When we can’t walk or stand because of feet or knee problems, we soon realise how much we take our limbs for granted in our day to day activities.

Despite the fact that arthritis or injury like torn ligaments or tendons are common complaints that cause the loss of mobility, often it is simply a collection of muscular problems causing pain in these areas.

Remedial massage can usually play a major role in either healing or significantly alleviating these problems.

For successful treatment, however, it is important… as in most cases of remedial massage… to consider the overall picture and look at all the muscles affecting the movement of the hips, thighs, knees, legs, ankles and feet, because they are all closely interconnected.

Remember the little ditty that goes something like “The toe bone’s connected to the foot bone’s connected to the leg bone’s connected to the knee bone….” was spot on.

Major leg muscles like Hamstrings, Quadriceps and “Calves” are fairly well known, but there are plenty of others with names names not so common, and their actions also play an important role in movement and stability of the legs and feet, and therefore, the entire body.

It is the feet, ankle and knee joints which support the entire weight of the body. Problems with these areas will cause “flow on” effects throughout body as a whole.

Which muscles to massage.

Starting from the top of the hips, here’s some movement muscles which, in most cases, should be massaged to effectively treat leg, knee or feet problems:

· One joint hip flexor (Iliopsoas) muscles:

From the side of the spine from about mid-back, it passes across the front of the hips to the top of the femur (thigh bone). When the hip flexor muscle on one side of the body pulls tighter than the other, it tilts the hip laterally (upwards) on that side, causing imbalances in most leg muscles. (If there is problems in the lower back, this should always be treated.)

One leg will hang slightly in adduction, the other in abduction, though this may not be evident to the untrained eye.

· Buttocks muscles:

Mainly the Gluteus Maximus, Medius and Minimus and Piriformis muscles, and play a key role in medially and laterally rotating the thigh (turning the leg inwards and outwards) and extending the hip. Problems with these will turn the knee and feet away from their proper alignment, also creating imbalances in leg muscles and exerting unequal forces on the knee joint and feet, in particular the arches.

· Two-joint hip flexor muscles (Tensor Fascia Latae/Iliotibial Band – ITB, Rectus Femoris (main Quadriceps muscle) and Sartorious:

These muscles get their “two joint” name because they go both across the hip joint and the knee joint.

· All the muscles of the thigh and lower leg, some of which go across the knee joint.

It is important to remember most of the muscles that go right to the tips of the toes extend up to just below the knees. So when trying to massage out a foot or ankle problem, it is important to follow the muscles right up to the knees.

· Feet Arches.

Last, but certainly not least, are the feet arches:
Flat feet will cause the legs to medially rotate (turn inwards) at the knees. High-arched feet will cause the legs to laterally (turn outwards) – again causing imbalances in the knees.

If you are being treated for leg, knee, ankle or feet aches and pains which you consider to be related to muscle imbalances (rather than to specific injury) and your practitioner does not include all the above factors, ask why.

Injuries like muscle tears and strains, post-operative recovery procedures, arthritis and gout however, will require more specific or specialised treatments.

Some people put up with leg or other problems for years assuming nothing can really be done when they may simply be related to a combination of tight muscles and easily treated by looking at the “big picture.”

With any massage however, it’s advisable to wear comfortable underwear that’s not too tight.

I’m not referring to your nagging wife or lazy husband.  This is all about pain in that muscle tucked in behind the Glutes… the Piriformis, and someone in the world of the wise has named it the Piriformis syndrome.

The Piriformis Syndrome effects countless numbers of people daily, and doctors refer to it as neuropathic entrapment.  That means that a muscle deep under the gluteal area called the Piriformis is tight or inflamed which decreases the performance or flow of the largest nerve in the body (the sciatic), which passes behind it.  Sometimes, it goes through the muscle.  Tightness in the Piriformis  will cause pain can be in or around the muscle, and along  the sciatic nerve, usually in the back of the thigh, and possibly all the way down into the foot. Shooting pain along the sciatic nerve distribution is called sciatica.  Pain can also be referred up into the lower back region.

