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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 . 55 posteromedial and superior to inferior along a span of 2–3 inches. Depending on how tall the client is (in other words, how long the muscle is), you should be able to access the entire abdominal belly with two or three points of contact. SUPINE POSITION—ABDOMINAL BELLY PALPATION Having the client in supine position is likely the position most often used by therapists to palpate the abdominal belly of the psoas major. The client lies supine with a bolster under the knees (Image 3A). It is important to have a bolster that is large enough to slacken the hip flexor musculature so the pelvis falls into posterior tilt sufficiently to slacken the anterior abdominal wall. If you do not have a large bolster, multiple bolsters can be used. If only one small bolster is available, another option is to place that bolster under the fitted sheet, assuming sheets are being used for draping, and place the client's feet against the bolster. The tension and friction of the fitted sheet should hold the bolster in place and support the position of the client's lower extremities (Image 3B). If there is no fitted sheet, a long towel (or flat sheet) could be used instead. Place the towel under both sides of the client's buttocks with the middle of the towel wrapped around the distal anterior legs of the client (Image 3C). The weight of the client's body will hold the towel in place and the client can relax in this position, allowing a slackened anterior abdominal wall. The contact point to begin palpation can be anywhere along the course of the abdominal belly of the psoas major. One commonly used guideline is to begin with the palpating fingers halfway between the umbilicus and the anterior superior iliac spine (ASIS) (Image 4). However, this location is not necessarily correct because you need to be lateral to the rectus abdominis, and this muscle is fairly wide in many people. Ask the client to flex their trunk at the spinal joints (an abdominal To access as much of the psoas major as possible with each contact point on the client's body, we should direct our pressure as far superiorly and as far inferiorly as possible. 2A: Pressure directed posteromedially. 2B: Posteromedial and superior. 2C: Posteromedial and inferior. Images by Christopher Paul Photography. www.christopherpaul.nl. 2A 3A 2B 3B 2C 3C It is important to have the client's thighs in flexion at the hip joint so that the anterior abdominal wall is slackened. 3A: A large bolster is placed under the client's knees. 3B: A small bolster is placed under a fitted sheet. 3C: A towel is placed under the client and around the distal legs. An initial guideline for where to begin palpation of the abdominal belly is halfway between the umbilicus and the anterior superior iliac spine (ASIS). 4