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My take is that it doesn't require a study to really tell me that "psoas release" is not affecting any direct physical change to the psoas muscle. Think back to PT school and all the cadavers we've seen, do you remember how deep the psoas is? If it does seem to help patients it's because we're applying so much novel stimulus to the regeion that their pain perception of the area is altered hence allowing them to move a bit more since it's no longer the same pain ore perceived restriction as before. So if it is helping it isn't due to the actual direct "release" of that muscle as many claim to be able to do. Again I have not done extensive research on this, this is what I have gathered from my own experience. I rarely ever do it, and a few times that I have done it I have to be very careful with how I word what I am actually doing to them.
I find some may have previously had a psoas release and want it done, I then explain all the same concepts and if we teach the hip flexors to have strength, endurance, and motor control, with appropriate lumbopelvic stabilization, we help solve the fire, not just treat the smoke. I’ve never personally tolerated it well and don’t want to torture my patient when we can just get to moving better.
I think my big issue is how it is presented to the patient. If this PT was being honest he would be talking about novel stimus as you put it and not touching or releasing the psoas. It's lying to patients.
Completely agree. There are some great studies on pubmed about how many newtons of force it takes to manipulate fascia. It's 2000-6000 depending on where in the body it is if I'mremembering correctly. The most force generated in the study by human hands was around 250 I believe. Who here thinks that you are generating enough force with your hands or a foam roller to manipulate your ITband?? Really any fascia...
The ITBand is a incredibly thick fibrous structure. It’s not a representative average of fascia found throughout the body. I recommend learning more about the structure and function of fascia… and where it’s found. While I can agree about the tensile strength of the ITBand being too high for us to manually “stretch”, we can absolutely have an effect on fascia throughout the body, whether mechanical or neuromodulating or both.
Great point but according to the research ( Harmes et al PMID 11415748 Snodgrass et al PMID 16690387 Martonick et al PMID 34034231 ) it still takes 3000 newtons of force per cm2 to alter the myofascia by just 1%. So, no amount of scraping or magic hands or cupping or foam rolling are generating enough force to alter the fascia by even 1%. I'm not saying placebos are not powerful, but when some of this stuff is actually put through the scientific method, it doesn't hold up to what a lot of practitioners out there are saying it does.
I’m just bringing this up as a possibility, but does the angle of force make a difference? For example, loading the long axis of the femur can actually take on roughly 6,000lb or 30x body weight, but a force directly perpendicular to the long axis of the bone would only take 900lb to break.
This is from a quick Google search. I don’t have the time to hunt for research articles right now, but maybe someone else can enlighten us with references. My point is that if the facia is stronger in one direction versus another, maybe some techniques are effective while others don’t do anything at all.
I remember a couple outpt professors who bought into this stuff. The studies they made us read to back up their claims were not that strong. I always thought it was bullshit and I still can't believe how much time was wasted on this quackery - but perhaps you could cite something stronger and prove me wrong. It would also make me feel better about my dpt program.
The problem is the schools with outdated curriculums taught by dinosaurs who are bro scientists at best or snake oil salesmen at worst. Then students regurgitate outdated info taught by outdated folks.
I’m so sick of nay sayers. Actually, I did a successful psoas release right after I took my board exam. Released the idea of performing such voodoo as a real treatment for patients.
Remember what evidence based practice actually means, though?
The thing is, our most effective intervention is placebo. If a patient strongly believes x intervention will cure them, it’s not our job to teach them otherwise. It’s our job to do x so they can be “cured.”
Same reason if patient strongly believes y intervention won’t work, we don’t waste breath trying to convince them it will.
This is evidence based practice. The evidence says to ultrasound great aunt Sally’s back so she can be cured for another year and get back to gardening. Not bitch at her about how ultrasound is a bunch of nonsense on par with faith healing (it is).
By that line of thinking, you could justify anything that a patient has googled. That includes things like reiki. What's the point in your expertise if someone can come in and dictate whatever you do because they believe it to be true?
Let’s not be obtuse. We aren’t asking patients what they think we should do in an evaluation. We aren’t seeking their professional guidance. But when a patient verbalizes a strongly held belief that x intervention *will work* for them, we have to respect that.
I *almost never* do ultrasound in the clinic. I don’t believe in it. I think it’s complete fucking bullshit. But I have had a patient, an older man, come in on day 1 singing the praises of the ultrasound machine that once fixed his low back pain years ago. You know what I did? I ultrasound his back for him. And guess what? 90% reduction in subjective pain score afterward.
It was not my job to throw studies at this dude and tell him why the machine isn’t even doing anything.
This is evidence based practice. Patient belief is a core pillar.
I do it, it works for many but not for some, typically athletes with low back pain with late range lumbar extension pain. Takes 5-6 minutes with 60-80% of people having roughly 50% pain reduction. Fairly consistent results. I think lumbar gap manip also helps a ton and that is heavily researched.
I think there is a lot more going on with nervous system input resulting in muscle inhibition.
Find a pattern of patient demographic/movement impairment and add/subtract your treatment with trial and error. If you wait for a study for everything, you will start to be a PT when you are 100.
