Healthcare and Medicine Reference
Fig. 9.25 The human psoas
muscle makes a unique journey
around the front of the pelvis -
forward and up from the
trochanter to the iliopectineal
ridge, then back and up to the
lumbar spine. No other animal
makes use of such a course for
the psoas; in most quadrupeds,
the psoas does not even touch
the pelvis unless the femur is
extended to its limit.
Fig. 9.27 The inner line of hip-spine locals comprises the
pectineus, linking via the lacunar ligament with the psoas minor.
the lesser trochanter (and the linea aspera just below it)
over to the iliopectineal ridge (Fig. 9.27). From here, with
the connecting fascia of the lacunar ligament and only
a slight change in direction, we can pick up the psoas
minor (which is expressed as a muscle in about 51% of
the population, but is expressed as a fascial band in
nearly 100%). 9 The psoas minor runs on top of the fascia
of the psoas major to insert, or reach its upper station,
at the 12th thoracic vertebra.
On the lateral side, we begin with the iliacus, widen-
ing up and laterally from the lesser trochanter to attach
all along the upper portion of the iliac fossa (Fig. 9.28).
The fascia covering the iliacus is continuous with the
fascia on the anterior surface of the quadratus lumbo-
rum, which takes us up to the TPs of the lumbar verte-
brae, just behind the psoas attachments, as well as to the
12th rib (DVD ref: Early Dissective Evidence: Deep Front
Thus, when either the lower lumbar vertebrae or the
thoracolumbar junction (TLJ) are being pulled down
and forward toward the front of the pelvis, any or all
three of these pathways could be involved, and all three
should be investigated in dealing with a lower lumbar
lordosis, compressed lumbars, an anteriorly tilted or
even a posteriorly shifted pelvis.
In the misty past when this author began teaching
manual therapy, few practitioners knew much about the
psoas or how to find and treat it. In the past 20 years,
its role has been more widely recognized, sometimes to
the exclusion of these important more-or-less monartic-
ular accompanying muscle groups, which, to be effec-
tive in changing patterns in the groin area, should draw
Fig. 9.26 The DFL attaches the inner femur to the core structures
in front of the spine, including the diaphragm and mesentery (not
pictured). In the center of these connections lies the psoas major
express, flanked by two sets of locals.
troversy as to exactly what functions the psoas per-
forms, 2,4- 8 there is not about the territory it covers, which
is from the lesser trochanter to the bodies and TPs of the
1st lumbar and often the 12th thoracic vertebrae.
We can cover the same territory in two other ways,
one medial and the other lateral to the psoas major itself.
On the medial side, we could follow the pectineus from