The One Rule of Effective Fascial Release, And Why Massage Doesn’t ‘Release’ Fascia

Have you ever wondered why massage therapy doesn’t “release” fascia? I mean…those deep tissue massages hurt! They must be doing something, right?

I want to let you in on a little secret that will help you understand fascia and how to create changes within that soft tissue system that last.

First…let’s dive into a mini crash course on fascia, just in case you’re still unsure exactly what this stuff is.

What is fascia?

Fascia is a collagen-like substance that permeates the entire human body. Every nerve ending is coated in a piece of fascia, as is every muscle fibril and fiber, every muscle bundle and group, and all of this turns into tendon and ligament, which attach to our joints. Even our bones and organs are wrapped in fascia! We have more of this substance in our body than anything else.

While the picture to the right is a great example of how it wraps the muscle fibers, what that image doesn’t show is all the billions of nerves it wraps that travel within the soft tissue system, which means this stuff isn’t linear – it’s a vast and criss-crossing matrix.

Fascia is supposed to be elastic, flexible, STRONG and resilient. Since it wraps literally everything in the body that supports LIFE, I have come to believe it is meant to be almost bulletproof; like the Kevlar that protects our nerves, muscle fibers, bones and organs. (It’s much, much more than this, but this’ll do for today’s crash course).

If fascia were easily change-able we’d be in BIG trouble! Every time we bump into anything we’d damage ourselves. Heck, even sitting down would cause a re-molding of the fascia in our hips and butts if fascia were that quick to change.

Thus, it is my conclusion that fascia will not change easily due to ANY outside force attempting to change it (if it did, it would betray one of its primary roles in our evolution!)

This includes most methods of massage therapy as well as all those fancy new gadgets and gizmos one the market right now that claim to melt or release your fascia if you smash and blast it hard enough.

To truly change the fascial system, we have to ask the fascia to change itself.

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Release Tibialis Anterior and Peroneals Fascia to Relieve Pain on TOPS of Feet, Shin Splints, Foot Cramps and More

If you have tendonitis or pain on the TOPS of your feet, cramping on the BOTTOMS of your feet, shin splints or a strained/pulled soleus muscle then you are going to LOVE this. (And those are just a FEW of the things this technique can help with).

TOOLS NEEDED: Lacrosse ball and 25+lb weight plate (most gyms have both of these).

Please take the necessary steps to do this with the same equipment I’m using in the video, because I want you to get the BEST result, and you will NOT get the same result using a tennis ball, golf ball, soft ball or any ball without a weight plate.

Let’s look at some anatomy shall we? (Hello my fellow body/anatomy nerds!)

The fascia here affects SO MANY things:

Remember, it’s the FASCIA we’re after in terms of releasing tissue, not any particular muscle(s).

The muscles are important though because they indicate which direction(s) the tissues move in terms of shortening and lengthening and acting on various joints – and it’s where and how the tissues are being asked to move combined with the fascial restrictions within the muscle groups that is what creates the pain patterns I’m about to talk about.

Tibialis anterior:

Otherwise known as the “shin muscle,” tibialis anterior (or TA for short) attaches laterally at the top of the tibia, near the knee, and (via its distal tendon) attaches to the medial cuneiform (a bone on the inside of the foot) and first two metatarsals (which lead to the big toe bones).

Got BIG TOE issues? This is definitely something to check!

TA dorsiflexes the ankle and inverts the foot.

Peroneals:

All three peroneal muscles attach to the fibula and metatarsals of the foot.

Here is where things get interesting: all three of these muscles evert the foot, but two peroneal muscles – fibularis or peroneus longus and fibularis or peroneus brevis – plantarflex the foot while fibularis or peroneus tertius dorsiflexes it!

So between tibialis anterior and the peroneals all acting on the foot in opposing ways, it’s no surprise that if the fascia gets clogged, tight, dehydrated or stuck…ANY of these actions of the foot could become confused leading to dysfunction (or pain) anywhere downstream of the knee – the ankle and retinaculum, the tops of the feet and toes, the plantar fascia, pain with eversion or inversion…and possibly pain upstream as well, due to gait changes or how the ankle affects the knee which affects the hip, etc.

Let’s explore the most common issues this release technique will help relieve:

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Mobility Work and Foam Rolling for Fascial Release FAQ – How Long, How Often, Should it Hurt or Bruise?

