Issue link: https://www.massageandbodyworkdigital.com/i/1060121
DRAPING FOR THE ABDOMINAL BELLY Draping is extremely important for professional modesty and client comfort. For clarity of visualization, the photos throughout this article show the client wearing clothing. However, appropriate draping techniques for the abdominal belly of the psoas major for a male and female client are shown here. (the external and internal abdominal obliques and transversus abdominis) put together. Therefore, successful palpation of the abdominal belly of the psoas major requires finding the lateral border of the rectus abdominis so you can drop immediately off it laterally and palpate through the anterolateral abdominal wall musculature. To accomplish this, ask the client to flex the trunk at the spinal joints, effectively doing an abdominal crunch (sit-up), and palpate from medial to lateral on the rectus abdominis until you locate its lateral border. Then, drop immediately lateral off it, and this will be your initial point to begin palpation of the psoas major. Brace/support your palpating fingers. Because the abdominal belly of the psoas major is so deep, it requires more force to reach it than the average muscle palpation. For this reason, it is a good idea to brace/ support your palpating fingers with the fingers of your other hand. I usually like to palpate with the fingertips of my index, middle, and ring fingers. It helps to slightly flex the middle finger to create a flat surface of all three fingers for palpation, otherwise the middle finger sticks out more and can feel pokey and uncomfortable for the client. An alternative palpation contact is to use the thumb, supported by the fingers of the other hand. But caution should be observed when using the thumb because it can be a strong and uncomfortable contact. You want to be sure that the client is comfortable. As a general rule, it is best to palpate with your finger pads because they are more comfortable for the client. Fingertips can be pokey and uncomfortable. However, with deeper palpations, including the abdominal belly of the psoas major, you pretty much have to lead with your fingertips. But if you can, slightly modify the angle of entry of your fingers, you can flatten out your contact to be somewhat toward your finger pads instead of purely leading with your fingertips. Work with the client's breath. The abdominal belly of the psoas major is quite deep, so the client is often sensitive to its palpation. This is especially true if this muscle has never been palpated before. Therefore, it is very important to help the client relax by working with their breathing. Ask the client to breathe in, then as the client exhales, slowly sink in toward the muscle. Sink in slowly. Whenever you are palpating a deep muscle, it is a good idea to sink in slowly. This allows the client time to accept your palpation pressure. Approach the muscle in two or three passes. Because the abdominal belly of the psoas major is so deep and the client is often sensitive, do not necessarily try to reach the abdominal belly all at once in one pass. Instead, approach the muscle in two or three passes. If three passes are used, as the client breathes out, sink in slowly, approximately one-third of the way. Then, on the second exhalation, sink in slowly another third of the way. Then on the third exhalation, sink in the rest of the way until you reach the muscle belly. Ask the client to flex the thigh at the hip joint. Once you believe you have reached the psoas major, you can confirm you are there by asking the client to flex the thigh at the hip joint. This will engage the psoas major without engaging the anterior abdominal wall musculature. However, it is important to ask the client for only a gentle to moderate contraction. Ask them to move the thigh into flexion only 1 inch or less; otherwise, the musculature of the anterior abdominal wall might contract and harden to stabilize the pelvis (anterior abdominal wall muscles create a force of posterior tilt of the pelvis, which stabilizes the pelvis from the anterior tilt force from the hip flexor musculature). If this were to occur, you would not be able to palpate through the anterior abdominal wall to feel the psoas major. Palpate the entirety of the abdominal belly. The abdominal belly of the psoas major is fairly long, running from T12 all the way to the inguinal ligament. Therefore, you cannot access and assess all of it with just one palpation contact point. For this reason, you will likely need two or three contact points. At your initial point, to access as much of the muscle as possible, direct your force not just posteromedially toward the muscle, but also posteromedially and superiorly toward it and posteromedially and inferiorly toward it, covering a span of approximately 2–3 inches (Image 2). Then, lift your palpating fingers to find a new point of contact, either superior or inferior to your initial point of contact, depending on where you began along the muscle. At this new point, again direct your pressure