If you have pain walking uphill or up stairs, along with pain after prolonged periods of sitting, it’s quite possible you have a dicky Piriformis.

Where is it?

The origin of the muscle is the front the sacrum.  The sacrum is that triangular shaped bone at the base of the spine between the two hip bones, forming the pelvic girdle. The Piriformis Muscle then goes through the greater sciatic foramen (that’s a hole in the pelvis) before it blends into its tendon and inserts onto the top of the Femur at the Greater Trochanter ( hip bone).

The sciatic nerve travels through the greater sciatic foramen (that hole I told you about) behind the Piriformis Muscle.  In about 15% of the population, the sciatic nerve goes through the Piriformis muscle. It’s no surprise then that those within that 15% would be much more likely to experience Piriformis syndrome. Regardless, a tight and/or inflamedPiriformis will eventually lead to a condition known as Sciatica.

Function?

The function of the Piriformis is to abduct and laterally or externally rotate the femur. Abduction of the thigh means to move the leg out to the side away from the body. Lateral (a.k.a. external) rotation means to rotate the hip such that your toes are pointed out to the side instead of forward.

Runners, cyclists, and weightlifters usually experience the condition. Another cause is sitting for prolonged periods with the hips abducted and externally rotated. This can occur at one’s desk, but it is also very common while driving for long periods of time.

Treatment:

Stretching is good.  Deep tissue massage is  also invaluable in treating Piriformis Syndrome.  Undoubtedly, the best  technique is an active release. It’s a very precise technique that’s used to remove any adhesions that might have formed within the Piriformis or between it and the Sciatic Nerve.

A deep tissue massage can help if the therapist is familiar with the anatomy of the deep gluteal muscles.  If you’re experiencing the symptoms of Piriformis Syndrome or tight Gluteal muscles, make a booking and feel the difference Remedial Massage can make.  With any massage however, it’s advisable to wear comfortable underwear that’s not too tight.

Iliopsoas

The Iliopsoas is sometimes classified as two muscles, Iliacus and Psoas major, with Iliacus arising from the Ilium and Psoas from the vertebrae.

Action:
Flexes and laterally rotates hip as well as flexing the  torso when the legs are fixed (e.g. laying to sitting).

Typical use:
•    Climbing a step.

Sartorius

The Sartorius is a two joint muscle and so is weak when the knee is flexed and the hip is flexed at the same time. It works better during single movements.

Action:
Flexes, abducts, laterally rotates thigh at hip. Flexes, medially rotates leg at knee. Abducts the hip and externally rotates the hip as it flexes the hip and knee.

Typical use:
•    Sitting in a cross-legged position.

Rectus Femoris

The Rectus Femoris muscle is part of the Quadriceps muscle group.

It is the only muscle of the group which crosses the hip joint and is a powerful knee extensor when the hip is extended, but is weak when the hip is flexed.

Action:
Extends leg at knee. Flexes thigh at hip.

Typical use:
•    Kicking a football.

Gluteus Medius

The Gluteus Medius is an important muscle in controlling the level of the hips.

Weaknesses in gluteus medius often result in a trendelenburg sign, an abnormal gait cycle where the hip of the swinging leg drops down, rather than raises up.

This results in increased degrees of knee flexion in order to clear the ground.

Action:
Abducts and medially rotates hip. Tilts pelvis on walking.
The posterior fibres externally rotate the hip.
The anterior fibres internally rotate the hip.

Typical use:
•    Stepping sideways out of the bath.

Gluteus Minimus

This is the smallest of the three gluteal muscles and sits underneath the gluteus medius.

Action:
Abducts and medially rotates hip. Tilts pelvis on walking.

Typical use:
•    Getting out of a car.

Gluteus Maximus

The Gluteus Maximus is the largest and most superficial of the three gluteal muscles which forms the rounded shape of the buttocks.

