Massage & Bodywork

JANUARY | FEBRUARY 2019

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The psoas major is an incredibly important muscle that can be involved in conditions of the lumbar spine, the sacroiliac and hip joints, and the diaphragm and pelvic floor (Image 1). To determine whether the psoas major is a factor in your client's health, you need to be able to perform an accurate physical assessment. At the heart of this assessment is palpation. THE ART OF PALPATION Muscle palpation assessment involves two steps. The first step is to find the target muscle, locate all its borders, and discern it from adjacent tissue. Once that's been completed, the second step involves assessing the health of the muscle tissue. Is the muscle globally tight or loose? Are there myofascial trigger points? Taut 52 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 9 P A L P A T I O N O F T H E P S O A S M A J O R By Joseph E. Muscolino, DC A T H O R O U G H E X P L O R A T I O N O F H O W T O A C C E S S T H I S C O R E M U S C L E and tender bands? This is the crucial step that determines what treatment, if any, is necessary for the client. But this second step can only be performed if you are successful with the first step. There are many books, articles, and videos that demonstrate palpation protocols on how to locate target muscles for palpation. But more important than memorizing these protocols is to understand and reason through fundamental guidelines of palpation. An ideal palpation protocol usually involves finding a way for the client to perform an isolated contraction of the target muscle. If this can be done, the target muscle will be the only hard, soft tissue amidst a sea of soft, soft tissues. This way, it can be discerned from adjacent tissues, now allowing the therapist to confidently assess its health. Finding a way for the client to perform an isolated contraction requires knowledge of the attachments of the target muscle, as well as the actions of not only the target muscle but also all the adjacent muscles. Armed with this knowledge, you find a joint action that the target muscle possesses that the adjacent muscles do not. Therefore, the adjacent muscles remain relaxed and soft while the target muscle contracts and becomes palpably hard, thereby succeeding in your goal of making the target muscle be the only hard, soft tissue amidst a sea of soft, soft tissues. GENERAL GUIDELINES FOR PALPATION OF THE ABDOMINAL BELLY OF THE PSOAS MAJOR Regardless of the position in which we place the client, palpation of the abdominal belly of the psoas major usually involves the following steps: Have the client's thighs in flexion. Having the client's thighs flexed at the hip joints slackens the hip flexor musculature so that the pelvis can fall into posterior tilt. Posterior tilt of the pelvis allows the anterior abdominal wall musculature (the rectus abdominis, external abdominal oblique, internal abdominal oblique, and transversus abdominis) to be slackened, allowing your palpating fingers to sink through the anterior abdominal wall to reach the abdominal belly of the psoas major. Contact the client immediately lateral to the rectus abdominis. The anteromedial rectus abdominis is thicker than the other three anterolateral abdominal wall muscles

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