So you bought yourself a shiny new foam roller or lacrosse ball (or other mobility tools), or maybe you’ve had these for a while…but you’re not sure you’re doing things correctly, or enough, or maybe you’re wondering if you’re OVER doing it?

Today’s episode of Mobility Mastery Monday should answer your questions!

The video has it all, but here’s a recap of my 5 tips for the best self fascial release sessions:

1. How OFTEN should you be foam rolling?

This is fairly personal, or individual – meaning some people will need more while other people need less. I’m about to give you some guidelines, but no matter what I tell you I encourage you to LISTEN to your body, because it will tell you how much is enough (and the other 4 tips today will help you know what it’s telling you).

Generally speaking, for fascia health maintenance (meaning, there’s nothing ‘wrong,’ you’re not working on an injury or pain pattern) I suggest 2-3 times per week. If you just loooove your foam roller and want to do more, by all means do more.

If you ARE working on recovering from an injury or using fascial release to get yourself out of pain, then you could go after your target areas ONCE PER DAY for a week or two. Max. You do NOT need to do twice a day – if you do, chances are you’ll get pretty sore.

You certainly do not need to do your entire body every day.

2. Should you feel sore or get bruised doing this work?

The short answer is NO.

If you were in my office getting worked on by me I’d tell you that about 1 in 30 people get sore (even though what I do is FAR more intense than a foam roller or lacrosse ball). Given I’m not in your living room or gym with you and can’t control what you’re doing or HOW you’re doing it, chances are greater with self work that you might get a little sore from this.

If you’re doing things CORRECTLY, you should NEVER get sore OR bruised.

If you ARE getting sore, here are some things to check:

  1. Are you using a super hard or knobby roller? That can often cause soreness or bruising. I recommend starting with a SOFT foam roller, and maybe you’ll stick with that forever. You can work up to a harder roller but I never ever recommend the knobby ones for fascial release work.
  2. If you’re using a lacrosse ball, are you digging it into your tissue trying to give yourself a deep tissue massage? If so, you can definitely get sore or bruised. To do this correctly you want to PIN an area of your body TO the lacrosse ball (often needing to use your other hand to hold it steady) while another part of you moves. You’re trying to pin and stretch/release the fascia, NOT dig into it.
  3. Are you spending too much time on one spot? This can often make you sore – see tip #5 for more on this.

Regarding BRUISING:

I do not endorse or advocate that bruising is a good thing UNDER ANY CIRCUMSTANCES. It’s not the end of the world if it does happen, but in my private practice I avoid it at all costs (and only 4-5 people have ever bruised from my work since 2008 and it was only in small areas like the tops of the feet). I want you to avoid looking like you’ve been beaten up too! This is my personal and professional opinion and I’m sure there are plenty of people out there who disagree with me, and that’s ok.

Here’s why I feel so strongly about this:

A BRUISE – meaning, a red, black and blue or yellow/green spot – is a soft tissue injury called a contusion. What causes the discoloration are small capillaries and blood vessels that have BURST and spilled their blood into the surrounding tissues. Those capillaries and blood vessels are DAMAGED. Thankfully, our body has a brilliant way of dealing with this by sending in hormones to contain the bleeding and heal the damaged tissue, so a bruise isn’t something to freak out about. However, the reason I want you to avoid bruises is because even IF you are creating some good through whatever method caused the bruising – you’ve also caused some (or a LOT) of damage. Inflammation is likely to occur, and if it’s a really bad bruise it might hurt so much you won’t want to be as active (which sucks), or it might take as much as a week or two to heal fully.

I’ve been using my body weight (sometimes all 145lbs of me) stepping on people since 2008, and soreness and bruising are NOT common. It is NOT a necessary part of healing fascia.

3. Should it hurt?

Yes. And no!

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What to do For a Pulled or Strained Hip Flexor or Groin Muscle

If you’re suffering with a strained or pulled hip flexor or groin muscle, this post is for YOU – find out why they happen and more importantly what to do about it.

Unlike other common strains, this area doesn’t follow my typical theory on strains being a symptom of reciprocal inhibition issues between two opposing muscle groups. This injury happens (in my opinion) due to the upper and lower thigh muscles working at odds with each other. Let me explain.

We have a LOT of muscles that flex the hip:

The psoas and iliacus (or iliopsoas), rectus femoris (a quadriceps muscle), sartorius, tensor fascia latae, pectiuneus, adductor brevis, adductor longus, adductor magnus and gracilis.

