The Psoas Fix: Unlock Pain-Free Movement

Key Takeaways From This Video:

• You're about to learn about the anatomy of the psoas, also known as the iliopsoas, which is a combination of two muscle groups: the psoas and the iliacus.

• The psoas originates on all five lumbar vertebrae, influencing these vertebrae, and merges with the iliacus, which connects to the inside bowl of the pelvis. Together, they attach to the inside of the upper thigh bone, or femur.

• While these two muscles have slightly different functions, for most people, the difference isn't dramatic. The psoas is generally agreed to be a hip flexor, contributing to moving the leg forward during walking, for example.

• The psoas may also contribute to a slight rotation of the femur due to its attachment point, but it's not a significant contributor to this function.

• It's important to think about muscles as they work together, not in isolation. When performing a hip flexion activity, for instance, you're not only engaging the psoas but also other muscles that contribute to the operation.

• The psoas also plays a role in stabilizing the lumbar vertebrae and can induce a shearing activity on the lumbar spine, potentially contributing to lower back pain and instability.

• The psoas has a relationship with the diaphragm muscle due to its attachment on the lumbar vertebrae and its connective tissue associations. The diaphragm, located under the rib cage, assists with breathing and stabilizes the rib cage.

• Throughout the course of the program, you'll learn more about how the exercises and movements recommended are related to the positioning of your rib cage. The aim is to get everything working together in a synchronous unit to optimize the function of all areas and reduce the load on problematic areas.

• Regardless of where you feel pain, the goal is to look at the optimized function of all these areas and improve them as best as possible.

Key Takeaways From This Video:

• You're now going to learn about the movements of the pelvis as a whole, and how the psoas and other hip flexor muscles influence the position of the pelvis, particularly in a condition called anterior pelvic tilt.

• Anterior pelvic tilt is a forward tipping of the pelvis, which can cause an inward arching of the lower vertebrae or lumbar spine. Conversely, a posterior pelvic tilt, where the pelvis rocks backward, can flatten or reduce the curve of the lumbar spine.

• It's important to note that anterior pelvic tilt is a natural and normal phenomenon. Men typically have about 0 to 5-7 degrees of anterior pelvic tilt, while women have around 7 to 10 degrees. Having more than this doesn't necessarily mean something is wrong, unless the tilt is significantly more, such as 30 degrees.

• The sacroiliac joints, where the pelvic bones meet the sacrum at the bottom of the vertebral column, can influence the whole structure of the pelvis. However, it's important not to obsess over small increases in anterior pelvic tilt.

• The sacroiliac joints have been a hot topic in relation to low back pain. While these joints can be problematic in certain situations, such as trauma or during and after pregnancy, it's generally untrue that these joints can move a lot or "slip out of place."

• Pain in the area of the sacroiliac joints doesn't necessarily mean the joints themselves are causing the pain, as there are many muscles, connective tissues, and nerves in that area.

• It's virtually impossible to separate the lower lumbar spine from the sacroiliac joints and the hips, so it's more helpful to describe pain in the lower back region as lumbosacral hip area pain.

• In this program, you're not going to address sacroiliac joint problems specifically. Instead, you'll focus on improving the function and balance of the entire system.

Key Takeaways From This Video:

• You're about to learn about the influence of the pelvis on the hip, which is often overlooked. It's important to understand that hip movement isn't just about the leg moving while the pelvis is fixed, but also about the pelvis moving while the leg is fixed.

• For instance, if your pelvis moves forward while your leg stays still, your hip is still technically moving into flexion. This understanding can help you identify which structures might be under stress or influence during hip activities.

• An example of this concept is the clamshell exercise, a classic glute exercise. If you're laying on your side with your hip bent at a 90-degree angle and you lift your knee, that's hip abduction. However, if you keep your hip still and move your pelvis instead, you're accomplishing the same relative motion.

• This concept is crucial because it extends the understanding of how the pelvis influences how the hip sits in the socket. If you're dealing with hip issues and you're not considering what the pelvis is doing, you're missing a significant opportunity to improve the situation.

• Even in cases of severe osteoarthritis or a degenerative hip joint, while you can't fix the degeneration, you can maximize the function of the hip joint by improving the mechanics of the pelvis and mid-spine.

• Throughout the course of the program, you'll see the relationship between all these parts. If you're limited in how much you can improve the hip joint itself, you can still make progress by optimizing the function and positional influence of the areas above the hip.

Key Takeaways From This Video:

• You're about to learn how to assess psoas tension, and it's crucial to understand the difference between an orthopedic range of motion test and the perception or feeling of muscle tightness.

