Issue link: https://www.massageandbodyworkdigital.com/i/1060121
another way is to use the adductor longus as a landmark, first locating the adductor longus, and then palpating laterally across the pectineus until reaching the psoas major. PRECAUTION WHEN PALPATING THE FEMORAL BELLY You should be aware of one precaution when palpating the femoral belly of the psoas major—there is a neurovascular bundle composed of the femoral nerve, artery, and vein that overlies the psoas major (and adjacent musculature) in the proximal thigh (see Image 12). To avoid pressure on the femoral artery, as you sink slowly into the tissue, feel for the pulse of the artery. If felt, you can move your palpating fingers ever so slightly to the lateral or medial side of the artery. From this contact point, access the femoral belly tissue that is deep to your fingers and angle in medially or laterally to access the tissue that is immediately deep to the artery. If your pressure is exerted on the femoral nerve, you would know this by the client reporting what would likely be experienced as sharp shooting (nerve) pain into the thigh. If this occurs, move your palpating fingers slightly lateral or medial as appropriate and then palpate as you did when working around the femoral artery. APPROXIMATION OF LOCATION— FEMORAL BELLY PALPATION One way to locate the femoral belly of the psoas major is to approximate its position by finding the midpoint of the thigh from lateral to medial (Image 13). You can approximate the midpoint and place your palpating finger pads there, immediately distal to the inguinal ligament. It is important to remain as close as possible to the inguinal ligament or you may be palpating too far distal into the thigh and will be beyond the psoas major and unsuccessful in your palpation. Then, strum parallel to the inguinal ligament, which will be approximately perpendicular to the femoral belly, and feel for the rounded contour of the femoral belly. It is important that this strumming is a large enough excursion of movement so that you are off one side of the belly, then onto its prominence, and then off the other side of the belly (Image 14). This rounded contour should stand out and be fairly easily palpable because the iliacus on its lateral side and the pectineus on its medial side are both flatter muscles that sit a bit deeper, allowing the psoas major to have a prominence that is apparent. Once you believe you have located the femoral belly, ask the client to gently/ moderately flex their trunk at the spinal joints (an abdominal crunch/sit-up) and feel for the belly of the psoas major to engage and palpably harden. It is important that this contraction is fairly mild in strength; otherwise, all the hip flexors might engage to stabilize the pelvis (the anterior abdominal wall flexor musculature that flexes the spine will also create a force of You can find the femoral belly of the psoas major by approximating the midpoint of the thigh from lateral to medial. The ASIS can be used as the most lateral location of the proximal thigh. 13 14 15A 15B Palpation of the femoral belly of the psoas major in the proximal thigh. Supporting the client's thigh in passive flexion will slacken the tissue of the proximal anterior thigh, allowing deeper access into the femoral belly of the psoas major. 15A: The client's thigh is supported by the therapist's knee. 15B: Close-up of palpation deeper into the muscle. at the spinal joints. But before you can feel its contraction, you need to at least find the approximate location of its femoral belly. Then, you can engage the muscle and confirm you have indeed found it. There are three ways this can be done. One palpation protocol to find the femoral belly of the psoas major is to approximate its location midway in the thigh from lateral to medial, and then locate and palpate it by feeling for its contour. Another method is to use the sartorius as a landmark—first finding the sartorius, and then palpating medially across the iliacus until you reach the psoas major. And yet 62 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