MOST of these muscles perform other actions as well, such as adduction, abduction (TFL) and knee extension.

A strained or pulled hip flexor most often occurs in dancers, martial artists, runners (especially sprinters or mountain runners who do a lot of uphill work) and soccer, football and hockey players.

What all of these sports have in common:

A LOT of quad dominance! It’s also likely during these sports that you’re asking those muscles of the thigh to both flex the hip AND extend the knee, sometimes at the same time or one after the other with a lot of power (think of kicking a soccer ball, or a jump kick in martial arts).

Of course you can absolutely experience a pulled or strained hip flexor without being one of these athletes, and the cause/solution will likely still be the same.

NO injury, unless traumatic or due to a fall or sudden impact, occurs in isolation or is due to ONE thing you do. Even if the pain comes on suddenly, in all likelihood there’s been a slow build-up of something that has made an injury likely to occur.

It is my opinion that in this case, that something is overworked and fascially restricted lower quad tissue – where the rectus femoris fascia gets stuck to the fascia of vastus intermedius and vastus medialis (two other quad muscles), and starts to pull the adductors, sartorius and gracilis towards the quads – making these muscles less able to do their job without straining to do so.

The strain or pulled muscle occurs when we ask the hip flexors and knee extensors to work simultaneously or in rapid succession. And here is where reciprocal inhibition does come into play for a moment – in order to “cock” or wind up the hip flexor and knee extensor muscles, they need to lengthen or stretch (like stretching a bow back before letting the arrow loose).

Since there is so much fascia and muscle restriction within the quads, including the quadriceps tendon which attaches to the knee joint, the brain detects the possibility of a tear happening, and in the few split seconds it takes to wind those muscles up (aka stretch them) your body starts to enact a stretch reflex by pulling the hip flexor muscles back, and since you’re already getting ready to contract them powerfully – BAM! When you do = major muscle contraction, major strain, major pain.

This scenario is different than a typical strain because it occurs within the muscle group that IS the problem, rather than its opposite.

What’s the solution?

Release that lower quad restriction!

EVERY single person I’ve worked on since 2008 that has had this issue (which includes a LOT of Jiu Jitsu people, soccer and dance athletes) has had a huge knot of restricted fascia here.

The picture on right shows the area you’re looking to target – rectus femoris and where that quad muscle meets the vastus medialis (and intermedius, which is under rectus femoris).

The video above shows you what to look for, what to do and how to do it.

Next steps:

  1. If going after the lower quad doesn’t get you the desired result, especially if you have a pulled GROIN muscle (vs high/top of the quad area), then your next best bet is to go after your low adductor fascia. You’ll also be looking for a knot there. Click here to go to my post and video for this technique.
  2. If that doesn’t get it to 100%, try releasing your TFL. Click here for that post and video.

How to get the BEST and fastest results:

  • Chances are high that if you’re experiencing this injury your low to mid quad fascia has a giant knot in it. Spend as much time as necessary hunting around to either rule this in or out. If you’ve found a giant knot, then…
  • Spend 20-40 seconds on EACH SPOT (start on the LOWEST SPOT and move up but do NOT go past your mid thigh), moving your lower leg back and forth to “shear” the fascia and release it.
  • There will likely be 2-3 spots within this low to mid quad area. More than likely it’s the same “knot” or adhesion, you’re just attacking it from every possible angle.
  • If this is an acute injury (meaning it JUST happened within a few days of you finding your way here), I would do this once a day for a week.
  • If you click to the other blog posts, PLEASE READ THE ENTIRE POST but especially the “How to get the most out of this technique” section at the bottom.
  • DO NOT USE A KNOBBY FOAM ROLLER FOR THIS! You will likely bruise your tissue and it will suck so much you may never want to use a foam roller again! I generally advocate using a soft or standard black foam roller. If you need help figuring out which foam roller is right for you, click here.

And THAT is it folks! Grab your foam roller and give this a try. Please comment with your experience or questions!

 

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What to Do For ‘Pulled’ Muscles or Strains – and How to Prevent Them!

Have you ever been playing a sport or doing your favorite activity when suddenly a muscle goes into spasm and quite literally “grabs” your attention and steals your movement mojo?

If so then you know what it’s like to experience a muscle strain, or “pulled” muscle.