• A standard test for psoas tension involves allowing the leg to drop over the end of a table. Normal values range from -5 to 10 degrees. If someone falls within this range, the test is graded as normal.

• However, people vary dramatically in their range of motion. Some people may have excessive range of motion, indicating hyper flexibility, while others may not reach the normal range, indicating a shortened or hyper contracted muscle.

• It's important to have proper testing done to confirm if the psoas muscle is truly shortened or hyper flexible. However, feeling like the psoas is tight is not the same as it actually being tight in a range of motion assessment.

• A muscle feeling tight can mean it's guarded, hyperactive, or painful, which can give the perception of tightness without actual tightness. This can lead to excessive stretching or massaging of the psoas muscle, adding excess flexibility to a muscle that doesn't need it.

• If the psoas muscle feels overworked or fatigued but has plenty of range of motion, the focus should be on the muscles surrounding the psoas that may have their own issues but may not have any symptoms.

• It's crucial to have accuracy in the tests to ensure you're not going in the wrong direction in the therapeutic process.

Key Takeaways From This Video:

• You're about to learn how to self-assess the psoas and associated hip flexor muscles. Remember, these tests can provide useful information but won't give you a complete picture of what might be happening inside the joint. For that, you may need visual imaging through a medical professional.

• The psoas muscle connects to all five lumbar vertebrae and attaches on the inside of the thigh near the groin area. Its primary function is to flex the hip, bringing your knee up towards your chest.

• Other muscles associated with the psoas are the rectus femoris (one of your quadricep muscles), the tensor fasciae latae (a small muscle off to the side of the hip), and the sartorius (the longest muscle in the body).

• The first test, called the Thomas test, is done laying on your back. You'll bring one knee up to the chest, which should flatten the back. If there's shortness in the psoas muscle, the opposite leg will start to pull up off the table. If the leg starts to rotate or spill out to the side, you may need to look at the tensor fasciae latae and the iliotibial band.

• The second test is performed by laying down with your leg hanging over something. This test can help identify tightness in the rectus femoris muscle. You'll be looking at how far the thigh bone descends and the knee angle. If the leg cannot go more than a certain angle, it indicates a shortened rectus femoris muscle.

• You should also observe which direction the leg goes. If it drops out to the side, it could indicate shortness in the tensor fasciae latae and the iliotibial band. If it moves into the midline, it could indicate laxity that allows the hip to rotate in quite a bit.

• If you find shortness in the psoas and the rectus femoris, the testing position itself can be a great stretch. A simple standing quadricep stretch with a little bit of a tail tuck can also help stretch the rectus femoris.

• If the leg moves in toward the midline and rotates inward, it's common in individuals who are hypermobile or sat like a "W" as children. There's often resistance to external rotation, and you may need to address multiple things around the hip.

• Remember, a psoas assessment is not just a psoas assessment. You need to evaluate multiple things around the hip to optimize your hip function.

Key Takeaways From This Video:

• Assessing psoas strength and endurance is a complex task. It's important to remember that the psoas doesn't work in isolation, but as part of a unit with other muscles, including the rectus femoris, tensor fasciae latae, and sartorius.

• Traditional muscle testing, such as having a person lay on their back and lift their leg against resistance, may not provide accurate results. This is because the therapist can directly influence the test and it doesn't reflect the way most people use their muscles in daily life.

• Instead of trying to isolate the psoas, consider using "predictor exercises" that strengthen the muscle as part of a functional unit. This approach can lead to more significant improvements over time.

• For example, incorporating a squat training program can strengthen the quadriceps, including the rectus femoris, which is part of the hip flexor group. As these muscles get stronger, you may see improvements in psoas-related activities.

• It's important to progress exercises and not spend excessive amounts of time on isolation exercises. Once you become adequate in certain movements, progress them and move on.

• There is no single test that can definitively determine if your psoas has enough strength and endurance. Instead, focus on hitting your milestones in terms of exercise progressions.

Key Takeaways From This Video:

• There are certain scenarios where you should seek medical advice rather than relying solely on exercise or physical therapy. These include:

• If you experience pain in the lower abdomen, especially on the right side, during hip flexor activity. This could be indicative of an appendix issue.

• If you experience pain in the genital region or lower abdomen that radiates down into the groin area. This could be related to an umbilical or abdominal hernia, or pudendal nerve compression.

• If you experience severe pain, nerve tingling, or neural symptoms in the groin or saddle area. This should be an immediate red flag for medical referral.

• If you experience severe pain or feelings of apprehension during simple activities like bringing your knee towards your chest. This could be a sign of significant issues like osteoarthritis of the hips or a torn labrum.