Action:
Extends and laterally rotates hip and keeps the knee extended via iliotibial tract

Typical use:
•    Extension phase of walking upstairs.

Piriformis

The Piriformis muscle is an important muscle. The sciatic nerve passes underneath this muscle on its route down to the posterior thigh.

In some individuals the nerve can actually pass right through the muscle. This can lead to sciatica symptoms due to a condition known as piriformis syndrome

Action:
Laterally rotates, abducts and stabilises the hip.

Typical use:
•    Taking the first leg out of the car.

Biceps Femoris

The Biceps Femoris is one of the three muscles which form the hamstring group forming the back of the thigh.

The muscle is often described as having a long head (the attachment from the ischium) and a short head (attached to the femur).

Action:
Flexes and laterally rotates knee and laterally rotates the hip when the knee is flexed. The long head extends hip.

Typical use:
•    Bending the knee to step over something.

Semitendinosus

When running the hamstrings act eccentrically to slow down the knee extension motion.

Hamstring strains are common in individuals with chronically tight hamstrings or who do not warm-up thoroughly.

Action:
Flexes and medially rotates knee, and extends the hip.

Typical use:
•    Bending the knee to step over something.

Semimembranosus

The Semimembranosus is the most medial of the three hamstring muscles.

Chronically tight hamstrings are often a contributary factor to lower back pain and knee pain.

Action:
Flexes and medially rotates knee, and extendsthe  hip.

Typical use:
•    Bending the knee to step over something.

Pectineus

The Pectineus is positioned between the Iliopsoas and Adductor Longus muscles and is part of the short adductor group with adductors brevis and longus.

Action:
Flexes, adducts and medially rotates the hip.

Typical use:
•    Kicking a football.

Adductor Brevis

The Adductor Brevis is the smallest and shortest (hence the name brevis, meaning short in latin) of the three short adductor muscles.

Groin strains are common injuries to the adductor muscles, which occur without a thorough warm-up or in individuals with chronically tight or weak adductor muscles.

Action:
Adducts and flexes the hip.

Typical use:
•    Bringing your second leg into the car.

Adductor Longus

The Adductor Longus is the middle of the three short adductor muscles.

Groin strains are common injuries to the adductor muscles, which occur without a thorough warm-up or in individuals with chronically tight or weak adductor muscles.

Action:

Adducts, flexes and medially rotates hip.

Typical use:
•    Bringing your second leg into the car.

Adductor Magnus

The Adductor Magnus is the largest groin muscle and is one of the two long adductor muscles (gracilis is the other).

It is usually decribed as having two parts, hamstring and adductor parts.

Action:
Adductor portion: adducts, flexes and medially rotates hip. Hamstring portion: extends hip.

Typical use:
•    Bringing your second leg into the car.

Gracilis

The Gracilis is another muscle which works in conjunction with the groin muscles, or adductors.

Action:
Adducts hip. Flexes knee and medially rotates the hip when the knee is flexed.

Typical use:
•    Sitting with the knees pressed together.

The Gluteal group of muscles consists of three  muscles: Gluteus Maximus, Gluteus Medius and Gluteus Minimus.  “Gluteus” is from the Greek and means rump.  “Maximus” is the largest of the muscles and “Minimus” the smallest.  The role of the Gluteus Maximus is different from the Medius and Minimus muscles because of their attachment points.

The Gluteus Maximus is the largest and most posterior of the group, and is the big overlaying muscle in the buttocks.  It originates at the posterior Sacrum, Ilium and the superior gluteal line of the ilium, and attaches to the gluteal tuberosity of the femur and the iliotibial tract.  This muscle contracts to swing the upper leg backward, and is heavily used during swimming and squatting.

The Gluteus Maximus extends the femur at the hip and laterally rotates the extended hip. The Gluteus Maximus is used mostly for power as in going upstairs, jumping, rising from a sitting position, climbing or running.  I think it’s one of the hardest working muscles of the body.

