Hip Flexor Phobia

[JasonE]

Ever since I've entered this profession, I have been amazed at the number of MTs who are uncomfortable with working on the hip flexors. In most cases, I've been told "we didn't spend much time on it in school" as the primary reason they avoid treating hip flexors. :?

A number of MTs have further suggested that working the hip flexors is a bad idea for male MTs. "It's kinda close to the groin," and "It'll freak people out," are representative comments.

The hip flexors are sorta important. They play key roles in balance, posture, core strength and stability, contribute to back pain, hip pain, leg pain, may inhibit the glutes, and a few hundred other things. Iliopsoas major and minor, iliacus, and pectineus are too vital to be ignored.

There are many ways to address the hip flexors. Some authorities recommend working from distal to proximal attachments, while others advocate avoiding direct pressure above the inguinal ligament. Other authorities recommend stretching them and/or using compressed air to release them. The key, in my opinion, is to find a way that works for you, and become comfortable with doing the work. If you have several different approaches you know how to use, great!

As a male MT, I exercise due caution and educate my clients before working the hip flexors. This process begins during the intake prior to the session, and we communicate more during the session so I know the client and I are on the same page. Whether they are supine, sidelying, or prone, and regardless of the method(s) employed, my clients know what we are working on and why. Though they may experience some physical discomfort, they remain mentally/emotionally comfortable with having me do the work.

The "hip flexor phobia" that afflicts some MTs creates opportunities for me to build my client base. Some MTs, afraid to do the work, have referred clients to me. This is always appreciated, and I do my best to provide excellent treatment for those clients... and they usually decide to stay with me!

Don't fear the hip flexors. Learn to understand and treat them, and to effectively communicate with your clients when they need the work, and reap the rewards!

[BlackSwanMassage]

I have never shied away from any particular part of the body due to its proximity with "no-no spots". I have taken great pains to explain to my clients ahead of time what muscles I will be working, and why that work serves a greater purpose toward the whole treatment. The only real complaint I've ever gotten about the hip flexor work has been, "WAIT! That tickles!" In which case, we have to work into it with deep breaths and gradual movement.

In my opinion, any male MT who refuses to do certain work based on the muscle's location, whether they realize they are doing it or not, only serves to undermine the work that we all do as therapists. To be unwilling to treat the body as a whole due to the location of some of the muscles implies that there's a certain wrongness to working those muscles. That creates a barrier later on with a client that some other male MT will have to work to break down if the client is to be effectively treated.

To those who say, "Well, it will upset the client," I reply, "Transference." Have you talked to them about it? Have you explained it? If they say no after you've given a thorough explanation as to the reason behind the work (and a couple of mine have), then you move on, and don't do the work. That's their preference, and that's fine. But to project your feelings of discomfort onto the client and assume awkward feelings that might not even be there is doing your client a disservice--and making it harder for the next person who has to work on that client.

[NaplesLMT]

Taking a CEU course that addresses hip flexor work really boosted my knowledge and therefore my confidence. I suspect that this is at the root of many therapists reluctance to do the work. The same goes for working the ilio psoas. My spouse is also a LMT. She has lined shorts in various sizes for shy people to wear. After a few visits most people are comfortable enough to go without.

[Gaspen]

I agree with the above posts. As a massage therapist (male or female), it is important to educate the client as to which muscles are going to be worked and why. Whether the client is a male or female, the muscles are sometimes located in 'sensitive' places. If the client chooses not have a muscle worked, that is their choice. It should not be the therapist's. It's our responsibility to serve the client within our scope of practice which includes our comfort level. If a MT is uncomfortable working on the hip flexors or any other muscle group, take a course or two, read some books with illustrations, view a DVD, etc., until your comfort level broadens. I tend to form a professional relationship with my clients. As they become more and more familiar with me and my working style, I'm able to do more and more work. In most cases, however, I generally do not do specific work on most of the hip flexors until the 2nd or 3rd appointment. This allows the client to become more comfortable with my work, approach, and trust and allows me to understand the particulars of a cleint's response to work (pain response, holding patterns, etc.).

[michiganMT]

in response to Gaspen's post:

My instructor says almost the same thing. there are 2 other guys in my class of 20 and we were all a little nervous at first, but the girls always looked out for us and encouraged us. it's nice to here it from a fellow male therapist, thanks Gaspen.