Healthcare and Medicine Reference
In-Depth Information
the groin, so that you drop both the skin and your
fingers into the femoral triangle at the same time (DVD
ref: Deep Front Line, Part 1, 52:22-54:40).
Once into the space, if you extend your fingers, the
fingernail side will contact the lateral side of the pubic
bone. Ask your model to lift her knee toward the oppo-
site shoulder (combining flexion and adduction) and, if
you are properly placed, you will feel the pectineus pop
into your fingers - a band an inch or more wide near
the pubic ramus. The muscle can be best worked in
eccentric contraction while the client either slides the
heel out to full leg extension, or pushes down on her
foot, creating a pelvic twist away from you.
To find the psoas at this level, move your fingers just
anterior and a little lateral of the pectineus. Avoid
putting any pressure or sideways stretch on the femoral
artery. On the lateral side of the artery (usually; it can
vary which side of the artery affords easier access) you
will find a slick and hard structure lying in front of the
ball of the hip joint. Have your model lift her foot
straight off the table, and this psoas tendon should pop
straight into your hands. There is little that can be done
with it at this level in most people, as it is so tendinous,
but this is the place where the psoas rests nearest the
The iliacus is adjacent to the psoas, just lateral to it,
and is chiefly and usually distinguished from the psoas
by being a bit softer (because it is still more muscular as
opposed to the tendinous psoas at this level). It can be
followed (skipping over the inguinal ligament) up to its
anterior attachment inside the lip of the anterior iliac
The iliacus and psoas can both be reached above the
inguinal ligament in the abdominal area as well. Stand-
ing beside your supine model, have her bend her knees
until the feet are standing, heels close to the buttocks,
and place your fingers in the superior edge of the ASIS
(DVD ref: Deep Front Line, Part 1, 59:15-1:02:03). Sink
down into the body, keeping your fingerpads in contact
with the iliacus as you go. Keep the fingers soft, and
desist if you create painful stretching in the model's
peritoneal structures (anything gassy, heated, or sharp).
The psoas should appear in front of the tips of your
fingers at the bottom of the 'slope' of the iliacus (DVD
ref: Deep Front Line, Part 1, 1:02:05-1:12:30). If the psoas
remains elusive, have your model gently begin to lift her
foot off the table, which should immediately tighten the
psoas and make it more obvious to you. At this point,
you are on the outside edge of the psoas, and these
fibers come from the upper reaches of the psoas - the
T12-L1 part.
Although you can follow these outside fibers up, it is
not recommended that you work the psoas above the
level of the navel without a detailed understanding of
the kidney's attachments.
Having found this outside edge, keep a gentle contact
with the 'sausage' of the psoas, staying at the level
between a horizontal line drawn between the two ASISs
and one drawn at the level of the umbilicus. Move up
and across the top of the muscle until you feel yourself
coming onto the inside slope. It is important not to lose
Fig. 9.30 The meeting place between the upper and lower tracks
of the DFL is the front of the upper lumbar vertebrae, where the
upper reaches of the psoas mingle with the lower crura of the
diaphragm, where walking meets breathing. It corresponds closely
to the location of an essential spinal transition (T12-L1), as well as
the adrenal glands and solar plexus.
evident than the posterior septum in most people, and
is evident in the thin client when he or she simply holds
the entire leg off the table in a laterally rotated position.
As you palpate the septum for depth and freedom, alter-
nate the client's movements of adduction with knee
extension (which will activate the quadriceps under
your fingers) to help you be clear about where the line
of separation lies (DVD ref: Deep Front Line, Part 1,
At the top of this septum, it widens out into the
femoral triangle, bounded by the sartorius running
to the ASIS on the outside, the prominent tendon of
adductor longus on the medial side, and superiorly by
the inguinal ligament (Fig. 9.24). Within the femoral tri-
angle, medial to lateral, are the pectineus, psoas major
tendon, and iliacus. The femoral neurovascular bundle
and lymph nodes live here also, so tread carefully, but
do not ignore this area vital to full opening of the hip
Have your model lie supine with her knees up. Sit on
one side of the table facing her head, with one of her
thighs against the side of your body. Reach over the
knee, securing the leg between your arm and your body,
and put your entire palmar surface onto the medial
aspect of the thigh, fingers pointing down. Drop your
fingers slowly and gently into the opening of this 'leg
pit', with your ring or little finger resting against the
adductor longus tendon as a guide, so that the rest of
your fingers are just anterior and lateral to it. Watch out
for stretching the skin as you go in; it sometimes helps
to reach in with your outer hand to lift the skin of the
inner thigh before placing your palpating inner hand in
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