods, on the anterior part of the low spine, it leans against the quadratus lumborum and slightly rocks every once in a while, but it watches with acute awareness, the wall behind it, and the organs and guts as they move like wind through the trees. Every once in a while, it is called on to play a role in its community. In its heyday, it could lift the leg up and bring it out into external rotation like nobody else in its little town.

0:09:07.1 AD: It could also, if it really needed to, bring the whole torso down to the thigh. And on a really good day, it had the strength to rock the pelvis back into a posterior pelvic tilt, which would make the quadratus lumborum really upset because the only thing that guy ever wanted to do was push the glutes out like some show-off who doesn't yet get how things work around here. But these days, the psoas is happy collecting spider webs. It is fond of its rocking chair and quiet spot in the woods where it can wave an angry finger at the passers-by who make too much noise, and the QL playing handball on its back door, an over extended colon, an irritated bladder, or the collective noise of the iliacus, the glutes and the erector spinae wanting to stand and walk around, these are all too much for the old man in the back, who just wants to spend his energy growing his beard. Working on the psoas is a little like opening the door of the cabin in the woods and shining a blaring light on someone who quite simply has gotten used to the dark. If you barge in with nervous energy and voracious speed, you will only scare it further into a darker corner.

0:10:15.6 AD: Old man psoas requires a certain finesse that you have access to, it just means first, that your approach should be calm and slow. Envision this, with your client supine, have them flex their knees so that both feet rest on the table, knees in the air. Your starting points from here are the umbilicus, otherwise known as the belly button, and the ASIS also known as the anterior superior iliac spine, also known as the front hip bone that you have most likely banged on a corner of a countertop a few times in your life. Draw an imaginary line between those two points and find the middle of that line. Now, call on your sense of peace and ease. Remind yourself that this old man's bark is worse than his bite. He is scary indeed, but he is not going to hurt you. And you are not going to hurt him. He just hasn't had human contact in a long time. With soft finger pads, orient your pressure towards the table, about 2-3 inches lateral to the spine. This clears the aorta and the vena cava, but before you unravel and lose any progress you might have made, remember that you will feel the pulse of the aorta loud and clear, and you can smoothly slide to the side of that to locate the psoas.

0:11:31.5 AD: You're not there yet though. First, settle, then orient, then slowly make your way in. Have your client take a deep breath into their belly and let your fingers rise with their abdomen. Then, as they exhale, let the weight of your fingers find the old guy in the corner. This may take a few breaths to get where you need to be, but your calm confidence will prevail. Once you have your sights on the psoas, offer the kind of pressure that elicits comfort, not kickback. Think of this extension as an olive branch to bridge the gap. Draw the psoas to you instead of forcing yourself on to it, you will feel a certain texture and density that is unique to this muscle. Once you are there, ask your team for some support. If you are on the right psoas, have your client slowly lift their right leg off the table just a little, about 10 degrees. This will engage old man psoas, but not so much that he will fight you back or simply give up. You will feel it fire very clearly.

0:12:35.1 AD: And at this point, you have done 90% of your job. To bring it all home, ask your client to relax their leg back down to the table, and in this sweet spot of a moment, coax the psoas into the light. Some gentle friction, a few steady gliding techniques, a little compression. Remind it that interaction with the world around it is not so awful. As a matter of fact, it can be rewarding, coming out of the cobwebs and feeling the flow of life is a healthy first step for someone who has chosen to disappear. The important part here is to work with efficiency, this is very different from urgency. If your client senses that you feel pressed, they will pick up on that, and the psoas won't wanna cooperate. But if you maintain a peaceful pace and make these initial communications efficient, the next time you knock on his door, the more willing he will be to open it. Working with the psoas is a long-term project that can begin from there, but the first step is that initial contact. Once he feels safe with you, he can begin to break away from the old patterns that kept him isolated and in the dark. Your ability to stay calm in the face of fear and work with a sense of purpose instead of urgency, is what he has been waiting for.

0:13:53.0 AD: Old man psoas has a youthful new glow, thanks to you. And here we are, the end of the episode. Thank you to the extraordinary crew over at ABMP for helping me get my words into your ears. And if you wanna get any of your words into my ears or more accurately, into my brain via my eyeballs, from a computer screen, drop me a line at rebelmt@abmp.com. That's R-E-B-E-L M-T @abmp.com. I always wanna hear your questions, comments, suggestions or salutations. Also, if you're interested in checking out anything else I'm doing, head over to rebelmassage.com where you will find all sorts of fun things to click on, like homemade organic products for your practice, cool links to continuing education classes, thoughts I have typed up and posted here and there, and other Rebel Massage dabblings. I'm impressed you've made it all the way to the end, but because you have, allow me to offer a glimpse into our next episode. Tune in next time, as I bring you the story of one massage therapist whose determination to help his clients understand their chronic pain, led him to create one of the most successful and funny pain research websites around.

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