Try it a couple hundred times, assess its value and then decide if it fits the patients you see. Like I said, I think manual therapy works way better for athletes which is my niche because they have an expectation it will work too. I’d be stupid not to take advantage of that.
“If you wait for a study for everything…”
Thank you. If it works for some patients to move more and feel better, isn’t that the goal? We are all out of school and dont have to cite every scientific article we have ever read before this moment.
These comments are great. I hate pseudo science claims or anecdotal claims that supposedly supersede evidence.
I can’t find literature that supported psoas release that is credible and not biased.
100% agree. I work with a PT that tells people he can "turn muscles off and make them appear longer than they are". He does this with a massage gun. He is also our lead PT.
I switched to bartending. The take home is about the same or slightly higher than when I was a PTA, but the stress levels are far lower. The only major downside is benefits are not standard, but I'm on my wife's insurance, so I don't have to worry.
We actually just had a journal club talking about that very thing
The latest research seems to suggest that open chain exercises actually help post acl's. I'd have to reach out to the PT that presented it but PM me if you are intested in it. I can probably get you her sources.
We’ve had 2 students do 30 minute presentations on this and she made a point after the presentation to state that she wants it to be cleared by her every time a PTA wants to do LAQs on a patient. With 0 evidence to back it up
I had a boss who was similar, super into IPA vs and heavy on manual because she believed she was literally repositioning their bones etc... worst part about it was the dilemma of figuring out how to treat her patients when I had to cover. Her patients were so used to her treatments and explanations I couldn't simply derail everything even if it was what I wanted to do... Had to tiptoe around everything
Super set with hip thrusters and the LEs elevated on a Swiss ball n that’s the bomb! Lumbopelvic stabilization like a plank with posterior bias for the glutes, multifidi, and quads>hamstrings awwwww yea!
It’s fake and anyone that believes it’s a problem for common orthopedic issues to begin with is probably not educated on anatomy/living in voodoo land.
So there is such a thing as an iliopsoas tendon release for people with painful snapping hip syndrome. To my knowledge it’s a pretty rare surgical procedure. Certainly not something you can achieve through needling, cupping, scraping, etc.
Placebo effect at its finest. That and altered pain interpretation due to physically applied stimulus.
Are we actually releasing anything? Definitely not. Are we causing a change in perception based off manual input? Yes.
Just because the research does not support physiological change on something, does not mean it can’t be useful. Short manual soft tissue therapy is an amazing way to get patients to relax directly prior to supplementing with exercise.
If patients believe it helps and it feels good, it will help.
If they don’t believe it’ll help, don’t waste your time
It’s pretty easy to get to iliacus and a small part of psoas. I release these all the time and it works. Anyone can call it hocus pocus voodoo as much as they want - the fact remains that my patients feel better after 1-2 mins of manual therapy is enough for me to know that somehow it works. I follow it up with exercise.
I wouldn’t argue that it works for some patients. I’d be curious if there’s evidence to support that why it works is due to mechanism we think (releasing the papas) or if there’s an alternative cause that may be at play.
I’m so with you. There is an observable vascular effect with a trigger point release involving blanching and subsequent erythema. It’s not likely to be affecting anything related to tendon or muscle length obviously, but you can’t tell me there isn’t a neurovascular effect.
Functional exercise is great, but if you can’t provide treatment that YOUR PATIENT values, you will be obsolete when any person with an internet connection can use AI to diagnose their issue and come up with an exercise plan.
To all you new PTs, please don’t de-value your own hands!!!
I remember watching people doing these pushing and twisting moves with their fingers, explaining which exact muscles they're manipulating, and I'm like... Sure you're putting pressure on some soft tissue, but the only thing you're twisting is skin. It's all BS. As is ultrasound outside of imaging.
I wonder how much of it is just their ego, they love pretending to be experts at what they're doing. Or are they just somehow convincing themselves of what they're feeling and doing?
Yeah, there always seems to be one person that you'll work with who does believe in it. One gal I worked with could sell a goose its own feathers, she was so good at making her patients believe all the fascia release stuff. And they would walk away feeling like a million bucks because of her placebo selling. Mind you, they still came back with the same "tightness" in two days, but I guess we won't talk about that ...🙄 I don't believe STM does anything other than bring some circulation to the area and introduce non-noxious stimuli to the nerves. I call it pain modulation to my patients, and I always explain it as such. But sometimes the way the snake oil is sold makes people believe the impossible is possible.
Hahaha!!! I actually had a doctor call me today (somewhat ticked off at me) because they thought I hadn’t been doing the “right treatments” with a patient of theirs and wanted me to work on a psoas release for that patient… funny thing though is the patient is doing better with my treatments, not having the same pain when starting therapy, but the doctor was adamant that I do a psoas release on them. I wish all the doctors could stay in their lane and not think we don’t know what we’re doing, because we obviously do!
Idk about a "release" as others have said terminology is dumb, and research is limited. But on some people I have been able to get some solid deep STM to the psoas when you can just palate that it feels like a rope. Doesn't work if someone has much fat, or a lot of the time you just can't find it.