• If you're over the age of 50 and experiencing chronic psoas-based issues, it's important to have an evaluation of your hips. A simple x-ray can reveal significant issues like osteoarthritis.

• Always consult with your medical doctor if you're experiencing these symptoms. They will be able to provide appropriate medical evaluation and treatment.

Key Takeaways From This Video:

• Goal setting is a critical component in overcoming chronic issues. It helps you to focus on areas of improvement, rather than just on the presence or absence of pain.

• It's important to align your expectations with the reality of the therapeutic process. Remember, it's not an overnight fix.

• Pain is an experience, not a direct sensation. It's more effective to consider nerve sensitivity as a way to gauge progress in a therapeutic process.

• There are several ways to evaluate progress in a therapeutic program:Intensity of discomfort: Any reduction in the level of discomfort can denote progress.

• Type of discomfort: A transition from sharp, jolting pain to a dull ache can show progress.

• Frequency of discomfort: A decrease in the frequency of discomfort is a sign of progress.

• Improvements in function: If you're able to do more activity with the same or less discomfort, you're getting better.

• It's important to focus on improvements in function. Pain can fluctuate due to various factors, many of which are beyond our control.

• Keeping a journal can help you track your progress and identify patterns or triggers for increased sensitivity or pain.

• Set positive goals that focus on improving function and noticing small improvements. This will help your brain to focus on success and reduce nerve sensitivity.

Key Takeaways From This Video:

• This program is designed with you in mind, whether you're dealing with chronic pain, aiming to improve your movement goals, or seeking to enhance your overall health and well-being.

• While the focus of the program is on the psoas muscle, it's also beneficial if you're dealing with lumbo-pelvic-hip issues. It covers the lower spine, pelvis, and hips, providing a comprehensive approach.

• The goal here is to help you transition from where you are now to where you want to be, with a strong emphasis on setting realistic expectations.

• It's highly recommended that you watch all the introductory videos. They offer a comprehensive understanding of the therapeutic process and ensure you don't miss any crucial information.

• The program is designed to cater to all fitness levels. It starts with basic exercises and gradually progresses to more advanced ones. Even if you consider yourself an advanced fitness enthusiast, it's advised to start with the beginner exercises.

• The end goal of the program is to help you transition from basic exercises to gym-based activities, such as the split squat. Upon completion, you should be able to resume a normal fitness program.

• You're encouraged to leave feedback on the videos and share your successes with the program.

• Ultimately, this program aims to optimize your body, reduce nerve sensitivity, and help you return to your desired activities.

Key Takeaways From This Video:

• The movement-based approach to psoas issues aims to desensitize nerves to movement stimuli and improve tolerance, essentially sending non-threatening information from tissues and nerves to the brain.

• Ideally, the movement work should be pain-free training. While some research supports exercising through pain, this should ideally be medically supervised.

• The goal is to train the nerves that movements can occur without being threatening, leading to a down-regulation of nerve sensitivity.

• Flare-ups, or sudden increases in symptoms, are common during the therapeutic process, especially when starting new movements. These can often be avoided by not doing too much too soon and avoiding movements that feel threatening.

• Flare-ups can also be caused by factors unrelated to movement, such as poor sleep, excessive caffeine, or stress. During these times, you may need to adjust your exercises.

• It's important not to get hung up on the volume or speed of exercises. The key is to be thorough, meet objectives, note improvements, and steadily move forward.

• The goal is to continually expose the nerves to non-threatening stimuli, sending safety information to the brain, which in turn makes the nerves less sensitive. This creates a positive feedback loop in the therapeutic process.

Key Takeaways From This Video:

• Access the Program: Inside the PDF download section, you'll find links to the entire Google Drive folder containing all the programs, as well as individual links to specific programs like the stretching program or phase one exercises.

• Start with Stretching: The psoas stretching program is where you begin. It helps address tight muscles and teaches coordination of movement. It's recommended to do the stretching program at least once a day, or twice if possible.

• Phase One Exercises: You can combine the stretching program with phase one exercises or start with stretching alone. Follow the order, repetitions, and sets as recommended in the phase one document.

• Progression Through Phases: How long you stay in a phase depends on the individual. It could be one week or up to three weeks. The program might take some people six to eight weeks, while others might take six months.

• Direct Psoas and Hip Flexor Training: This is a challenging question and depends on the individual case. The program includes direct psoas and hip flexor training in progressions, but it might not be necessary for everyone.

• Don't Mix Phases: Stick to one phase at a time and follow the progressions. Some exercises may carry over between phases to allow for more practice and progression.