There is one thing you absolutely MUST do to recover quickly – and one thing you must NOT do.

I’ll get to those in a moment.

First, it’s important to understand WHY strains happen, because – while I am sure some of you are here and currently experiencing a strain or pulled muscle – I am hoping the rest of you will use this information to prevent this from happening in the first place (can we make prevention sexy please?!)

In order to understand why and how a strain happens, we have to understand how muscles work.

Reciprocal inhibition – the key to understanding muscles and injury recovery/prevention!

I’ve had my eye on this process for over 5 years as a guiding touchstone for how to help people in pain and it’s never failed me. I’ll certainly do an entire episode dedicated to just this because the topic seems sorely lacking in the field of pain relief and injury recovery/prevention; but for now we’ll explore it in relationship to strains and pulled muscles.

Reciprocal inhibition is a process by which opposing muscle groups (and the nerves that act on them) work synergistically on a joint: one group flexes that joint while the other extends it.

In order for one muscle or group to contract, the opposing muscle or group MUST relax and stretch.

The simplest example of this is: when you contract your hamstrings your quad has to stretch and relax, right? The opposite is true as well: in order to stretch the quads, the hamstring must contract. (Think of a standing quad stretch).

How this relates to muscle strains:

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How to Release Your Pec Minor Fascia – For Shoulder Pain & Shoulder Mobility Issues

Pec minor – a small but very important muscle!

If you have shoulder issues of any kind – from shoulder pain, rotator cuff or shoulder mobility issues (including partially frozen shoulders or seriously forward rotated shoulders) then this technique should be at the top of your list for self-help techniques.

If you have breathing or rib issues this could be related as well.

Pec minor is actually somewhat difficult to get into. Pec major and the clavipectoral fascia sit on top of it, and when your arm is resting or hanging at your side you can’t get into it at all. In order to get at this triple headed small muscle and its fascia you’ll need to raise your arm and target a very specific spot for release. (I show you exactly how in the video).

To be clear, what we’re actually going after here is the fascial adhesion that can occur between pec minor and pec major (specifically the , the clavipectoral fascia and possibly coracobrachilais as well.

For such a small muscle, pec minor plays a critical role in shoulder joint, scapular/rotator cuff and rib health.

From the picture to the left you can see how (because of its attachment at the coracoid process of the scapula), if shortened or adhesed, pec minor can pull both the shoulder joint and the scapula into forward rotation, and/or elevate the ribs. Someone who, later in life, has a serious hunch or “wings” showing in the upper back – you can bet they have a very short, tight, adhesed pec minor (in addition to probably a lot of other fascial tightness in the front as well).

If you’re someone who has ribs “go out” a lot, I would instantly suspect ridiculously tight pec minor tissue. This would not be the thing itself that makes a rib go out, it just sets you up and makes it much more likely. This has been true of my clients who play lacrosse, train jiu jitsu or those who have experienced a traumatic fall or impact such as a car accident, falling onto a shoulder or their head while snowboarding etc.

How to get the most out of this technique:

  • You’ll need a lacrosse ball for this one. I do NOT recommend a tennis ball, softball, golf ball or really any other ball. This particular area is SO TRICKY to get into in a way that you can hold the position, so you’ll need the grip or stickiness of the lacrosse ball to make it work.
  • Spend however long you need to get the right spot! This technique will be almost useless (for its intended purpose anyway) if you don’t successfully find pec minor. It can be incredibly tricky to nail. Watch the video as many times as you need to get it right.
  • Look for (or FEEL for) a slight “THUMP” that would indicate an adhesion between pec minor and pec major.
  • MOVE SLOOOOOOOWLY. Slowly. Very very slowly.
  • Did I say move SLOWLY? Haha. If you move too fast on this one you’ll pop off of pec minor in half a second and not even know it.
  • There are probably only 2-3 spots MAX you can find and release here. Most people probably only have two spots worth doing.
  • Spend 20-30 seconds on each spot WHEN YOU GET IT RIGHT. If it takes 10 seconds at a time to find and re-find a good spot, that’s ok.
  • Move your arm after!
  • Notice what changed, if anything.
  • Obviously, if you have a serious impingement, mobility issue or pain present, this technique alone probably isn’t going to eliminate it. Use the search function on this website to find other techniques for your particular issue, or leave a comment with your questions.

