"I Am Psoas Hell!"Lately, I have been getting clients who report hip and low back pain. Some even feel the pain in the groin making life a little challenging to say the least.
Because many of us spend lots of hours sitting where the body is in a constant state of flexion, this can shorten major hip flexor muscles, the psoas or iliopsoas. (pronounced "so-as")
Because of the clinical implications these guys have, there are entire books dedicated just for them. Frankly, there isn't enough space for me to truly give them their due here. I will touch upon some of the major facts about them in this article.
The psoas muscles are long and flat. About 16 inches in length. They are also quite thick. In animals, it is referred to as the "tenderloin". My apologies to my vegatarian friends. Here is a link to an image of these muscles.
They connect the trunk of the body with the legs. They originate at the T12 vertebrae and insert into the inner thighs. They flex the hip and the spine. These muscles act as "guy wires" and lifts the upper leg towards the body (used for walking) and conversely, pulls the body towards the legs when the legs are in a fixed position. (Think of a forward fold in yoga)
When these muscles are shortened, they can cause the following symptoms:
The way we stand, sit or walk can distort these muscles. Prolonged sitting is a huge factor in shortening these muscles as they remain contracted to keep us in a sitting position.
If you suspect you are having any of the above symptoms, there are a couple of things you can do. Since these muscles are in a state of excitement, you can visit a licensed massage therapist (that's me :) ) and they can relax these muscles in a very gentle and effective manner. Another is to retrain them. They are dysfunctional and will need to "re-learn" how to function correctly again. Here is a wonderful link I found on how you can retrain your psoas muscles.
If you have any questions regarding this information, feel free to reach out to me. You can email me or call me at 602-730-2508.
I look forward to seeing you in my cozy treatment room.
Our quick-flip lifestyles can be rather hard on our bodies. We spend so much time worrying about our next task, we never take time out for ourselves, let alone give ourselves anytime for any self-care.
Oftentimes, I will have someone visit me who is in a crisis, meaning they are in so much pain, they need to see me right away. When they call in such distress, I can only imagine their body will have substantial knots or as we like to refer to them, "trigger points".
The typical phone call or office visit usually sounds something like, "I must have slept wrong", "My low back hurts really bad", "I woke up with a headache" or they may say something like "I am having pain between my shoulder blades".
I get asked by a lot of my clients where do these nasty knots come from? Why are they there? There are many factors that result in trigger points so this isn't an easy question to answer. Because I get asked often about them, I feel I've been presented with an opportunity to address trigger points.
The definition of a trigger point by authors and pioneers in the field of trigger point study, Travell and Simons is, "a highly irritable localized spot of exquisite tenderness in a nodule in a palpable taught band of muscle tissue". Really, what that means is trigger points hurt like heck when the massage therapist places her elbow in them.
Now that we have the definition of a trigger points, let's delve more into their physiology. First, we must start with the basic unit of a muscle, the contractile unit known as a sarcomere. Trigger points exists when when these contractile units are unable to release from their contracted state. When these sarcomeres are unable to relax, they are unable to circulate blood and fulfill any metabolic need. This results in oxygen deprivation and can result in accumulation of metabolic waste products which can cause further irritation.
Individuals with trigger points near the neck and shoulders may report a numbness and tingling in their fingers. This is due to the enlarging of the muscle and its ability to compress nerves that have to pass through it. Sometimes, it is labeled by physicians and peripheral neuropathy.
The effects of trigger points can be far-reaching. Most individuals who are experiencing active trigger points will have limited movement. This is because trigger points will keep the muscles short and stiff. Trigger points also have an interesting effect on the central nervous system. Authors Travell and Simons have also listed some of these effects to be quite unimaginable from, reddening of the eyes, excessive tearing, blurred vision, droopy eyelid, goosebumps to persistent nasal secretions.
What are some trigger point causes? There are some obvious causes such as accidents, falls, strains and overwork. Ever overdo it at the gym? The effects can last for days and sometimes weeks long after the event occurred. There are also avoidable and unavoidable muscle abuse that factor in as
Avoidable muscle abuse such as chronic overloading in work situations also known as "overuse syndrome," repetitive motions injury," and repetitive strain. Basically, this means you worked the heck out of these muscles beyond their endurance threshold and now they are angry at you! I remember many years ago my right shoulder and neck would always hurt. It wasn't until I saw a massage therapist that I realized I was spending many of my days shuffling through airports and I would always carry my heavy laptop bag over my right shoulder.
There is the unavoidable muscle abuse that results from falls, accidents and collisions. Other muscle abuse can occur from surgeries where the muscle is cut and stretched, prolonged immobility such as casts can provoke trigger points.
Why do trigger points seem to come back? This too is a very complex question to answer. There are many factors that result in persistence of trigger points.