• Video Demonstrations: Each PDF contains links to Vimeo or YouTube videos to watch demonstrations of the exercises. Click on the name of the exercise to view the video.

• Keep It Simple: The program is designed to be simple and step-by-step. Start with the phases and go through them systematically. Check the question and answer section if you have any questions, and don't hesitate to reach out if you have any challenges.

Key Takeaways From Video:

• Sitting or standing for long periods isn't necessarily bad, but the lack of movement can lead to increased nerve sensitivity and discomfort. You're designed to move, and movement provides your nerves with the blood flow, oxygen, and nutrients they need.

• The issue with sitting or standing is the static nature of these positions. Try to incorporate movement into your routine as much as possible.

• When it comes to hip issues, be mindful of the positions that are most provocative. Sitting with your hips at a 90-degree angle can cause compression and discomfort.

• To alleviate this, adjust your seated position so that your knees are lower than your hips. This opens up the hip angle and can provide relief.

• Consider using a kneeling chair, which can open up the hip angle to around 120 degrees. However, these chairs may not be comfortable for long periods, so consider rotating between different types of seating.

• Set a timer to remind yourself to move every 30 minutes. This can help to offset the challenges of sitting or standing in one position for too long.

• Remember, the goal is to keep moving and to adjust your environment to support this. This can help to reduce nerve sensitivity and discomfort associated with prolonged sitting or standing.

Key Takeaways From Video:

• Crossing your legs can be a provocative factor for certain types of discomfort, particularly for issues related to the psoas muscle or the glute medius.

• While crossing your legs might initially provide relief from symptoms, the length of time you maintain this position can lead to discomfort. The key message is to keep moving and avoid staying in one position for too long.

• Be aware of your habitual leg-crossing patterns. Do you typically cross your right leg over your left, or vice versa? Do you cross at the ankles or thighs? Understanding these habits can help you identify potential sources of discomfort.

• Try to alternate the way you cross your legs, especially if you typically favor one side. This can help balance the strain on your muscles and joints.

• Avoid awkward leg-crossing positions that can distort your hip alignment and cause your spinal muscles to work harder to stabilize you. These include the "double cross" (where one leg is crossed over and then wrapped behind the other) and sitting on your foot.

• If crossing your legs provokes nerve sensitivity, it's a good idea to avoid this habit, at least temporarily, until the affected area is less sensitive.

Key Takeaways From Video:

• Driving can present similar challenges to sitting, particularly due to the static hip angle and lack of movement. The 90-degree angle of your knees while driving can be problematic for some, especially those with psoas issues.

• The type of car seat you have can also contribute to discomfort. For instance, bucket-style seats can exacerbate symptoms for some individuals.

• Lack of movement is a significant issue while driving. Depending on your commute, you could be in a static position for extended periods, which can lead to discomfort.

• To mitigate these issues, try to incorporate movement where possible and safe. For example, at traffic stops, perform hip shifting maneuvers to break up the monotony of the sitting position and pump blood into your tissues.

• Consider using a seat pad, cushion, or lumbar support roll to change the position of your pelvis and potentially alleviate discomfort.

• If sitting is a significant trigger for your discomfort, try to limit your driving time where possible. Alternatively, sandwich your driving time with corrective exercises or stretches before and after your journey to keep your body moving and reduce the impact of prolonged sitting.

Key Takeaways From Video:

• Sleep should ideally involve minimal to no psoas muscle activity as you're not working against gravity. However, residual nerve sensitivity from the day's activities or the position you sleep in can cause issues.

• When sleeping on your back, placing a support underneath your knees can help soften the tension on the psoas muscle and improve the hip angle.

• If you prefer sleeping on your side, be aware that resting your knees on top of each other can lead to hip adduction and internal rotation. This position can compress the tissues in the groin area and increase tension on the outer part of the hip and thigh, potentially causing discomfort.

• Using a bolster between your knees while sleeping on your side can help alleviate these issues.

• As you progress through the corrective elements of your program and reduce overall nerve sensitivity, you should experience more comfortable rest at night.

• Remember, better sleep leads to reduced nerve sensitivity, which in turn allows for more tolerable exercise, creating a positive feedback loop.

• Be sure to watch the specific video on sleeping positions and recommendations for more detailed guidance.

Key Takeaways From Video:

• The impact of activities on pain can vary significantly from person to person. Some people may experience increased nerve sensitivity and pain from basic household activities, while others can engage in strenuous activities like running or golf without provoking symptoms.

• If you feel comfortable with certain activities and your healthcare provider approves, you are encouraged to continue with them. However, always pay attention to your body's responses.