 

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How to Choose a Body Worker for Pain Relief (Opinion)

 

So you’re in pain or dealing with an injury and you want the help of someone in the bodywork field to sort you out. How do you choose the BEST person for you?

This can be a daunting decision, with thousands of choices that often looks similar on paper (or the web).

If you’re NOT in pain, then my opinion is simple: see whoever you want! Do what feels good. See the person you like the most.

When you’re in pain, however, there are a few critical distinctions to make and important points to consider if you want help actually getting out of pain AND finding the root cause so it doesn’t come back.

How to choose a body worker for pain relief:

First of all, here are some very basic things to consider:

  • MANY (I would say the majority of) manual therapists – massage therapists and other body worker practitioners – are not necessarily trained to help people eliminate pain.
  • Having said that, there certainly ARE capable manual therapists and body work practitioners out there who have been trained to relieve pain at its source, and this post is designed to help you find THOSE people and learn how to differentiate between your average massage therapist or someone you would go to for relaxation vs. someone who can help you get and STAY out of pain.

First off, let’s weed out the therapists who probably CAN’T help you:

Before I list these, I want to be clear I’m not knocking these therapists or discounting their work – I think there’s room for ALL of us and room for every modality. I just think it’s important for all of us (clients and practitioners alike) to know who we are seeing and WHY, with an honest look at scope of practice. I was a massage therapist for a year (8 long years ago!) and in that time I never helped my clients eliminate their pain for good. I wasn’t trained to do that and I went through a very comprehensive training that included myofascial massage, orthorpedic massage as well as the typical deep tissue, swedish etc.

Here are the modalities and people I would NOT consider seeing if you are looking for pain relief:

  • Your corner massage chain or generic massage therapist.
  • This includes therapists whose work consists mostly of Swedish, deep tissue or very general whole body massage.

Here are the practitioners and modalities you might consider, CAREFULLY: (and use my interview questions to make a wise decision here!)

  • Massage therapists or massage businesses who list “sports massage” or something like this as an option (often an “upgrade” that you pay extra for). A lot of the time these therapists are allowed to say they practice “sports massage” when they had a few hours of training for “athletes” while they were in massage school. This does NOT mean (in my opinion) that they know how to find the root cause of pain. MAYBE THEY DO. Some people have had extra training that gives them the authority to make this claim with confidence. This is where I want to encourage you to interview people, because you never really know from the average website bio (see below for questions to ask and what to look for when interviewing practitioners).
  • Manual therapists who say they do “myofascial massage.” Like I said above, I was trained in myofascial massage but NONE of that training included teaching us how to find the ROOT cause of pain. Generally speaking, THIS IS SIMPLY A MASSAGE MODALITY or technique. It does NOT mean this person will be able to release your fascia (it takes a very skilled person to do this with their hands. They absolutely ARE out there and if you can find one of these that’s AWESOME!)
  • All other modalities that do not (necessarily) include training to find the root cause of pain, from energy work to deep body work – reiki, craniosacral therapy, shiatsu, trigger point therapy, thai massage, reflexology etc. I like to speak from personal experience and personally, I haven’t directly experienced eliminating physical pain with any energy technique. Maybe I’m not open minded enough. That said, I have friends who have and I believe them. The mind is extremely powerful! If you believe in energy work and believe your practitioner is saving your ass, then they probably will! I definitely believe in energy being stored in the body, as well as emotions, trauma etc. My personal preference is to access that energy in a very physical way. So – if energy work is your jam, carry on! As for some of the other ones I listed above, it’s for the same reasons as the above two that I list these: most of the time the training for these modalities does not include how to find the root cause of pain. This doesn’t mean there aren’t some really skilled practitioners out there who specialize in shiatsu, Thai massage or trigger point therapy that can help eliminate pain. So once again – please refer to the interview questions to help you determine if one of these practitioners is right for you.
  • ALL other body work modalities fall into this category of being potentially supportive (if you interview them and like their answers): Alexander technique, Feldenkrais, Bowen, chiropractic, Trager and Rolfing, or Structural Integration, ART, Mashing, Rossiter etc (I’m sure there are many more).
  • Just because someone was trained in something potentially helpful does NOT mean they are GOOD! Your job is to find out if they are, and their job is to make sure you know it when you call or walk into their office.

Questions to ask when interviewing a practitioner:

The very FIRST thing I urge you to ask any professional before you see them is

Question #1:

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How to Release Your Plantar Fascia – Helps Plantar Fasciitis, Heel Pain, Ankle Mobility & the Whole Body!

