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Hip Flexors - Fear, Surgical Trauma, Psoas Release with Remedial Massage

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"...I suspect recently sighted cases are due to trauma from Caesarian delivery."


At the core of our being, linked to the diaphragm, crossing the kidneys and adrenal glands, attached to the lumbar spine, engaging in fundamental locomotion and protective foetal reflexs, activated by fear, there is a strong relationship between the Psoas hip flexor muscle and primal responses. 


Hip flexors are muscles crossing the hip joint that pull the leg forward bringing the knee toward the chest. The primary hip flexors are Psoas and Iliacus and it is Psoas treatments that have been a clinic highlight with several cases silently crying out "Fix me please!!!". 


The most common cause for Psoas issues I encounter is sitting for prolonged workers, drivers, travellers or sleepers favouring the foetal position. Hold the hip flexed at 90 degrees long enough and the soft tissue in front of the hip shortens. Hip joint injury and over exercise can also be culprits. I suspect recently sighted cases are due to trauma from Caesarian delivery; the degree of dysfunction chronic and acute. 


Apart from using PNF stretch and positional release techniques, I've shied away from direct treatment on the Psoas muscle excepting in these acute cases. It is deep in the abdomen in a hard to get place that can cause high degrees of discomfort. However, when it needs it, it needs it and I position the client to take pressure off the abdomen by flexing the thigh at the hip while lying supine or on the side. Slowly pressing through the abdominal muscles and intestines, seeking the hard length of muscle lying next to and anterior to the lumbar vertebrae of the spine. A well developed Psoas feels to be up to an inch in diameter but a more common size is half an inch or less. From its' lowest attachment point at the base of the spine at L5, it traverses through the abdominal cavity to the front of the hip attaching to the top of the femur roughly 2/3's of the way up the inguinal crease. 


Initial treatments combined with positional release and PNF stretching are limited to engaging my fingertips with the tight Psoas and gently applying pressure. When release occurs, straightening the leg to open the hip lengthens the muscle and allows further pressure to be applied. Subsequent treatments can progress to more extensive cross fibre massage along the length of the muscle. 


The first sign of a positive outcome is flattening at the small of the back; lying on the table the client will feel more contact between table and back, the practitioner will find less room to slide a hand under the back. The client will report reduced lower back pain, a feeling of standing more erect and improved breath. 


Naturally, fascial release of the diaphragm, general somatic release, relaxation, meditation and exercise enabling the body to achieve a para-sympathetic state greatly assists this treatment.


In the interest of brevity and to clearly focus readers' vision on the condition, I did not expound on the full range of treatment and rehabilitative exercise I employ to relieve this condition.  Less invasive and more gentle Indirect Fascial Release techniques targetting the psoas muscle, hip joint and torso generally are an effective adjunct to the direct approach described above. The direct approach is still required, particularly for remodelling scar tissue. Strengthening and stretching/relaxing musculature about the pelvis rectifying position of the hips and lordosis of the spine is also necessary.

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