• Use a symptom journal to track any patterns in your pain levels following certain activities. If you notice a pattern of increased nerve sensitivity 24 or 48 hours after a specific activity, take note and consider this information when deciding whether to continue with the activity.

• Some people may be able to tolerate temporary flare-ups after certain activities, and as they get stronger through exercises and gain function, the nerve sensitivity may decrease over time.

• However, for others, it might be beneficial to temporarily reduce exposure to certain activities that provoke pain in order to decrease nerve sensitivity, and then gradually reintroduce these activities.

• Always consult with your healthcare provider for advice on managing your activities and pain levels. Their input, combined with your symptom journal, can provide valuable guidance in making decisions about your activity levels.

Key Takeaways From Video:

• Sleep quality is highly correlated with nerve sensitivity and your sensitivity to painful stimuli. Lack of sleep can make you more sensitive to all types of stimuli.

• Sleep issues can be triggered by pain, but the reverse is also true: sleep issues can exacerbate nerve sensitivity.

• It's important to evaluate your sleep quality when dealing with a psoas issue or any nerve sensitivity issue. On a scale of 1 to 10, with 1 being poor sleep and 10 being excellent, your sleep quality should ideally be at least a 7.

• If your sleep quality is below a 7, consider getting evaluated. The issue could be behavioral, requiring a good sleep management routine, or it could be due to undiagnosed conditions like sleep apnea or insomnia.

• Addressing sleep issues should be a priority when dealing with nerve sensitivity issues, as poor sleep can slow down the therapeutic process.

Key Takeaways From Video:

• While anti-inflammatory diets and protocols can support the main treatments in this program, they are unlikely to completely resolve psoas issues on their own.

• Anything that reduces harmful input into the central nervous system can be helpful in the therapeutic process. For example, if you're dealing with digestive issues or poor sleep, these can agitate your nervous system and exacerbate psoas issues.

• Systemic conditions like fibromyalgia, neuroinflammation, or autoimmune conditions can benefit from anti-inflammatory measures, as they address the system as a whole.

• It's not recommended to blanketly apply anti-inflammatory protocols for the context of this program. It's important to consider your individual health situation and seek the help of a nutritional professional if needed.

• It's often best to tackle one issue at a time, such as nutrition, sleep, or musculoskeletal issues. Once one area becomes stable, you can add in another.

• While anti-inflammatory supplements can be helpful, they should be used in the context of the overall therapeutic process. It's important to focus on exercises, movements, and pain education to directly impact the psoas issue.

Key Takeaways From This Video:

• Chronic pain, defined as nerve sensitivity persisting past the expected healing time of tissues (usually around six to nine months), is often associated with feelings of anxiety and depression.

• Anxiety and depression can be both precipitating factors for chronic pain and the result of dealing with chronic pain.

• Stress and worry specifically related to the area of pain can increase the sensitivity of the nerves and the brain's focus on that stimuli.

• Chronic pain can lead to increased levels of anxiety and depression due to the uncertainty and concern about the nature of the problem, especially when multiple healthcare providers are unable to provide relief.

• Addressing feelings of anxiety and depression can be crucial in reducing nerve sensitivity and aiding the chronic pain process.

• Gaining understanding and control over the therapeutic process can send safety messages to the brain, reducing feelings of threat and thus reducing pain.

• Pain education is vital in the therapeutic process when dealing with a chronic issue. Understanding what's going on can reduce stress and anxiety associated with the issue.

• If necessary, seek counseling to help develop coping skills and further understand your experience, which can help to alleviate fears and concerns.

Key Takeaways From This Video:

• Manual therapy, which includes massage therapy, physical therapy, chiropractic, and acupuncture, can be effective depending on the person and context. However, it should not be the sole focus of treatment.

• The goal of manual therapy is to send non-threatening information into the nervous system through hands-on therapy, causing a reset in nerve sensitivity and reducing it.

• Flare-ups, or sudden increases in symptoms, can often be avoided by not doing too much too soon and avoiding movements that feel threatening.

• Aggressive manual therapy is not always better and rarely is. It's not about breaking up scar tissue or adhesions, but about sending non-threatening information to the nervous system.

• Joint mobilization can be useful, either done by a practitioner or as self joint mobilizations. These can help guide a little extra range of motion or reduce some joint threat.

• Finding the appropriate practitioner for manual therapy can be challenging. Look for certain types of certifications or ask for referrals.

• In general, no more than about five visits are necessary for thorough manual therapy in one area. Continual treatment in one area becomes redundant and may indicate the issue is elsewhere or the person is not doing the necessary follow-up work.

• The key is to find the amount of therapeutic work necessary to help you self-regulate and deal with the issue yourself through ongoing exercise and stretching work.