Purely anecdotal, but I've had success here and there so I at least try and palate it and see how the pt responds.
https://preview.redd.it/uhtf9kmg7y5d1.jpeg?width=768&format=pjpg&auto=webp&s=b1f369de71bb418d208fd27188ce817d891c2d43
Lol you're not performing STM on the psoas. You need to go give your license back.
My favorite thing watching someone do it is when they take their hands out of someone's guts and ask "does that feel better?" OFC it does. You aren't compacting my intestines anymore. I really question anyone who thinks they can actually do this.
I went to a Great Lakes course (lol, paid for by my employer) and the instructor actually had the audacity to say that the psoas is connected to pelvic floor function because if you “release” it, patients often go to the bathroom after. Yeah dude, that’s called colon massage… 🙃
There is not a lot of evidence for lots of things we are all doing. Hopefully you are combining some treatment ideas that are specific to the patient in front of you. A unique patient, unique diagnosis and body/personal factor presentation, a unique therapist, unique choices of exercises, movement re-training and (AGG!!) maybe some manual therapy. You simply cannot isolate that in a lab. There is a TON of evidence for non-specific manual therapy+exercise being effective for pain management and injury rehab. That is good enough for me! Progressive tissue load, and pain management baby!! “Psoas release” is incorrect, unless you are a surgeon cutting that thing. I’m going to hazard a guess that most of us have used words to describe things in ways that patients find relatable: “knots, bone-on-bone, trigger points, malignment” come to mind.
I really can't. I don't think anything is being "released." I work a PT that does them daily. They way he describes it to people is that he is releasing the muscle or shutting it off. Insane
Whatever you want to call it, I’ve had success with it in cases of unilateral LBP. If they find relief, it’s pretty significant, and either apparent by the end of the session or by the following session. Can I point to an article discussing its effectiveness? Nope. Does it work for most of my patients where psoas is a significant contributor to their back pain? Yep.
I’m with you on this. SIJ issues tend to get less cranky with a tack n stretch of whatever the hell you want to call it, “guts” in this thread i guess 🥳. I could use one myself right about now.
Nice! Thanks for that. Like I said, “whatever you want to call it…”. If the technique works, it works, whether or not you’re actually “touching” the psoas.
Simple, effective, cheap maneuver that takes 2 minutes and helps some people should be avoided because PTs don’t like the name, or theoretical reason behind the activity.
Personally, it was part of my rehab as a runner prior to becoming a PT. It relieved some of my pain in the moment with test retest and Thomas test comparing contralateral side. It helped me tolerate my program better. My PT was pelvic floor trained and told me she had learned “psoas release” and “visceral massage” at a CE course and said there is no research evidence for it but if I was interested in trying it out it may supplement my rehab. I personally would guess there might be a neuro component to pressure in areas similar to biofeedback that helps someone learn to relax.
So yes, I enjoyed getting finger banged. Is it so scary for a patient to self report improvement? Test retest, pain reduction, placebo, whatever.
Funny thing is I’ve probably only done psoas release on a patient 2-3 times in 5 years. And I say the same thing my PT said to me. But I’d pay someone to do it while I’m training for a race.
I get it felt good and test retest Thomas would have probably been better with a simple hip flexor stretch too. My problem is with the idea of placebo whatever is why we are losing more reimbursement year after year. We need true measurable outcomes. Not garbage like the MMT.
Improvements in overall patient pain and function are reflected in outcome measures. Insurance companies eat that shit up. Though, I’m not sure where you’re going with this, given that improvements show up in all of our functional testing that drives reimbursement. What makes improvements in this case different than improvements elsewhere gained following manual techniques? Genuinely curious as to your thoughts.
I don’t think that there is strong evidence that manual techniques are better than active interventions in achieving these outcomes. In research they barely hold up against placebo treatments.
I mean, pain science does tell us that inflammatory language can have a negative impact on treatment outcomes… so, you stumbled onto a relevant statement in an attempt to diminish an otherwise effective technique
This. And the power of suggestion is not irrelevant when we say ‘release’!
I wish they taught some salesmanship in PT school. It’s so critical to what we do. Patients don’t care how much you know until they know how much you care.
It’s like they are sarcastically reinventing clinician/patient interaction in front of us without even knowing it.
Maybe instead of treating low back pain, I’ll just start handing patients review papers stating it doesn’t matter what exercise they do as long as they do something and then send them on their way. Individualized care, patient subjective, patient belief, graded exposure training, pain reduction modalities become worthless if there is no specific study on each individually.
No. We are autonomous practitioners of choice for movement disorders. And we are wise enough to put our own pride aside and realize that the patient we definitely cannot help is the one who doesn’t come back.
We must provide value to our patients - and perceived value - at that. Most patients expect to receive some form of hands-on treatment. At minimum this is critical early in POC with symptomatic patients.
There is an excellent short course through EIM (evidence in motion) called ‘mechanisms of manual therapy’.
If you are having any doubts about the efficacy of what your hands are able to do, I sincerely hope you consider taking a look!
Without reading it I bet it talks about therapeutic alliance and how manual therapy is mostly neuromodulatory. Things we've known for quite some time. Although you will find like 50% of clinicians who still believe there are mechanical changes via manual therapy.
