The Psoas and the Piriformis

[Pompal 09.]

Hello to all
I went to Body World in San Jose, CA, last weekend and it was awesome! I really got into the different poses of the specimens- hard to say they were cadavers because they were posed so life like. After looking at the psoas and piriformis I got to thinking about palpating them. I spoke this week with a pelvic floor PT, she set me straight on a few lingering questions I've had and I throw this out for the group.

First, the psoas is really near some other structures of the circulatory, digestive and nervous system. I remember that Whitney Lowe advocated against direct palpation of this muscle. The PT agreed; say that the lateral femoral nerve, ilogastric (sp?) something and other structures made her work the insertion on the lesser trochanter of the femur. She also said that she had luck with releasing the psoas by releasing the lumbo-dorsal fascia first. Hmm, I remember being in a St. John NMT class and one of the teachers pushed so hard into my psoas that I fainted. :shock:
I avoid direct pressure and have had luck with MET work while the client is sidelying. Any thoughts?

As for the piriformis, I was again surprised at how small is seems when compared to some anatomy books. The PT told me that it's almost impossible to palpate this internally, unless you have ET fingers. She took a cadaver class and they all tried and failed to reach it. Makes me wonder why St. John was so big on this internal work in the '90's. It's out of scope of most MTs, I believe.

Anyway, I was amazed and informed after seeing the exhibit and talking to the PT. Just thought I'd share my experience.

Rubmyster,
keeping my hands where they belong

 

[stormer_xxi]

Psoas and Piriformis

OOPS.
I just made a boo boo. I mentioned that St. John wanted to work the piriformis internally and I was wrong.
I think it was Janet Travell in her books. I spoke to a friend last night and he mentioned some other pelvic floor muscle.
Sorry for the confusion,
taking my foot out of my mouth
Rub

 

[webkinzlover525]

Psoas and Piriformis

OOPS.
I just made a boo boo. I mentioned that St. John wanted to work the piriformis internally and I was wrong.

No, you weren't wrong. I know that St. John taught internal work because the massage school that I went to quit letting him have seminars there when the owner walked in to one of his classes one day and saw the students wearing gloves with their fingers inserted into their partner's rectum.

Now, I don't know if which muscle they were aiming for but he definitely taught internal work.


Angie

 

[Pompal 09.]

I was confused by the concept of internal palpation.....guess I understood better than I wanted to have understood! :? We did learn some intraoral work with the pterygoids, but that's it. No thanks on anything else.

We were taught to palpate the psoas through the abdominal wall, but very gently, when the more superficial layers allowed that, along with working it's femoral attachment. With the piriformis.....how on earth would anyone go about *trying* to palpate that internally? :shock: (Note: this is a rhetorical question. Please, if you know the answer, I do not want it!!!!! Thank you.) It is very accessible and beneficial to palpate. Externally.

Ai yi yi...........

 

[Pompal 09.]

Interesting discussion! I do a fair bit of abdominal work, and much of it involves the iliacus and iliopsoas. I learned a basic approach to psoas in school, but it took a long time and was often uncomfortable for the client. Still, I got some good results with it.

Over the last year my technique has advanced a lot, and now I can access almost anyone's psoas (so far) in a short time with minimal discomfort. I'd much rather receive the work I do now than the work I did a year ago! :

I'll be training under Whitney Lowe in March, so I'll ask him about working the psoas. It will be interesting to hear his thoughts. Right now I'm still attempting to absorb some Thomas "Anatomy Trains" Meyers info, and that will keep me busy enough! :shock:

 

[ItseyBitsey]

First, the psoas is really near some other structures of the circulatory, digestive and nervous system.

When I learned Lymph Drainage Therapy, I was amazed by how effective the abdominal LDT was for releasing muscle tension in the abdomen, gluts & low back. I think it's because 1/2 the lymph nodes in the body are located in the abdomen, so when they're congested, everything gets tight. When they're released, everything else follows. Now, my abdominal massage is 95% LDT.

 

[Pompal 09.]

Bliss, interesting info on LDT. I'm planning on taking the CranioSacral I from Upledger either this summer or winter. I've been considering taking their LD class as well.

 

[Hannah Iced Over]

What a great (and somewhat amusing) thread.

After I went to BodyWorlds, I was rather amazed that I've ever palpated the psoas... they looked much deeper than they feel!

I too was likewise amazed at the small size of piriformis. The exhibit left me thinking differently about my hip work.

As far as internal work... jokes about internal piriformis work were ongoing through our deep tissue quarter ;-) Even made it into the end-of-quarter coffee house show

 

[Zeina]

It seems that most MT's palpate psoas major by going through the intestines(?)
I always follow the surface of the iliacus (which is usually more of a problem than psoas) keeping my fingers deep to the intestines. Eventually moving medially to slowly palpate the inferior belly. The artery also moves out of the way.
Working directly on the lesser trochanter is even more of a problem - its deep to the femoral nerve, very painful attacment, and less effective. Instead work about 1 inch or more inferior to the ingunal ligament - that's where the trigger point is.