The Gluteus Medius and Minimus muscles are located below the Maximus, and all three are referred to as ‘the Glutes’.

When these and other butt muscles are tight and visually pleasing to the opposite sex, there is the possibility of adverse effects on the body elsewhere in the body.

Sciatic Pain:

The Piriformis is often involved in Sciatic pain.

The   Piriformis  Muscle is a short, small muscle that is located deep in the buttock region. It functions to rotate the thigh, and helps to stabilise the hip joint during walking. This muscle lies next to a major nerve (the Sciatic Nerve) and blood vessels.

The Sciatic Nerve starts at the Lumbar vertebrae 4 and 5, (L4 and L5) passes through a notch in the hipbone under the Piriformis muscle and travels down the leg.

In most people, it passes under the Piriformis Muscle, and in others, it passes right through it.

If the Piriformis is tight for whatever reason, it can compress the Sciatic nerve causing pain to the lower back, buttocks or the legs.  This is a condition known as Sciatica.

Pills may provide temporary relief but they don’t address the cause.

Often, a simple remedial massage technique can make the symptoms of sciatic pain just disappear without the need for anti-inflammatory tablets or other treatments.

If you’ve ever visited a remedial therapist and mentioned that you have a sore back, sore legs, sore knees and or feet and he or she doesn’t at least mention working on or releasing your butt muscles, then question their qualifications.

The therapist may have to consider that the patient has limited time, but those muscles are very significant.

If the therapist doesn’t understand their implications for the rest of the body, he or she may not be as qualified as you think.

For obvious reasons, some people are dubious or uncomfortable about having their buttocks massaged.  Other people will say it’s “just magic” because if it’s done professionally with no embarrassment ,they’ll only feel the tight spots disappearing and realise how much better they are going to feel later.

At the end of the day however, whether or not you want the therapist to massage your buttocks is up to you.  Just bear in mind, your “nice tight butt” is not just something you sit on.  It’s a range of vital muscles that can have various impacts on the rest of your body.

Not massaging the buttocks… in other words, just massaging a sore back means the therapist may just be treating the symptom of the problem, not the cause or an important contributing factor.  With any massage however, it’s advisable to wear comfortable underwear that’s not too tight.

The Psoas is perhaps the single most involved muscle, and it is the cause of most grief in the low back, neck, shoulders and especially the hip joint.  Often, the patient will complain of feeling sore in the groin.

A contracted Psoas will significently reduce performance in athletes and accident victims and has a detrimental affect on our ability to function properly at work.  When it is released, it gives a profound feeling of relief, and is likened to a heavy weight being removed from their hips and lower back.

The psoas major plays an important role in maintaining the lumbar lordosis.  Contractures of one or both psoas (major and minor) through over use or muscular imbalances will definitely affect pelvis rotation.

In most back and hip pain complaints, the cause is often the psoas muscle which is one of the most important muscles in the body. Problems related to the Psoas include: low back pain, sacroiliac pain, sciatica, disc problems, spondylolysis, scoliosis, hip degeneration, knee pain, and menstruation pain. The list can also include pelvic tilt, leg length discrepancies, lumbar lordosis and kyphosis

Primarily, the Psoas flexes the hip and the spinal column with an average length of 400 millimeters. It’s a very powerful muscle, and runs down the lower mid spine beginning at the 12th rib connecting with the vertebral bodies, discs and transverse processes down the lumbar vertebrae.  Then it passes across the pelvis to attach on the inside top of the leg at the lesser trochanter.

The lower portion combines with fibres from the iliacus muscle, which sits inside the surface of the pelvis and sacrum, to become the Iliopsoas muscle as it curves over the pubic bone and inserts on the lesser trochanter.

What is the function of the Psoas?

The psoas functions as a hip and thigh flexor, which makes it the major walking muscle.
If the legs are stationary, its action is to bend the spine forward.  If sitting, it stabilises the trunk.  The lower psoas brings the lumbar vertebrae forward and downward to create pelvic tilt.