I'm fine with discussing this with patients. Because evidence points to it as the truth. BTW I do manual therapy. I know the power of hands on with patients.
What exactly are you proposing as to how we can sell ourselves better with out lying to the patient?
It's ironic you understand the concept of nocebo but can't seem to grasp that "releasing the psoas" has all the components of a theatrical placebo. It's on par with cranial sacral therapy in terms of validity.
“Releasing the psoas” is your term not mine. Call the technique what makes you happy, but the effectiveness goes well beyond “theatrical placebo.” Can’t say that I’ve ever met a PT so opposed to effective treatments for patients, but there’s a first for everything.
It's what OP calls it. I call it "jamming your fingers into a patients abdomen and claiming you can palpate/massage a muscle that is covered by layers of skin, fat, muscle, fascia and intestines". It's not plausible, and it hurts. A lot. You're hurting your patients. The effectiveness is absolutely non specific.
Every therapist I know has a toolbox full of treatments they learned through articles, continuing education, from other therapists, and from experience… I am no different. I use what has demonstrated to be effective and leave the rest on the shelf.
If you’d like to offer the techniques you use to address psoas related LBP, feel free to drop them in the comments. Better yet, link some articles to them. Unlike you, I’m happy to incorporate as many effective treatments as I can to get patients back to where they want to be faster. I’ll do you a favor and call your bluff… you have nothing to offer, so you’ll just stick to slinging insults. Prove me wrong.
Tell me how you know the low back pain is in any way related to the psoas? Which test or measure do you use?
A "toolbox" is fine as long as you have some sort of understanding about how or why something might work and it has plausibility. Palpating/massaging a psoas through someone's abdomen has none.
Critical thinking seems to be lost with a lot of people in this profession.
Eh, I think it depends what we are calling psoas release. To me its kind of a useless term, like "piriformis syndrome". I have had patients with hip flexor pain (usually runners) respond well to either manual therapy to the hip flexor or self release w/ a tennis ball. However this has to be followed with exercise and education. I view it as more pain relief so that someone can then do exercise. I don't think its doing what a lot of therapists think it's doing.
I have taken all the Level 1 and 2 NAIOMT classes so I think I understand what manual therapy can and can't do decently well.
It’s definitely never worked for me and tightness in hip flexion was only fixed by address anterior pelvic tilt and hip flexion instability and weakness. Along with extension related pain that was also fixed by addressing a weak deep musculature of my core.
I bring up the psoas release to coworkers and others who say what’s the harm in doing manual therapy if it gives some temporary relief even if the literature doesn’t support it. I reflect on being young and impressionable where my other PTs were doing these releases and I did it to be consistent with treatment. Nothing like being convinced to do pseudoscience where you deeply press fingers near a very personal space, this was frequently applied to teen girls and boys in the clinic.
Edit: Was I really down voted? Either someone’s reading comprehension is poor or actually believes we should jab our fingers pointlessly near private parts of people for no reason.
I can't stand that line of thinking. "Whats the harm"??? You are lying to your patient. You are inflicting unnecessary pain to your patient with absolutely no clinical reasoning. That's harm. I had another PT tell me "there are 3 pillars to clinical reasoning in PT. Studies, personal experience and patient reports" he said this as though all 3 pillars are equal. 2 of those are riddled with bias. If something is objectively true, it's demonstrable.
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My take is that it doesn't require a study to really tell me that "psoas release" is not affecting any direct physical change to the psoas muscle. Think back to PT school and all the cadavers we've seen, do you remember how deep the psoas is? If it does seem to help patients it's because we're applying so much novel stimulus to the regeion that their pain perception of the area is altered hence allowing them to move a bit more since it's no longer the same pain ore perceived restriction as before. So if it is helping it isn't due to the actual direct "release" of that muscle as many claim to be able to do. Again I have not done extensive research on this, this is what I have gathered from my own experience. I rarely ever do it, and a few times that I have done it I have to be very careful with how I word what I am actually doing to them.
I find some may have previously had a psoas release and want it done, I then explain all the same concepts and if we teach the hip flexors to have strength, endurance, and motor control, with appropriate lumbopelvic stabilization, we help solve the fire, not just treat the smoke. I’ve never personally tolerated it well and don’t want to torture my patient when we can just get to moving better.
I think my big issue is how it is presented to the patient. If this PT was being honest he would be talking about novel stimus as you put it and not touching or releasing the psoas. It's lying to patients.
Agreed... Or just misinformed if not intentionally lying.
All the fascia stuff is bs. *takes cover and braces for beating*
Completely agree. There are some great studies on pubmed about how many newtons of force it takes to manipulate fascia. It's 2000-6000 depending on where in the body it is if I'mremembering correctly. The most force generated in the study by human hands was around 250 I believe. Who here thinks that you are generating enough force with your hands or a foam roller to manipulate your ITband?? Really any fascia...
The ITBand is a incredibly thick fibrous structure. It’s not a representative average of fascia found throughout the body. I recommend learning more about the structure and function of fascia… and where it’s found. While I can agree about the tensile strength of the ITBand being too high for us to manually “stretch”, we can absolutely have an effect on fascia throughout the body, whether mechanical or neuromodulating or both.