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This is a simple technique that will help your WHOLE body.

I’m pretty sure ALL of us could use this one!

If you have plantar fasciitis, heel pain, ankle mobility issues, big toe articulation problems or Achilles tendonitis then this is definitely a technique you’ll want to add to your mobility toolbox. Just make sure you’re taking care of the root issue first! For plantar fasciitis, heel pain and Achilles tendonitis – click here for my main technique that addresses these issues at the source.

As usual with Mobility Mastery techniques, this is NOT intended to be a massage for your feet! (Though your reward for doing the technique is massage-like 🙂 )

We are attempting to PIN and RELEASE the restricted fascia and any fascial adhesions on the bottom of the foot.

There are a BUNCH of tiny muscles down there.

The fascia that wraps each of those muscles along with the plantar fascia itself can get stuck to each other. All of that fascia can get dehydrated, brittle, inelastic and because of these things pain and all the “itis’s” can happen – plantar fasciitis, heel pain, tendonitis on the tops of the feet, big toe articulation problems, ankle mobility restriction, Achilles tendonitis…etc.

This can happen due to a variety of factors: if you’re a woman who wears high heels, it’s almost inevitable you will have one or more of the above issues eventually; if you work on your feet all day, especially if you’re not moving much but standing in place; if your body type, lifestyle, sports, habits etc have created fascial restrictions UPSTREAM, you may have PAIN here and you’ll need to find out if the plantar fascia is actually tight and restricted, or simply getting irritated and pulled on – or BOTH.

How to get the most out of this technique:

  • Make sure if you have pain on the bottoms of your feet or any of the issues listed above that you FIRST look for the root cause and go after THAT first – then come to this technique as a way to “comfort” what is hurting.
  • PLEASE USE A LACROSSE BALL! For the best possible result, a lacrosse ball is the single best tool. All other balls will NOT give you the same result.
  • If you don’t have a lacrosse ball and you’re desperate to try this immediately – use what you have and then get your booty to a sporting goods store ASAP! They only cost $6 (give or take). And then do it right 😉
  • Make sure the entire weight of your leg is resting on that ball before doing the technique.
  • Make sure your heel doesn’t drop down too much, nor your toes. Try to keep the weight of your leg directly over that spot you’re targeting.
  • Start near the ball of your foot and work your way towards the heel.
  • If you feel or hear “crunching” noises while opening your toes, you’re doing it RIGHT! That’s the feel and sound of your plantar fascia releasing.
  • If this SUCKS – you’re probably doing it right, and you can be sure your plantar fascia is restricted and needs help to relax.
  • If this doesn’t suck at all and you have pain in your feet – perhaps you didn’t find the right spot, OR – your plantar fascia may not be restricted at all, but is in pain because of something else that is. It could be your calf, your hamstring, glute or even upper body fascia. You’ll need to look for the root cause.
  • Try 3-4 spots with the technique, and then…
  • DON’T FORGET YOUR REWARD! After releasing all that fascia, roll your foot around on the ball for as long as you want. This usually feels AMAZING afterward. If you prefer a different kind of ball, a frozen waterbottle or rolling pin for this part – go for it. This is simply meant to be a FEEL GOOD endorphin releasing reward for your WHOLE body!
  • Speaking of your whole body – if you DON’T have pain in your feet, but you have pain ANYWHERE ELSE in your body and you are ON your feet all day – give this a try!
  • In fact, if you’re on your feet all day I HIGHLY recommend buying yourself a lacrosse ball to keep at work and doing this one daily, or several times a day. Your entire body will thank you!

 

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Are You (Unknowingly) Making Your Pain WORSE? Learn to Help Your Body Find the ROOT CAUSE

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What if the FIRST thing you do when pain happens is the LAST thing you should do if you want true relief?

If you’re like most people on the planet when pain happens then you probably do the ONE thing that seems to be in our biology. It’s instinctual, habitual and seemingly benign. But chances are it WON’T get you out of pain, and it just might make things worse.

You go to and touch whatever is hurting:

  • Your knee gets a stabbing pain, folds you in half and you reach down to touch it.
  • Your back seizes up and you instinctively grab it and feel around as you try to stand upright.
  • Your shoulders hurt, so you massage them (or ask someone else to).
  • Your elbow hurts, and you grab hold of it.
  • You get a tension headache and hold your head in your hands.
  • Et etc.

