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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 . 63 itself. To facilitate this deeper palpation toward the lesser trochanter, it might be necessary to slacken the soft tissue in the region by placing the client's thigh in a position of passive flexion (Image 15). SARTORIUS AS A LANDMARK— FEMORAL BELLY PALPATION Another method for locating the femoral belly of the psoas major is to use the sartorius as a landmark and then palpate medially across the iliacus until you reach the psoas major. To first find the sartorius, locate the client's ASIS and drop off it immediately distal and slightly medial. This should place your palpating fingers on the sartorius. To confirm you are on the sartorius, ask the client to perform an oblique plane motion of the thigh at the hip joint that is a combination of flexion and lateral rotation, along with flexion of the leg at the knee joint. These are all actions of the sartorius and should nicely engage it (Image 16A). Then, drop immediately medial off the sartorius, and you will be on the iliacus (Image 16B). Palpate along the iliacus in baby steps, moving medially, parallel, and close to the inguinal ligament. At each baby step location, ask the client to perform a gentle/moderate contraction of trunk flexion (abdominal crunch). If you are still on the iliacus, you should not feel the musculature under your palpating fingers contract and harden because the iliacus does not engage with trunk flexion. But once you reach the psoas major, you should feel it contract and harden when the client flexes the trunk at the spinal joints. 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. ADDUCTOR LONGUS AS A LANDMARK—FEMORAL BELLY PALPATION Another method for palpation of the femoral belly of the psoas major is to use the adductor longus as a landmark. Like the sartorius, the adductor longus is a good posterior tilt of the pelvis that must be stabilized by a force of anterior tilt. This is accomplished by hip flexors, which are anterior tilters of the pelvis). Once located, follow the femoral belly distally in baby steps, asking the client to do a small trunk flexion abdominal crunch at each step along the way, until you reach the lesser trochanter attachment. Once you believe you have reached the actual lesser trochanter itself, ask the client to relax and feel for the difference between the soft, myofascial tissue and the hard, bony tissue. This assists us in locating the lesser trochanter bone 16A 17A 16B 17B Using the sartorius as a landmark for the psoas major femoral belly palpation. 16A: Engagement of the sartorius. 16B: Palpating the iliacus between the sartorius and psoas major. Using the adductor longus as a landmark for the psoas major femoral belly palpation. 17A: The proximal tendon of the adductor longus is indicated. 17B: Palpating the pectineus between the adductor longus and psoas major. landmark for palpation in the proximal thigh because it is so easy to find. Even at rest, the adductor longus's proximal tendon is usually taut enough that it can be easily located; it is probably the most easily palpable tendon in the proximal thigh (Image 17A). Of course, if needed, you could always ask the client to adduct the thigh at the hip joint and add resistance. This will make the adductor longus proximal tendon engage and be even more readily palpable. Once located, drop immediately lateral off the adductor longus and you will be on the pectineus (Image 17B). The pectineus