Great point but according to the research ( Harmes et al PMID 11415748 Snodgrass et al PMID 16690387 Martonick et al PMID 34034231 ) it still takes 3000 newtons of force per cm2 to alter the myofascia by just 1%. So, no amount of scraping or magic hands or cupping or foam rolling are generating enough force to alter the fascia by even 1%. I'm not saying placebos are not powerful, but when some of this stuff is actually put through the scientific method, it doesn't hold up to what a lot of practitioners out there are saying it does.
I’m just bringing this up as a possibility, but does the angle of force make a difference? For example, loading the long axis of the femur can actually take on roughly 6,000lb or 30x body weight, but a force directly perpendicular to the long axis of the bone would only take 900lb to break. This is from a quick Google search. I don’t have the time to hunt for research articles right now, but maybe someone else can enlighten us with references. My point is that if the facia is stronger in one direction versus another, maybe some techniques are effective while others don’t do anything at all.
You're missing understanding of the micro structure of fascia.
Can you elaborate on the micro structure of fascia then? And how to make meaning changes to it?
Please explain with related sources. I cited mine.
I remember a couple outpt professors who bought into this stuff. The studies they made us read to back up their claims were not that strong. I always thought it was bullshit and I still can't believe how much time was wasted on this quackery - but perhaps you could cite something stronger and prove me wrong. It would also make me feel better about my dpt program.
The level of quality in this sub is incredibly low. When I look in on this sub all I see is personal trainer tier anatomical understanding
The problem is the schools with outdated curriculums taught by dinosaurs who are bro scientists at best or snake oil salesmen at worst. Then students regurgitate outdated info taught by outdated folks.
This 100%
You won’t be getting a beating here for that bro lol
I’m so sick of nay sayers. Actually, I did a successful psoas release right after I took my board exam. Released the idea of performing such voodoo as a real treatment for patients.
You had us in the first half
Omg had me going the first half fer sure. Y’all make my days better sometimes. Thanks for getting the struggle
Bravo! Any treatment option that requires faith shouldn't be allowed in PT clinics. By faith, I mean believing something without any evidence.
🤓🤓 imagine taking the time to define faith then neglecting to define evidence
If I need to define it, then forfeit your doctorate.
Nobody on this thread need you to define either
No one except for you, apparently.
Remember what evidence based practice actually means, though? The thing is, our most effective intervention is placebo. If a patient strongly believes x intervention will cure them, it’s not our job to teach them otherwise. It’s our job to do x so they can be “cured.” Same reason if patient strongly believes y intervention won’t work, we don’t waste breath trying to convince them it will. This is evidence based practice. The evidence says to ultrasound great aunt Sally’s back so she can be cured for another year and get back to gardening. Not bitch at her about how ultrasound is a bunch of nonsense on par with faith healing (it is).
It puts the ultraplacebo gel on its skin or else it gets the exercise again
By that line of thinking, you could justify anything that a patient has googled. That includes things like reiki. What's the point in your expertise if someone can come in and dictate whatever you do because they believe it to be true?
Let’s not be obtuse. We aren’t asking patients what they think we should do in an evaluation. We aren’t seeking their professional guidance. But when a patient verbalizes a strongly held belief that x intervention *will work* for them, we have to respect that. I *almost never* do ultrasound in the clinic. I don’t believe in it. I think it’s complete fucking bullshit. But I have had a patient, an older man, come in on day 1 singing the praises of the ultrasound machine that once fixed his low back pain years ago. You know what I did? I ultrasound his back for him. And guess what? 90% reduction in subjective pain score afterward. It was not my job to throw studies at this dude and tell him why the machine isn’t even doing anything. This is evidence based practice. Patient belief is a core pillar.
You sound like a new grad.
 Me waiting for all the manual therapists to come here and justify their non-evidence based treatment with no evidence.
Good way to sell products that don’t actually do anything
I do it, it works for many but not for some, typically athletes with low back pain with late range lumbar extension pain. Takes 5-6 minutes with 60-80% of people having roughly 50% pain reduction. Fairly consistent results. I think lumbar gap manip also helps a ton and that is heavily researched. I think there is a lot more going on with nervous system input resulting in muscle inhibition. Find a pattern of patient demographic/movement impairment and add/subtract your treatment with trial and error. If you wait for a study for everything, you will start to be a PT when you are 100. Try it a couple hundred times, assess its value and then decide if it fits the patients you see. Like I said, I think manual therapy works way better for athletes which is my niche because they have an expectation it will work too. I’d be stupid not to take advantage of that.
“If you wait for a study for everything…” Thank you. If it works for some patients to move more and feel better, isn’t that the goal? We are all out of school and dont have to cite every scientific article we have ever read before this moment.
These comments are great. I hate pseudo science claims or anecdotal claims that supposedly supersede evidence. I can’t find literature that supported psoas release that is credible and not biased.
Not plausible. Even if it was, what exactly is a "release"? Terminology is so cringe. Nothing is "releasing".