Physical Factors such as bone structure, physical irregularities, postural stress, poor work habits, repetitive motion, lack of excercise are some physical factors. One of my teachers said it best. I don't remember word for word what he said but here's the gist, during our lifetimes, we are always fighting gravity. It's tough on our bodies and if our bodies aren't supported in this fight, they will either give up the fight or scream like hell.
Nutritional inadequacies. A lack in vital nutrients such as vitamins, B1, B6 and B12 and C and minerals such as calcium, magnesium, iron and potassium have been shown in patients with persistent trigger points. A balance of calcium, magnesium, iron and potassium are required for proper muscle function. Inadequate ingestion and absorption of nutrients due to excessive consumption of caffeine, alcohol, and tobacco are factors as well.
There are also emotional and psychological factors as well. Chronic tensing or guarding that never give muscles a chance to relax are sure to persist trigger points. In a previous life, I used to be an outage coordinator, where I was responsible for coordination of resources when an outage occurred. These were very stressful situations, I would sit for hours on end on a conference call bridge with my shoulders tensed up. I would go home with the worst tension headaches.
One of the best ways to mitigate these trigger points is to have a licensed massage therapist work them out. They are specially trained and skilled to feel for them and help them dissolve away. Keep in mind the factors listed above.
Lifestyle changes and regular bodywork will help keep your muscles and body nice and healthy.
We offer affordable wellness plans that make it easy for anyone to fit regular bodywork in their budget. You can find out more about ithere.
This has been a very common question I've been getting in my practice. I've been asked this question so much, that I feel I need to address it here. This particular entry mainly answers the question regarding private insurance companies.
The short answer to this question is "no". The reason isn't because I don't want to. In my research, I discovered that if you practice massage therapy in the State of Arizona, private insurance companies won't credential you. Credentialing gives you the ability as a massage therapist to bill the insurance companies directly. Until the laws change, I currently am unable to do so.
There are other avenues to explore if you want your massage covered by your insurance company. Your Health Care Provider (HCP) can prescribe or refer you to me. In order for your HCP to refer or prescribe, it must be deemed medically necessary. There are specific diagnostic codes That insurance companies will look for to determine medical necessity. Some common ones are:
There are many, many other diagnostic codes.. If you are feeling particularly curious or having trouble falling asleep, you can find them here:
I currently do electronic charting and will work with any HCP to track progress and help improve your condition. Some doctors' offices may be able to bill the insurance companies on my behalf to minimize your out-of-pocket cost.
If your HCP is unable to bill the insurance companies for my services, (more than likely this will be the case) I can furnish what is known as a "super bill". This is a detailed receipt that you would submit to your insurance company for reimbursement. The super bill will contain the appropriate Current Procedural Terminology (CPT) codes and the ICD-9 (International Classification of Diseases) diagnostic codes. Your physician will have to provide the ICD-9 codes in the prescription or referral. I have referral / prescription forms in my practice for your HCP to fill out.
Additionally, if you would like to have insurance cover your massage sessions, there is also a bit of leg work needed to see if you will be either reimbursed from your private insurance company or covered.
Here's an excerpt from a billing information form I located from my ABMP membership website that may help you determine whether or not you will be covered or reimbursed:
Private Health (Additional information is necessary if billing your health insurance) Does the insurance plan cover massage therapy? Yes ☐ No ☐ Does it cover massage therapy provided by a massage therapist (LMT, LMP, RMT, CMT, etc)? Yes ☐ No ☐
Does it cover massage therapy for this condition (____________________)? Yes ☐ No ☐
Does the treatment have to be referred? Yes ☐ No ☐
Prescribed? Yes ☐ No ☐
Does the treatment have to be pre-authorized? Yes ☐ No ☐
What is the annual massage therapy benefit (# of visits or $ amount)? ______________
How much is remaining for this year? _______________________
Do the benefit limits include PT, DC as well? Yes ☐ No ☐
How much is remaining for this year? ________________
What is the deductible? _____________
How much as been satisfied to date? _____________
Is there a co-pay? Yes ☐ No ☐ How much? _______________________ Does the massage/bodywork practitioner have to be a preferred/credentialed provider in the network? Yes ☐ No ☐
Is _________________________ a preferred/credentialed provider?
Yes ☐ No ☐
Are there out-of-network benefits available? Yes ☐ No ☐ If yes, what % is covered/what is the co-insurance payment? ______________
What is the deductible for out-of-network care? _______________________ How much has been satisfied to date? __________________
If you are receiving physical therapy or chiropractic care and you want to have your massage service covered as well, you cannot receive massage the same day as chiropractic or physical therapy. This is because it will look as though you are double-billing. The practitioner who submits the claim first usually will be the only one reimbursed.
I hope you find this somewhat helpful. If you are interested in having your massages covered by your insurance and have questions, feel free to contact me at firstname.lastname@example.org.
Another affordable option for massage / bodywork services is our monthly wellness plan. It's easy to enroll (no contract only 30 days notice to cancel). You can find out more information regarding our wellness membership here.