Psecrets of The Psoas Lab Handout
Thieme,Atlas of Anatomy, General Anatomy and Musculoskeletal System Thomas Test
Negative Test Positive Test Thomas Test (modified)
• Tests for:
• Iliopsoas tightness • Rectus femoris • Tensor fascia lata • Iliotibial band FPR Technique
• Dx: L2FRRSR • Straighten lumbar as a whole (flexion) • Rotate the right until you reach maximum tissue relaxation • Sidebend right until maximum tissue relaxation (softening) • Add some more flexion to L2-3 Add a compressive, distraction or torsional force to L3 • Wait 3-5 seconds and return to neutral passively • Recheck Counterstrain
• Psoas Tender Point Location • 2/3 of the distance from the ASIS towards the midline and slightly superior Counterstain • Psoas Treatment • Physician ipsilateral to tenderpoint • Identify tenderpoint • Bilateral Hip and Knee Flexion • Ankles and legs pulled toward tender point side(inducing sidebending) • Tenderness on re-palpation should be at 0-30 % • Maintain position for at least 90 seconds & return patient to neutral slowly & passively (on the patient’s part). • Physician reassesses the tenderpoint Counterstain
• Iliacus Treatment • Patient supine • Thighs are flexed with ankles crossed • Hips externally rotated • Monitor TP until tenderness on palpation is 0-30% of original • Maintain position for at least 90 seconds & return patient • Physician reassesses the tenderpoint Muscle Energy (ME)
• Acute • Reciprocal inhibition
• Chronic • Direct Isometric MFR and Mixed technique Abnormal Gluteus Firing
• Test hip extension firing pattern • 1) Hamstring • 2) Gluteus • 3) Contralateral Quadratus Lumborum • 4) Ipsilateral Quadratus Lumborum Abnormal Gluteus Firing
Position leg as shown & contract gluteus • Treatment in the following order: maximus • Address any tight anterior hip capsule component • Stretch iliopsoas • Retrain gluteus to fire Maintaining gluteal contraction and keeping toes on table, extend knee
Extend toes toward wall Counterstrain Piriformis
• Location of CTS tender Point • Measure from PSIS to ILA • Measure ½ between ILA and PSIS line to greater trochanter. • The midpoint of this line will be the piriformis muscle tender point Counterstain
• Piriformis Tender Point • Patient prone, affected leg off the table • Patients knee & hip are flexed /externally rotated /abducted while resting on physician’s lap • Maintain position for at least 90 seconds & return patient passively to neutral slowly • The physician reassesses the components of the tender point References • Rancont, C.M. (2007). Chronic psoas syndrome caused by the inappropriate use of a heel lift. Journal of the American Osteopathic Association, 107 (9), 415-418.
• Sutherland W.G. (1990). Teachings in the Science of Osteopathy. Portland, OR: Rudra Press, 279-281.
• Nelson, K.E. & Schilling Mnabhi, A.K. (2006). The patient with back pain: short leg syndrome and postural balance. In Nelson, K.E. &Glonek, T. (Eds.), Somatic Dysfunction in Osteopathic Family Medicine (408- 425). Baltimore, MD: Lippincott Williams & Wilkins.
• DiGiovanna, E.L., Schiowitz, S., & Dowling, D.J. (2004). An Osteopathic Approach to Diagnosis and Treatment (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
• Kuchera, W.A. (2003). Lumbar region. In Ward, R.C. (Ed.), Foundations for Osteopathic Medicine (2nd ed.) (727-751). Philadelphia, PA: Lippincott Williams & Wilkins.
• Kuchera, W.A. & Kuchera, M.L. (1994). Diagnosis and manipulative treatment: lumbopelvic region. In Osteopathic Principles in Practice (2nd ed) (393-512). Columbus, OH: Greyden Press.
• Travel, J.G. & Simons, D.G. (1992). Myofascial Pain and Dysfunction, The Trigger Point Manual (Vol. 2). Media, PA: Lippincott Williams & Wilkins, 90.