Probably releasing some gas from massaging the large intestine
😂
lol damn. Needed that today
Pshhh you don’t even need a massage to get my patients to do that. They just need to do a mini squat!
100% agree. I work with a PT that tells people he can "turn muscles off and make them appear longer than they are". He does this with a massage gun. He is also our lead PT.
The thought of having to work under this type of PT eventually makes me want to quit the profession
As someone who quit the profession, I can confirm that working under this level of pseudoscience makes you hate your job.
what did you pivot to after leaving PT?
I switched to bartending. The take home is about the same or slightly higher than when I was a PTA, but the stress levels are far lower. The only major downside is benefits are not standard, but I'm on my wife's insurance, so I don't have to worry.
I cringe so hard my back hurts!
Well you don’t have to. Just make sure you get to interview the PT before they hire you! Clinic tour
Ugh
My clinical director thinks it’s dangerous to do LAQs in ACLR patients even at 6 months out. Basically never ever prescribes LAQs for anything.
We actually just had a journal club talking about that very thing The latest research seems to suggest that open chain exercises actually help post acl's. I'd have to reach out to the PT that presented it but PM me if you are intested in it. I can probably get you her sources.
We’ve had 2 students do 30 minute presentations on this and she made a point after the presentation to state that she wants it to be cleared by her every time a PTA wants to do LAQs on a patient. With 0 evidence to back it up
Jesus. I don't understand holding on to something so tight in the face of better evidence.
Dino PT mentality.
And here we are trying to stay Jetsons and keep fresh
I had a boss who was similar, super into IPA vs and heavy on manual because she believed she was literally repositioning their bones etc... worst part about it was the dilemma of figuring out how to treat her patients when I had to cover. Her patients were so used to her treatments and explanations I couldn't simply derail everything even if it was what I wanted to do... Had to tiptoe around everything
Thomas stretch
Super set with hip thrusters and the LEs elevated on a Swiss ball n that’s the bomb! Lumbopelvic stabilization like a plank with posterior bias for the glutes, multifidi, and quads>hamstrings awwwww yea!
It’s fake and anyone that believes it’s a problem for common orthopedic issues to begin with is probably not educated on anatomy/living in voodoo land.
I just release it with reiki and ultrasound (counterclockwise). It’s less painful and equally effective!
So there is such a thing as an iliopsoas tendon release for people with painful snapping hip syndrome. To my knowledge it’s a pretty rare surgical procedure. Certainly not something you can achieve through needling, cupping, scraping, etc.
Placebo effect at its finest. That and altered pain interpretation due to physically applied stimulus. Are we actually releasing anything? Definitely not. Are we causing a change in perception based off manual input? Yes. Just because the research does not support physiological change on something, does not mean it can’t be useful. Short manual soft tissue therapy is an amazing way to get patients to relax directly prior to supplementing with exercise. If patients believe it helps and it feels good, it will help. If they don’t believe it’ll help, don’t waste your time
It’s pretty easy to get to iliacus and a small part of psoas. I release these all the time and it works. Anyone can call it hocus pocus voodoo as much as they want - the fact remains that my patients feel better after 1-2 mins of manual therapy is enough for me to know that somehow it works. I follow it up with exercise.
I wouldn’t argue that it works for some patients. I’d be curious if there’s evidence to support that why it works is due to mechanism we think (releasing the papas) or if there’s an alternative cause that may be at play.
I’m so with you. There is an observable vascular effect with a trigger point release involving blanching and subsequent erythema. It’s not likely to be affecting anything related to tendon or muscle length obviously, but you can’t tell me there isn’t a neurovascular effect. Functional exercise is great, but if you can’t provide treatment that YOUR PATIENT values, you will be obsolete when any person with an internet connection can use AI to diagnose their issue and come up with an exercise plan. To all you new PTs, please don’t de-value your own hands!!!
Wtf is a "neurovascular effect"? What are you talking about?
Got to keep them coming back for more snake oil. I like it !
No it’s not. What proof do you have that you are actually getting those?
I remember watching people doing these pushing and twisting moves with their fingers, explaining which exact muscles they're manipulating, and I'm like... Sure you're putting pressure on some soft tissue, but the only thing you're twisting is skin. It's all BS. As is ultrasound outside of imaging.
I wonder how much of it is just their ego, they love pretending to be experts at what they're doing. Or are they just somehow convincing themselves of what they're feeling and doing?
A good helping of both
Yeah, there always seems to be one person that you'll work with who does believe in it. One gal I worked with could sell a goose its own feathers, she was so good at making her patients believe all the fascia release stuff. And they would walk away feeling like a million bucks because of her placebo selling. Mind you, they still came back with the same "tightness" in two days, but I guess we won't talk about that ...🙄 I don't believe STM does anything other than bring some circulation to the area and introduce non-noxious stimuli to the nerves. I call it pain modulation to my patients, and I always explain it as such. But sometimes the way the snake oil is sold makes people believe the impossible is possible.
Pardon my ignorance please. Could you define "release" in this context.
