However, Henry, the Mckenzie approach can be seen as self-stretch
of the psoas, which is considered to be inhibited by impingement of
the innervating nerve. The rationale is different; the work is given to
the patient & clinical results are great. One great benefit to the McK
approach is that a thorough eval weeds out cases that don't respond &
finds the exact position for the "stretch" to work.
Sarah Fern Striffler, PT
Henry Tsao wrote:
> Dr Siff,
> I am more or less just telling you what I know so far about what I do,
> because I am still learning. But I agree, there needs to be more research,
> especially in the area of the psoas muscles.
> The first research that I came across (and when I remember the title I will
> tell you) did a correlation between psoas wasting using U/S scan and back
> pain. What the authors found was that in 80% of people with back pain for
> more than 6 months, the psoas was tight and had atrophied.
> I have seen in Brisbane a doctor who has developed the standing MRI, and
> what they have done is taken 5 patients with back pain, and measured from
> the MRI the diameter of the psoas and multifidus muscles at L2-3 region
> (where the psoas and multifidus is suppose to be the most bulky in fibres).
> These patients went through a regime of psoas stretch and spray over the
> next 3 weeks only, and had psoas stretches and psoas ice exercises to do at
> home. Over the 3 weeks, they re-MRI'ed these people and measured the
> diameters again. What they found is that there was a significant increase in
> the psoas and multifidus muscles diameter, and the patients subjectively
> stated that they were ~80-90% better.
> A standing MRI costs $2-3000 per person, hence you can understand why there
> isn't as much research... as far as I know, the doctor who did this wanted
> to find out for himself and to help the physiotherapists who were using the
> psoas techniques. I know this is not a very standardized research, but is
> the only few that I can find regarding the psoas muscles. I am not a
> researcher, but I am not going to give up what I do that works much better
> than conventional physiotherapy techniques simply because there is little
> research behind it.
> >From: [log in to unmask]
> >Reply-To: [log in to unmask]
> >To: [log in to unmask]
> >Subject: BACK PROBLEMS
> >Date: Fri, 29 Sep 2000 14:21:39 EDT
> >On9/29/00, Henry Tsao<[log in to unmask]> writes:
> ><< As with anything, it really depends on the presentation of the patient.
> >Sometimes you only need to treat the psoas muscles, where as other times
> >need to treat muscles of the lumbar spine, and sometimes even down to the
> >buttocks and to the lower limbs. The worst case that I have seen involved
> >almost all the muscles around the lumbar spine, but it did not mean that we
> >had to treat all of these, because some muscles will refer satellite
> >points to other muscles (eg, psoas can refers trigger points to quadratus
> >lumborum - so if you deactiave psoas, then you release quad lumb. also).>>
> >***This still suggests that we may as well treat everything that may relate
> >to the back pain and, after ruling out any serious pathology, fractures
> >ignore any further testing and have the patient execute a rather
> >trunk conditioning programme to 'balance" or "release" anything and
> >everything. Is there any evidence that the use of extensive manual,
> >non-radiographic testing to produce an 'isolationist' type of
> >regime is significantly more successful that this generalised sort of
> >conditioning approach?
> >Note that I am not stating this as a fact, but simply asking if there are
> >references to support an approach which is very popularly used in therapy.
> >Maybe a great deal of testing is unproductive and unnecessary.
> ><<However, I have read texts which say that in back pain, you "always" get
> >weak abs (particularly the transversus abs) and gluts, and tight iliopsoas
> >and extensor muscles. This is a big generalization, but true for most
> >patients. >>
> >***This sounds like a very safe bet. Mention MOST of the major muscles
> >are associated with trunk stabilisation and you are sure to correlate back
> >problems with "dysfunction" or "imbalance" in at least one of the muscles
> >listed. It is tantamount to saying, if the engine of a car is not running
> >well, then it must be due to the fuel system, the electrical system or the
> >fuel. We have to face the facts that back pain relates to such a plethora
> >possible structural, functional and psychological causes, that no
> >has yet been able to pinpoint any single or multiple cause of back pain.
> >Dr Mel C Siff
> >Denver, USA
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