IS DIRECT MANIPULATION ON THE PSOAS A GOOD IDEA?

There seems to be a trend towards direct manipulation of the psoas muscle through the anterior abdominal wall. I cannot stress enough that this is a bad idea. I recently had a patient complaining of lower left abdominal pain after a manual therapist performed deep manipulation from the lower abdominal wall towards the back of the body in order “to release his psoas”. I asked him to go to his family doctor and request an ultrasound. The ultrasound showed a tear in his lower abdominal wall.

Clemente A Regional Atlas of Human Anatomy

The psoas is a posterior abdominal wall muscle. It is retroperitoneal - it is behind the peritoneum (the connective tissue enclosing the organs). It is much closer to the back of the body than it is to the front as illustrated in the side view diagram below with the arrow pointing to the lumbar spine.

ABOVE Kamina Anatomie BELOW Left to Right: Pernkopf Atlas D’Aantomie Humanine (with organs, organs removed), Kamina Anatomie (arrow pointing at ovary), Pernkopf Atlas D’Aantomie Humanine (arrow pointing at psoas at level of umbilicus)

A considerable amount of anatomical structures are located anterior to the psoas - the anterior abdominal wall, the organs of digestion and reproduction. There is the potential for adverse effects such as the patient with the abdominal tear. Deep pressure on the anterior abdominal wall would not be advised during the first trimester of pregnancy or for a patient using a pessary for a uterine prolapse. The drawing below illustrates the placement of the psoas in relation to the front of the abdomen. The anterior approach by a manual therapist is not a good idea. Lying over a hard object to self release your psoas from the front is an even worse idea. STOP THE TREND!

Moore Clinical Anatomy