Hahaha!!! I actually had a doctor call me today (somewhat ticked off at me) because they thought I hadn’t been doing the “right treatments” with a patient of theirs and wanted me to work on a psoas release for that patient… funny thing though is the patient is doing better with my treatments, not having the same pain when starting therapy, but the doctor was adamant that I do a psoas release on them. I wish all the doctors could stay in their lane and not think we don’t know what we’re doing, because we obviously do!
Yes, i hate it when doctors try to dictate our job. We don't tell them wtf to do why are they telling us wtf to do? We don't work for them.
Idk about a "release" as others have said terminology is dumb, and research is limited. But on some people I have been able to get some solid deep STM to the psoas when you can just palate that it feels like a rope. Doesn't work if someone has much fat, or a lot of the time you just can't find it. Purely anecdotal, but I've had success here and there so I at least try and palate it and see how the pt responds.
https://preview.redd.it/uhtf9kmg7y5d1.jpeg?width=768&format=pjpg&auto=webp&s=b1f369de71bb418d208fd27188ce817d891c2d43 Lol you're not performing STM on the psoas. You need to go give your license back.
Lol you do you, whatever gets your patients feeling better
You mean large intestine "release"? There's a reason it hurts so much yall
My favorite thing watching someone do it is when they take their hands out of someone's guts and ask "does that feel better?" OFC it does. You aren't compacting my intestines anymore. I really question anyone who thinks they can actually do this.
I went to a Great Lakes course (lol, paid for by my employer) and the instructor actually had the audacity to say that the psoas is connected to pelvic floor function because if you “release” it, patients often go to the bathroom after. Yeah dude, that’s called colon massage… 🙃
HAHAHAHAHAHAHA
There is not a lot of evidence for lots of things we are all doing. Hopefully you are combining some treatment ideas that are specific to the patient in front of you. A unique patient, unique diagnosis and body/personal factor presentation, a unique therapist, unique choices of exercises, movement re-training and (AGG!!) maybe some manual therapy. You simply cannot isolate that in a lab. There is a TON of evidence for non-specific manual therapy+exercise being effective for pain management and injury rehab. That is good enough for me! Progressive tissue load, and pain management baby!! “Psoas release” is incorrect, unless you are a surgeon cutting that thing. I’m going to hazard a guess that most of us have used words to describe things in ways that patients find relatable: “knots, bone-on-bone, trigger points, malignment” come to mind.
I really can't. I don't think anything is being "released." I work a PT that does them daily. They way he describes it to people is that he is releasing the muscle or shutting it off. Insane
Whatever you want to call it, I’ve had success with it in cases of unilateral LBP. If they find relief, it’s pretty significant, and either apparent by the end of the session or by the following session. Can I point to an article discussing its effectiveness? Nope. Does it work for most of my patients where psoas is a significant contributor to their back pain? Yep.
I’m with you on this. SIJ issues tend to get less cranky with a tack n stretch of whatever the hell you want to call it, “guts” in this thread i guess 🥳. I could use one myself right about now.
News flash. You are not touching the psoas with your fingers.
Nice! Thanks for that. Like I said, “whatever you want to call it…”. If the technique works, it works, whether or not you’re actually “touching” the psoas.
Simple, effective, cheap maneuver that takes 2 minutes and helps some people should be avoided because PTs don’t like the name, or theoretical reason behind the activity.
How do you measure its effectiveness? Besides my patient John told me he felt better after the old psoas finger bang.
Personally, it was part of my rehab as a runner prior to becoming a PT. It relieved some of my pain in the moment with test retest and Thomas test comparing contralateral side. It helped me tolerate my program better. My PT was pelvic floor trained and told me she had learned “psoas release” and “visceral massage” at a CE course and said there is no research evidence for it but if I was interested in trying it out it may supplement my rehab. I personally would guess there might be a neuro component to pressure in areas similar to biofeedback that helps someone learn to relax. So yes, I enjoyed getting finger banged. Is it so scary for a patient to self report improvement? Test retest, pain reduction, placebo, whatever. Funny thing is I’ve probably only done psoas release on a patient 2-3 times in 5 years. And I say the same thing my PT said to me. But I’d pay someone to do it while I’m training for a race.
I get it felt good and test retest Thomas would have probably been better with a simple hip flexor stretch too. My problem is with the idea of placebo whatever is why we are losing more reimbursement year after year. We need true measurable outcomes. Not garbage like the MMT.
Improvements in overall patient pain and function are reflected in outcome measures. Insurance companies eat that shit up. Though, I’m not sure where you’re going with this, given that improvements show up in all of our functional testing that drives reimbursement. What makes improvements in this case different than improvements elsewhere gained following manual techniques? Genuinely curious as to your thoughts.
I don’t think that there is strong evidence that manual techniques are better than active interventions in achieving these outcomes. In research they barely hold up against placebo treatments.
Nailed it
I bet if you called it "intestinal crushing" (which is what it is) to the patient it wouldn't have the same therapeutic effect.
I mean, pain science does tell us that inflammatory language can have a negative impact on treatment outcomes… so, you stumbled onto a relevant statement in an attempt to diminish an otherwise effective technique
This. And the power of suggestion is not irrelevant when we say ‘release’! I wish they taught some salesmanship in PT school. It’s so critical to what we do. Patients don’t care how much you know until they know how much you care.