When we think of smooth, elegant and graceful movement in dancers and athletes we are looking at the psoas functioning at its optimum. It requires that the psoas maintains the pelvis in a dynamically neutral orientation that can move easily and retain structural integrity. This creates positions of the spine that require the least muscular effort.

Common Ailments

Sore back, shoulders and knees are common complaints of people who lead a full and active live. Let’s face it, there are many occupations that are not kind to muscles.

In most cases, one of the major common denominators of these problems is imbalance in a muscle group known as the Iliopsoas aka Psoas Major, Psoas Minor and Iliacus muscles.

These are the hip flexor muscles and extend from along the side of the spine from about mid-torso down to the base of the spine then across the front of the hips to the top of the leg.

Most people are familiar with muscle names like quadriceps (quads), hamstrings, calves, “abs,” biceps, triceps, “lats,” etc because they deliberately exercise them.  But I doubt if even .001 per cent of the population knows they have this Iliopsoas muscle group let alone its actions and the musclar imbalances it can cause in the rest of the body.

Because Iliopsoas muscles flex the hip, they contract every time you walk, run, jog, climb, sit or bend. Think about how much and how often this happens every day!

They are also postural muscles – in other words, they help hold you upright while you are standing and sitting – and are designed to take a lot of hard work and punishment before they ever feel sore.

But that does not mean they are not tight. If they are, they can put all sorts of uneven pressures on the hip.

They are quite substantial muscles and pull the front of the hips downwards, causing muscles in the lower back and along the spine to tighten as the back of the hips tilt up (hence the back pain).
Among these lower back muscles is the Quadratus Lumborum from the top of the hip on an angle to the spine.  It acts like guy ropes for the spine, helping to stabilise it and keep it balanced.

If the Psoas muscles from one side of the spine pull tighter than the other, it tilts one side of the hips higher, putting uneven pressures along the back of the spine and on several major leg muscles which go across the hips and knee joint.

Because the Iliopsoas group can cause tightness in muscles controlling flexibility of the spine (including Quadratus Lumborum), they also can have a big impact on shoulder muscles.

When you start to raise your arm above your shoulders, at about 150 degrees the shoulder blade begins to rotate upwards and the spine flexes to accommodate this.

If the spine is too rigid from tight muscles, then the muscles moving the shoulder blades need to work harder and can fatigue or become sore.

Pain in your back, shoulders or knees is usually due to tight or strained muscles in those areas but, in fact, it is often the hip flexors that have caused those muscles to be tight in the first place.

Hopefully from the above, you will agree the reason for muscle and joint pain is not always what it seems and that the therapist should look at the bigger picture to give you the most effective treatment.

A good tip if you’re ringing around to find a remedial massage therapist is to ask the masseur, “Can you do a Psoas (pronounced so-as) Release?”
A qualified and competent therapist will know straight away what you are referring to.

Psoas Release

A Psoas Release is a technique used to help release tight hip flexor muscles across the front of the hip, to balance the hip and get it back in correct alignment.  This then helps reduce or remove some of the uneven pressures on other muscles in your back and legs.
It involves putting pressure from the fingertips into the Psoas muscles just above the hips and lowering and raising the leg against this pressure to stretch the muscle.

It can sometimes be quite uncomfortable or painful, depending on how tight the muscle is, but the results are well worth a possible few minutes of discomfort well within your normal pain tolerance.

Without this technique, therapists who only treat the areas you say are sore are often only doing half a job (if the hip flexors are part of the problem)

In reality, they may only be treating a symptom of the problem, rather than the probable cause as well.

Health care is expensive enough without having to make repeated visits for problems which often can be fixed or greatly relieved quickly when a Psoas release is included in the treatment.

If you haven’t tried massage therapy for a bad back or that pain in your hips, make a call today.  Make an appointment and experience the many benefits that massage has to offer.  With any massage however, it’s advisable to wear comfortable underwear that’s not too tight.