This first act in and of itself is perfectly natural and it makes total sense that we’d instinctively want to make contact with our pain.

It’s what we do NEXT that truly matters.

Do you REACT to the pain and fixate on what’s hurting?

OR

Do you get CURIOUS and try to find the root cause?

The habit most of us have is to fixate on what’s hurting followed closely by an attempt to silence, comfort or eliminate the pain: maybe you take an over the counter pain killer that’s already in your medicine cabinet; maybe you gently rub or massage that area; maybe you ice it (because you probably learned the very outdated RICE protocol in middle school, which for the record I’m not a fan of at all).

When these mild reactions don’t work you might seek out help from professionals who are a little more aggressive than you: perhaps you try a deep tissue massage or a chiropractic adjustment. And while these might seem like very good ideas, if they are also fixated on the site of pain and not looking elsewhere for the CAUSE, then you’re still caught in the same trap.

Or maybe you try to isolate and immobilize the area via a knee, back, wrist or ankle brace or boot…

What’s missing from this approach?

What ALL of these reactions have in common is a complete lack of curiosity about and awareness of THE REST OF YOUR BODY.

This habit of fixating on what’s hurting at the exclusion of the rest of the body is so ingrained that most healing modalities in western culture have adopted it as well.

If you seek out a medical professional for help with your pain, chances are – unless they are very holistic in their approach to pain (and these professionals DO exist, though it’s been my experience that they are rare) – they will look at/palpate and/or X-ray, MRI or ultrasound the site of pain and suggest a course of action that focuses only on the site of pain: cortisone shots, pain pills, surgery, a brace, a boot, orthotics or shoe lifts etc.

Even so-called alternative and holistic methods more often than not (in my experience, and I was one of these when I was a massage therapist) focus on where the pain is, instead of looking for the cause. If you go to a massage therapist for back pain, I’d be willing to bet that a large majority of therapists will go straight for your back. If you go to a chiropractor for neck pain, chances are pretty high they will adjust your neck.

I will say I have sought out chiropractors, massage therapists and acupuncturists who “get” the idea that where the pain is isn’t the problem, so they absolutely do exist; but I had to weed through a bunch of others first who didn’t get it and I still see this mentality being the status quo of both western and alternative practitioners who deal with people in pain.

It’s my position that this is precisely why there are so many people in pain who aren’t getting the relief they so desperately want, because MOST of the time…

Where the pain is is NOT the problem!

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The Psoas – Our Body’s Insurance Policy Against Pelvic Instability & The Case for Leaving it ALONE

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Difficult to palpate, a challenging area to master as a manual therapist and dreaded by everyone getting worked on because of the horrible pain associated with it – in some ways “the psoas” is approached like the holy grail of the body: finding it can feel like a “quest” and while few are rewarded for their efforts many seem willing to die trying.

If you’ve jumped on the psoas-is-the-root-of-all-pain bandwagon, I have a few questions for you: if you’ve gone after the psoas attempting to release it – on your own, with a massage therapist, physical therapist or other method – are you better? Are you out of pain? If you’ve spent a lot of time trying to “release” this muscle, shouldn’t it be “loose” by now?

There’s been a LOT of hype about the psoas the last decade (or more). Is the hype justified? Is it really the most important muscle in the body and the biggest contributor to all of our pain?

I’ve instinctively felt for years that all this psoas hype is misplaced. I finally feel prepared to present my counter argument.

I’ve come to believe the iliopsoas are the most adaptive muscles in the human body, and our insurance policy against pelvic instability. This might make the iliopsoas two of the most important muscles in the body; however…in this scenario, if we are in pain then these muscles ARE LIKELY NOT THE PROBLEM, and if they appear “tight” they’re trying to HELP US. We’ve (unknowingly) taken out our insurance policy. Bolstering, blaming or otherwise focusing on the insurance policy that’s quickly running out because we haven’t fixed the root issue does nothing to heal the system that originally failed. If we heal the root issue our insurance policy can once again resume it’s role as critical back-up in case of system failure.

These are my theories and findings after 8 years in private practice and careful consideration of the science, anatomy, client stories and inner reasoning regarding this famous muscle group. I’m open to being wrong. I’m committed to keeping an open mind and learning alongside you, so please chime in with your thoughts.