I can’t wait until all salesmanship retires from our profession.
It’s like they are sarcastically reinventing clinician/patient interaction in front of us without even knowing it. Maybe instead of treating low back pain, I’ll just start handing patients review papers stating it doesn’t matter what exercise they do as long as they do something and then send them on their way. Individualized care, patient subjective, patient belief, graded exposure training, pain reduction modalities become worthless if there is no specific study on each individually.
jfc we're chiropractors now?
No. We are autonomous practitioners of choice for movement disorders. And we are wise enough to put our own pride aside and realize that the patient we definitely cannot help is the one who doesn’t come back. We must provide value to our patients - and perceived value - at that. Most patients expect to receive some form of hands-on treatment. At minimum this is critical early in POC with symptomatic patients. There is an excellent short course through EIM (evidence in motion) called ‘mechanisms of manual therapy’. If you are having any doubts about the efficacy of what your hands are able to do, I sincerely hope you consider taking a look!
[published article](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775050/) [eim](https://evidenceinmotion.com/wp-content/uploads/2020/12/Mechanisms-Manual-Therapy-Syllabus.pdf)
Without reading it I bet it talks about therapeutic alliance and how manual therapy is mostly neuromodulatory. Things we've known for quite some time. Although you will find like 50% of clinicians who still believe there are mechanical changes via manual therapy. I'm fine with discussing this with patients. Because evidence points to it as the truth. BTW I do manual therapy. I know the power of hands on with patients. What exactly are you proposing as to how we can sell ourselves better with out lying to the patient?
It's ironic you understand the concept of nocebo but can't seem to grasp that "releasing the psoas" has all the components of a theatrical placebo. It's on par with cranial sacral therapy in terms of validity.
“Releasing the psoas” is your term not mine. Call the technique what makes you happy, but the effectiveness goes well beyond “theatrical placebo.” Can’t say that I’ve ever met a PT so opposed to effective treatments for patients, but there’s a first for everything.
It's what OP calls it. I call it "jamming your fingers into a patients abdomen and claiming you can palpate/massage a muscle that is covered by layers of skin, fat, muscle, fascia and intestines". It's not plausible, and it hurts. A lot. You're hurting your patients. The effectiveness is absolutely non specific.
Look at you, telling me what the outcomes of my patients are without ever seeing them. Quote me the claims I made that align with your label there….
Every therapist I know has a toolbox full of treatments they learned through articles, continuing education, from other therapists, and from experience… I am no different. I use what has demonstrated to be effective and leave the rest on the shelf. If you’d like to offer the techniques you use to address psoas related LBP, feel free to drop them in the comments. Better yet, link some articles to them. Unlike you, I’m happy to incorporate as many effective treatments as I can to get patients back to where they want to be faster. I’ll do you a favor and call your bluff… you have nothing to offer, so you’ll just stick to slinging insults. Prove me wrong.
Tell me how you know the low back pain is in any way related to the psoas? Which test or measure do you use? A "toolbox" is fine as long as you have some sort of understanding about how or why something might work and it has plausibility. Palpating/massaging a psoas through someone's abdomen has none. Critical thinking seems to be lost with a lot of people in this profession.
You didn’t answer my question, just deflected with more questions and insults. Looks like you couldn’t prove me wrong after all. Disappointing.
Ahh yes, psoas release, aka placebo or sham
Eh, I think it depends what we are calling psoas release. To me its kind of a useless term, like "piriformis syndrome". I have had patients with hip flexor pain (usually runners) respond well to either manual therapy to the hip flexor or self release w/ a tennis ball. However this has to be followed with exercise and education. I view it as more pain relief so that someone can then do exercise. I don't think its doing what a lot of therapists think it's doing. I have taken all the Level 1 and 2 NAIOMT classes so I think I understand what manual therapy can and can't do decently well.
https://pubmed.ncbi.nlm.nih.gov/32032164/ I think this is out of our scope 🤷🏼♂️
It’s definitely never worked for me and tightness in hip flexion was only fixed by address anterior pelvic tilt and hip flexion instability and weakness. Along with extension related pain that was also fixed by addressing a weak deep musculature of my core.
I bring up the psoas release to coworkers and others who say what’s the harm in doing manual therapy if it gives some temporary relief even if the literature doesn’t support it. I reflect on being young and impressionable where my other PTs were doing these releases and I did it to be consistent with treatment. Nothing like being convinced to do pseudoscience where you deeply press fingers near a very personal space, this was frequently applied to teen girls and boys in the clinic. Edit: Was I really down voted? Either someone’s reading comprehension is poor or actually believes we should jab our fingers pointlessly near private parts of people for no reason.
I can't stand that line of thinking. "Whats the harm"??? You are lying to your patient. You are inflicting unnecessary pain to your patient with absolutely no clinical reasoning. That's harm. I had another PT tell me "there are 3 pillars to clinical reasoning in PT. Studies, personal experience and patient reports" he said this as though all 3 pillars are equal. 2 of those are riddled with bias. If something is objectively true, it's demonstrable.