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Working with the Psoas
A Myofascial Release Technique to Supplement your Acupuncture Treatment
If you are interested in more of this content on the psoas, we will expand on this subject on an online webinar at the end of the year or early 2021 for CEU credit. Keep an eye on the class schedule.
About the Psoas
The psoas major attaches proximally from the vertebral bodies and intervertebral discs of L4-T12 and the transverse processes of L1-L5 and then attaches distally to the lesser trochanter of the femur (Fig. 1).
In addition to its listed lumbar attachments, there are fascial connections of this muscle to the anterior longitudinal ligament, the renal fascia, and, in its superior fibers, the diaphragm (Fig. 2).
It has a strong influence on gait, spinal mobility and stability, and even proper breathing.
Fig. 2: The psoas and its relationship to the diaphragm and anterior longitudinal ligament
From a channel sinew perspective, the psoas majoris part of the myofascial plane of the Liver jingjin, coming up the medial thigh along with adductor longus, brevis and pectineus. As the psoas travels superior, it crosses the superior pubic ramus, and then dives deep into the body to meet with the Kidney jingjin.
The kidney organ itself has an intimate relationship with the psoas, as they move slightly up and down along the psoas with each breath as the diaphragm descends during inhale and rises during exhale. The renal fascia and the myofascial of the psoas are closely integrated; revealing a connection from the psoas to the kidney zang organ.
Fig. 3: Shortened right psoas causing R sidebend and L rotation.
The psoas can shorten bilaterally and pull the lumbar spine toward the lesser trochanter, causing lumbar lordosis and/or trunk flexion.
It can appear as if the person is not able to fully stand up and open the hip joint. Unilaterally, imbalances are more complex and there is some variation, but simply put, psoas shortening can be involved with spinal bends and rotations (Fig. 3).
ATS Freeing KID Jingjin Psoas
Fig. 4: Freeing the KID Jingjin at the Psoas
The following myofascial release technique, called Freeing the KID Jingjin at the Psoas,(Fig. 4) can be used for bilateral shortening; however, the technique really shines when working with unilateral imbalances. The goal of the technique is to integrate the movement of the right and left sides to achieve a more even tone and balanced position.
Let’s look at some simple instructions that involve accessing the psoas with the hands in the region of GB 27. We will also look at the movement the patient will be actively performing while you are manipulating the psoas.
With the patient supine, knees flexed and feet on the table, the practitioner slowly sinks bilaterally into GB 27 and directs the fingers medially following the edge of the iliacus to contact the psoas muscle.
The patient slowly lifts one foot while pressing the other into the table. Then, the patient slowly alternates sides. The rhythm should be that of slow walking.
The practitioner follows this movement and adjusts and modifies the pressure to facilitate a reduction of tension at fibrotic areas in the psoas.
That is enough to get started with the technique, but with access to the psoas you can use this muscle as a lever, almost like a puppet string, to balance the movement in the lumbar spine and hip. You might notice that one side of the psoas is very narrow and pulled more towards the midline, while the other is wider and more lateral. This will be the case with spinal bends and rotations. While the patient is performing this movement, you can gently mobilize the narrower medial psoas in a lateral direction and the more lateral one in a medial direction.
You might also take note as the patient presses one foot into the table and lifts the other, with one hand pulled down (on the pressing side) while the other is pulled up (on the lifting side). Does this feel even? You can nudge and encourage this movement if it feels sluggish on one side or the other. This will nudge and encourage the swaying in the spine that occurs with normal walking.
A Last Thought
Enter this area with the utmost respect and gentleness, despite the fact that you will be accessing a very deep layer. Gentle does not mean that you are holding back or not pressing deeply, but don’t bully your way in or work faster that the person’s body will let you in. For many patients, you might not do this on the first treatment, and you might consider doing some work with acupuncture and/or manual therapy on the abdominals before accessing the deeper psoas. If you can’t press in without forcing past the abdominal muscles, you may need to work with these spleen and stomach jingjin structures first. This will allow your deeper kidney jingjin treatment to be more effective.
Brian Lau, AP, C.SMA is has been on the faculty of the Sports Medicine Acupuncture Certification since 2014, and also teaches foundation courses with AcuSport Education. Brian lives and practices in Tampa, FL where he owns and operates Ideal Balance: Center for Sports Medicine Acupuncture (www.ideal-balance.net). He blogs on anatomy and TCM at www.sinewchannels.com.