 

[binababie]

palpating the psoas

I (Gil Hedley) will have a shot in my 4th DVD coming out in late spring early summer (The Integral Anatomy Series) which will highlight the relationship of the ovaries to the psoas, among other things. I know of folks who have induced ovulation (unintentionally) while doing psoas work...the ovary can easily overlay the psoas (as will be shown in the above noted DVD) and be palpated there while trouncing about. This is not to say that you can't work the psoas, but as a Rolfer I always preferred helping people to activate their psoas rather than satisfying myself/my protocol by "getting to it." With a client supine, feet flat and knees up, have them lift their foot straight off the table while you gently press into the belly lateral to the lumbar spine. The psoas will jump to your hand. When they notice this, they will be able to incrementally decrease the amount that they lift their foot while simultaneously feeling the psoas activate in their belly, to the point where they can just "think" "psoas" and it will activate. Nice, none invasive technique which engages their will and movement and connection without mashing about. Enjoy!!

 

[K M]

Gil - Thanks for the idea! It's very similar to a method I learned from one of Thomas Meyer's representatives in December.

BTW - Great to see you on these forums!

 

[Annamazing.!]

piriformis

I'll toss two cents in on the piriformis while I'm on it: specific muscles identified with conventional nomenclature are not functional units. They are anatomical units, and mental concepts. There is no such thing as a "piriformis" out there functioning on it's own, so the idea of assigning it responsibility for anything, whether good or bad, is a bit sketchy, though it is an easy path to follow as we are so often and easily mistaking our models for the much more complex phenomena of reality. Just because you can cut one out or put it on display does not make it any more real, it only proves that you are a competent sculptor, capable of rendering a whole into parts in order to demonstrate an idea.

The artistry of the Bodyworlds and Bodies Exhibition are wonderful and inspiring as art. It helps to remember what is not there which has been removed, allowing the artist to make their point and show what they want to show, and emphasize what they want to emphasize. There is an intense appreciate on the part of those exhibits for tissue from the muscle, nervous and bony layers, while the superficial and deep fascial layers are de-emphasized.

As an integral anatomist, I strive to put something like the "idea" of piriformis into it's context, understand it's relationships and continuities, and then inspire folks to address the reality in their hands as opposed to the stripped out mental concepts which, helpfully, can lead us into a more detailed and accurate perception of the reality (though we often commit more fully to the concept than the reality, perhaps because it seems easier to get a handle on it: it's right there on the flash-card, after all!).

I have a nice shot of piriformis a ways into my second DVD, which shows it sharing the tendonous aponeurosis with the neighboring layer of muscle tissue: one muscle, one grand twisty tie balloon, with many fascial compartmentalizations created most often by neurovascular penetrations of the layer or transitions of the bony form. Some day I'll have to pull that and toss it up on my gallery...always something to do!

 

[mimi]

In The TriggerPoint Therapy Workbook by Clair Davies, Davies demonstrates working on one own's psoas while in a sidelying position. This way gravity moves the intestines and other things out of your way. I have found this position works fine while working on someone else as well. You just have to make sure they're draped correctly.


That book is worth 10 times its inexpensive price.

 

[Blinkie]

thank you so much for this informed and informative discussion!!! i simply love that Rubmyster posted to share his experience, and that others contributed generously with their knowledge. tres awesome. gil, i especially appreciated your note of how the BodyWorlds bodies have been sculpted (i haven't seen it yet)--very interesting that those bodies inspire and amaze while continuing the misunderstanding about fascia and the discreteness of muscles.

Palpateit, I have such trouble accessing the iliacus.

 

[Lori]

piriformis

I'll toss two cents in on the piriformis while I'm on it: specific muscles identified with conventional nomenclature are not functional units. They are anatomical units, and mental concepts. There is no such thing as a "piriformis" out there functioning on it's own, so the idea of assigning it responsibility for anything, whether good or bad, is a bit sketchy, though it is an easy path to follow as we are so often and easily mistaking our models for the much more complex phenomena of reality. Just because you can cut one out or put it on display does not make it any more real, it only proves that you are a competent sculptor, capable of rendering a whole into parts in order to demonstrate an idea.

The artistry of the Bodyworlds and Bodies Exhibition are wonderful and inspiring as art. It helps to remember what is not there which has been removed, allowing the artist to make their point and show what they want to show, and emphasize what they want to emphasize. There is an intense appreciate on the part of those exhibits for tissue from the muscle, nervous and bony layers, while the superficial and deep fascial layers are de-emphasized.

As an integral anatomist, I strive to put something like the "idea" of piriformis into it's context, understand it's relationships and continuities, and then inspire folks to address the reality in their hands as opposed to the stripped out mental concepts which, helpfully, can lead us into a more detailed and accurate perception of the reality (though we often commit more fully to the concept than the reality, perhaps because it seems easier to get a handle on it: it's right there on the flash-card, after all!).

I have a nice shot of piriformis a ways into my second DVD, which shows it sharing the tendonous aponeurosis with the neighboring layer of muscle tissue: one muscle, one grand twisty tie balloon, with many fascial compartmentalizations created most often by neurovascular penetrations of the layer or transitions of the bony form. Some day I'll have to pull that and toss it up on my gallery...always something to do!

That was beautiful, reminds me of how Job's Body reads.

 

[misskelleygirl]

I've seen some of Gil's DVDs, including the second one he referred to. WOW! :shock: I highly recommend Gil Hedley's DVDs - very instructive, yet incorporating intuitive concepts to inspire creative thinking. He makes dissection look like an art form.