by Pat Mayrhofer

Therapeutic Application of Massage Stones: Psoas Muscle, MASSAGE MagazineThe use of massage stones goes far beyond the relaxing, “feel-good” massage we think of when envisioning stone massage. Massage stones, both hot and cold, are the best therapeutic tools massage therapists can have in their repertoire of techniques. In my series of articles on stone massage, I will guide you through releasing specific muscles and common problem areas with massage stones.

Low-back pain is one of the most common complaints from massage clients. Some suffer from herniated discs and others from muscle stress, strain and pulls. The following muscles are muscles most commonly attributed to the cause of low-back pain: psoas major and minor, iliacus, quadratus lumborum, gluteals, piriformis, deep hip rotators, iliotibial band, tensor fasciae latae and hamstrings.

Many years ago when I went to massage school, the most important statement I learned was, “The area of pain almost always lies.” I have found this to be true. In general, when helping a client who has discomfort, you must first find what is causing the problem. Then, you put your skills to work to release the problem. With low-back pain, I always begin by checking the psoas major and iliacus; together they form the iliopsoas. These iliopsoas muscles are hip flexors, which also laterally rotate and adduct the hip. They are located deep in the abdomen and stretch from the lumbar vertebrae to the lesser trochanter.

The psoas major originates from the transverse processes of all lumbar vertebrae, as well as the intervertebral discs above each lumbar vertebra, and inserts in the lesser trochanter of the femur. The action of the psoas major is to flex the thigh at the hip joint and to flex the vertebral column.

The iliacus originates in the upper two-thirds of the iliac fossa anterior and inferior iliac spine and inserts onto the tendon of the psoas major, which inserts on the lesser trochanter of the femur. The action of the iliacus is to flex the hip joint.

If these muscles are tight or contain trigger points, then they will pull the client forward, flexing the hip joint and causing stress on the low back. The iliopsoas is too often overlooked and is the first step in releasing low-back pain.

To achieve this release, the massage therapist should follow these steps:

1. Position the client in the supine position on the massage table, with a pillow or bolster under her knees.

Therapeutic Application of Massage Stones: Psoas Muscle, MASSAGE Magazine2. Have the client reach her arms up over her head. The client should not stretch. The massage therapist should then handle the client’s arms. Look at the knuckles on the thumbs and see if they match. The thumb that appears shorter shows tightness in the psoas. (Also, pay attention to any restrictions that might appear in the shoulder, which would affect the positioning of the thumbs.)

3. Bend knee on affected side.

4. Stand at the client’s side.

5. Through the sheet (never place a hot stone on bare skin without moving it), place one large hot stone (sacrum stone; 127 to 130 degrees Fahrenheit) on its edge on the landmark of the psoas. Ask the client to take several slow, deep breaths. The first breath should fill the abdomen, followed by deep breath filling the upper chest. Make sure the client breathes deeply, in through the nose and exhales with force out through the mouth. Follow the client’s exhalation with mild pressure with the stone in toward the psoas.

6. When the client inhales, hold the stone in place without applying any more downward pressure until the client takes another breath.

7. Once the psoas is reached, ask the client to take more regular breaths, while the stone is quietly held in place for several seconds.

8. Slowly move the edge of the stone gently back and forth to “strum” the psoas. With intent and quiet and slow movement, work the large stone back to the surface. It is important to release the pressure of the stone slowly and respectfully away from the psoas.

9. Once again, your client takes a deep breath. Place the stone on iliacus and work as before with the exhalation. Continue for several seconds until iliacus releases.

10. Recheck your client’s thumbs as before. If there is still a discrepancy, then repeat the routine.

11. If an additional release is required, then hold the stone on the psoas and ask your client to breathe while you raise her leg on the affected side with a “press and stretch” technique. Your client exhales as you lower the leg.

12. With a pair of hot stones (127 to 130 degrees Fahrenheit), introduce the stones to the exposed abdomen and massage the abdomen with an effleurage motion. (To introduce the stones, therapists must first pass the back of their hands on the skin, and then turn their hands over. With sufficient amount of pressure, move the stones in a smooth motion. This is done every time a hot pair of stones is applied.)

13. With cool marble stones, massage the abdomen to help reduce any inflammation in the psoas and other abdominal muscles.

14. After releasing the iliopsoas muscles, turn the client over and release the other muscles affected in the discomfort of the low back.

Join me next time as I look at another muscle that affects low-back pain.

Please look for future articles on, as I explore the exciting arena of stone massage. I will write about safety issues, contraindications, the expansion of stone therapy to different modalities, the evolution into cold-stone therapy with marble stones and now the resurgence of stone massage with the innovation of carved basalt stones. I will also discuss accessory products, such as massage oil, essential oils, heaters, textiles, DVDs and seminars. I look forward to an ongoing conversation with you.

Pat Mayrhofer is president and founder of Nature’s Stones Inc., an international massage-stone, education and supply company. She is a massage therapist with more than 15 years of experience, having taught for 13 of those years in Italy, Austria, the Dominican Republic and the U.S. Mayrhofer and her staff have created a comprehensive series of live, hands-on training programs, educational DVDs available for distance learning and a line of associated stone and textile products. For more information, visit