Psecrets of The PsoasLab 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

• Treatment in the following order:

• Address any tight anterior hip capsule component

• Stretch iliopsoas

• Retrain gluteus to fire

Position leg as shown & contract gluteus maximus

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.