Anatomy and function of the Iliopsoas:

Important distinctions: psoas major and iliacus are often lumped together (because they function synergistically) and are called the iliopsoas; psoas major and minor make up the psoas group; most of the hype talks about the psoas but either neglects iliacus, OR they use the word psoas when they really mean iliopsoas.

I’ll attempt to stick to these distinctions in this article.

Functions of the iliopsoas:

The iliopsoas flexes the femur at the hip joint (think of a hanging leg lift), and raises or flexes the trunk toward the hips from a supine or laying down face up position (think of a sit-up). They also laterally rotate the thigh at the hip, and psoas major laterally flexes the spine (side bending).

Psoas major also acts as a “shelf” for our organs to sit on, providing a barrier between those sensitive organs and nerves and our spine.

Iliopsoas – the most adaptive muscles in the body?

Most muscles have a primary function (action or movement). For example, your biceps flex your forearm while your triceps extend it.

Consider that all of the functions or actions of the iliopsoas can be performed by muscles that are bigger and usually stronger:

  • HIP FLEXION: The quad hip flexors in most people are overworked, almost always “on” and will attempt to perform hip flexion for the iliospoas in exercises like hanging leg lifts if given half a chance. Unless you’re extremely body aware and know how to turn your quad hip flexors “off” and let your psoas do the work, chances are you’re initiating and controlling most of this movement with your quad hip flexors, while the iliopsoas play backup.
  • TRUNK FLEXION: The quad hip flexors along with rectus abdominus will attempt to engage to help “flex” the trunk towards the hips through movements like sit-ups. You know this is happening if your lumbar spine curves (creating space between your back and the floor), your quads tighten up and your “abs” and even throat muscles like the sternocleidomastoid (SCM’s) engage to do the sit up for you. For the iliopsoas to be the major mover in this motion the legs must be kept stationary, the hips and head must remain in a neutral position and the iliopsoas becomes the main workhorse. If you’ve ever done a ton of sit-ups and your ABS got sore (rectus abdominus) but NOT your deep core muscles near your hip bones and toward your back, then you probably weren’t engaging your iliopsoas much.
  • LATERAL ROTATION OF THE FEMUR: The iliopsoas are NOT the major lateral rotators of the hip. This job belongs mostly to piriformis, gemellus superior, obturator internus, gemellus inferior, quadratus femoris and the obturator externus.
  • ADDUCTION: The iliopsoas also helps with hip adduction, but the primary hip adductors are adductor magnus, longus and brevis, with pectineus and gracilis obturator externus playing a part as well.
  • LATERAL TRUNK FLEXION: The quadtratus lumborum or QL muscles perform lateral flexion of the vertebral column, while psoas major contributes to the movement.

The primary actions of the iliopsoas are without a doubt hip and trunk flexion (in my opinion, and apparently the opinion of the internet). Yet I believe we rarely use the iliopsoas as the primary movers of these actions, relying instead on other muscles like the quad hip flexors and rectus abdominus, while the iliopsoas provide ancillary support and/or exist as our back-up muscles in case the primary movers fail to perform or become dysfunctional.

Many muscles, while responsible for a primary movement, also perform more than one action. The human body, after all, is a fully connected system that works as a whole to support movement.

Isolating ANY muscle group isn’t wise, because NO muscle functions in a vacuum and ALL muscles require the participation of the whole body. 

I propose that isolating the iliopsoas or psoas muscle(s) specifically and attempting to “treat” them in isolation is especially dangerous, because of ALL muscles in the body these are the most adaptable, the most willing to change based on our habits, posture, sports, lifestyle…and this is a very good thing! That’s their job!

It’s my position that the primary role of the iliopsoas is as an ADAPTIVE MUSCLE GROUP that, by being highly adaptable, supports the primary functions of many large and small muscles.

Because they are SO adaptable, they can step in (if the brain asks them to) to stabilize the pelvis if necessary.

I believe the iliopsoas is our body’s insurance policy against pelvic instability.

They are likely NEVER the cause of pelvic instability, and “releasing” them may destabilize our spine or pelvis making us more prone to injury, pain or instability.

If we are to help the iliopsoas do its job, then we would do best looking at the surrounding muscle groups and see who is overworking, who us under-working, who is inhibited and/or fascially restricted. Taking care of all of this IS taking care of the iliopsoas.

What if the psoas appears “tight”?

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