Over the past decade, I have noticed exponential growth in the self-massage tool industry. Tools now range from variations of small massage balls, foam rollers, canes, electric power massage tools to things that I don’t know what to call. Big picture wise, I believe this is a good thing, but it is not without a potentially dangerous downside. Today I want to focus on tools that are designed to work specifically on two of our major hip flexor muscles, the psoas major and the iliacus.
What makes self-massage with these tools potentially dangerous is the location of these muscles and the anatomy that you have to avoid damaging to get to them. If you look at images A & B, you will see that the psoas major and the iliacus (highlighted orange) are the deepest layer of muscle in the front of the spine and hip. In order to access those muscles, you have to make your way around the small (S) and large (C) intestines, which you can see in image C. These tools (image H & I) are designed to be placed into the abdomen with you laying face down; you will most certainly be pressing directly on these organs in that position. This leaves us open to potential injury, especially if there are any issues with poor digestion or bowel movement, both of which are common.
Image A: psoas major
Image B: iliacus
Image C: small (S) and large (C) intestines
The next layer down for hazards after the intestines are the abdominal aorta (red) and inferior vena cava (blue), which you can see in image D. These are two major blood vessels that you should not press on due to potential damage or blood flow restriction. Next, we have the lateral femoral cutaneous nerve (image E), the genitofemoral nerve (image F), and our ureters (image G). Now, as far as the nerves go, you will typically know when you are on them by the often sharp electrical pain, but you likely won’t know that you on a ureter until the damage is done and your self-massage session is finished. And, last but not least, there is the very real possibility of giving yourself an abdominal hernia, by going too deep too fast, or massaging a cyst or tumor when you think it is just a tight muscle.
Image D: abdominal aorta & inferior vena cava
Image E: lateral femoral cutaneous nerve
Image F: genitofemoral nerve
Image G: ureters
Image H: self-massage tool
Image I: self-massage tool
Doing safe massage of the psoas major and iliacus is an advanced skill. It requires formal training in anatomy and physiology and advanced palpation skills that take years to develop. Although it was something I learned in school by experienced teachers who were seasoned providers, I feel it could have been taught better.
I recognized early in my career that this was a skill that would require consistent practice and ongoing education to do safely and effectively. I have heard numerous stories of seasoned providers injuring their patients, such as causing an abdominal hernia, and there are countless licensed massage therapists that won’t work on these muscles because they are not comfortable with it. I mention these things to make the following point, if highly trained professionals can injure their patients, or are not comfortable doing this work, do you really think you should be doing it to yourself, even if advised to do so by your provider?
I understand that these tools are becoming more and more popular, and even some famous people have shared their positive experience with using them. It is my hope that you feel a little more educated now, and will give some serious pause and consideration if you are still interested in these tools.