Massage & Bodywork

JANUARY | FEBRUARY 2019

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Yo u r M & B i s w o r t h 2 C E s ! G o t o w w w. a b m p . c o m / c e t o l e a r n m o r e . 65 sits deeper and feels like it is in a bit of a trough or pocket. Palpate along the pectineus in baby steps, moving laterally, parallel, and close to the inguinal ligament. At each baby step location, ask the client to perform a gentle/moderate abdominal crunch. If you are still on the pectineus, you should not feel the musculature under your palpating fingers contract and harden because flexion of the trunk at the spinal joints is not a joint action of the pectineus. But once you reach the psoas major, you should feel it contract and harden with a trunk flexion abdominal crunch movement. You can then confirm you are on the psoas major by feeling for its rounded contour as explained above. Then, continue with the palpation protocol as above. SIDE-LYING POSITION— FEMORAL BELLY PALPATION The lesser trochanter attachment of the femoral belly can sometimes be successfully palpated with the client in side-lying position. To palpate the right-side femoral belly, the client lies on their right side with the right thigh in partial flexion at the hip joint and the right leg flexed at the knee joint. The other (left) lower extremity is flexed approximately 90 degrees at the hip and knee joints and supported by a bolster so as to not be in the way. You first need to find the gracilis as your landmark. This is done by asking the client to attempt to further flex the right leg at the knee joint against your resistance. You can offer resistance with a hand. Or, as shown in Image 18A, you can offer resistance using your leg; this allows both of your hands to be free for the palpation, allowing you to support your palpating fingers with the fingers of the other hand. This is helpful because the lesser trochanter is fairly deep and will require a moderate amount of force to reach it. Once you've located the gracilis, drop immediately off it posteriorly and you will be on the adductor magnus. The lesser trochanter attachment of the psoas major is deep to the adductor magnus, so you need to slowly but firmly sink in through the adductor magnus, reaching for the lesser trochanter (Image 18B). Confirm you have reached the psoas major's distal attachment on the lesser trochanter, either by feeling for the hard bony lesser trochanter itself, or by asking the client to flex the trunk at the spinal joints and feel for psoas major engagement; resistance can be given if you can comfortably place your hand against the sternum of the client. CONCLUSION When first confronted with having to palpate and assess the psoas major, it might seem like a daunting task. After all, to reach the abdominal belly of this muscle, you have to palpate through the intestines to reach the anterior surfaces of the bodies and transverse processes of the lumbar spine. Discerning the femoral belly from all the adjacent hip flexor muscles can be similarly challenging. But, armed with an understanding of the fundamental guidelines needed to palpate this muscle, along with how to apply these guidelines with the client in different positions, you can increase your assessment skills to palpate this muscle with precision and confidence. Fundamental to being an excellent clinical orthopedic manual therapist is your ability to assess so you can then appropriately treat your clients. Hopefully this article will create a solid foundation for your palpation assessment skills of this incredibly important muscle, the psoas major. Joseph E. Muscolino, DC, has been a manual and movement therapy educator for more than 30 years. He is the author of multiple textbooks, including The Muscular System Manual: The Skeletal Muscles of the Human Body (Elsevier, 2017); The Muscle and Bone Palpation Manual with Trigger Points, Referral Patterns, and Stretching (Elsevier, 2016); and Kinesiology: The Skeletal System and Muscle Function (Elsevier, 2017). He is also the author of 12 DVDs on manual and movement therapy and teaches continuing education workshops around the world, including a certification in Clinical Orthopedic Manual Therapy (COMT), and has created Digital COMT, a video streaming subscription service for manual and movement therapists, with new content added each and every week. Visit www.learnmuscles.com for more information or reach him directly at joseph.e.muscolino@ gmail.com. Palpation of the lesser trochanter attachment of the right-side psoas major with the client side-lying. 18A: Resistance to flexion of the leg at the knee joint is done to locate the gracilis. 18B: The lesser trochanter attachment is palpated immediately posterior to the gracilis. 18A 18B

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