The psoas major is an incredibly important muscle that can be involved in conditions of the lumbar spine, the sacroiliac and hip joints, and the diaphragm and pelvic floor (Image 1). To determine whether the psoas major is a factor in your client’s health, you need to be able to perform an accurate physical assessment. At the heart of this assessment is palpation. 

The Art of Palpation

Muscle palpation assessment involves two steps. The first step is to find the target muscle, locate all its borders, and discern it from adjacent tissue. Once that’s been completed, the second step involves assessing the health of the muscle tissue. Is the muscle globally tight or loose? Are there myofascial trigger points? Taut and tender bands? This is the crucial step that determines what treatment, if any, is necessary for the client. But this second step can only be performed if you are successful with the first step. There are many books, articles, and videos that demonstrate palpation protocols on how to locate target muscles for palpation. But more important than memorizing these protocols is to understand and reason through fundamental guidelines of palpation.

An ideal palpation protocol usually involves finding a way for the client to perform an isolated contraction of the target muscle. If this can be done, the target muscle will be the only hard, soft tissue amidst a sea of soft, soft tissues. This way, it can be discerned from adjacent tissues, now allowing the therapist to confidently assess its health. Finding a way for the client to perform an isolated contraction requires knowledge of the attachments of the target muscle, as well as the actions of not only the target muscle but also all the adjacent muscles. Armed with this knowledge, you find a joint action that the target muscle possesses that the adjacent muscles do not. Therefore, the adjacent muscles remain relaxed and soft while the target muscle contracts and becomes palpably hard, thereby succeeding in your goal of making the target muscle be the only hard, soft tissue amidst a sea of soft, soft tissues.

General Guidelines for Palpation of the Abdominal Belly of the Psoas Major

Regardless of the position in which we place the client, palpation of the abdominal belly of the psoas major usually involves the following steps:

Have the client’s thighs in flexion. Having the client’s thighs flexed at the hip joints slackens the hip flexor musculature so that the pelvis can fall into posterior tilt. Posterior tilt of the pelvis allows the anterior abdominal wall musculature (the rectus abdominis, external abdominal oblique, internal abdominal oblique, and transversus abdominis) to be slackened, allowing your palpating fingers to sink through the anterior abdominal wall to reach the abdominal belly of the psoas major.

Contact the client immediately lateral to the rectus abdominis. The anteromedial rectus abdominis is thicker than the other three anterolateral abdominal wall muscles (the external and internal abdominal obliques and transversus abdominis) put together. Therefore, successful palpation of the abdominal belly of the psoas major requires finding the lateral border of the rectus abdominis so you can drop immediately off it laterally and palpate through the anterolateral abdominal wall musculature. To accomplish this, ask the client to flex the trunk at the spinal joints, effectively doing an abdominal crunch (sit-up), and palpate from medial to lateral on the rectus abdominis until you locate its lateral border. Then, drop immediately lateral off it, and this will be your initial point to begin palpation of the psoas major.

Brace/support your palpating fingers. Because the abdominal belly of the psoas major is so deep, it requires more force to reach it than the average muscle palpation. For this reason, it is a good idea to brace/support your palpating fingers with the fingers of your other hand. I usually like to palpate with the fingertips of my index, middle, and ring fingers. It helps to slightly flex the middle finger to create a flat surface of all three fingers for palpation, otherwise the middle finger sticks out more and can feel pokey and uncomfortable for the client. An alternative palpation contact is to use the thumb, supported by the fingers of the other hand. But caution should be observed when using the thumb because it can be a strong and uncomfortable contact. You want to be sure that the client is comfortable.

As a general rule, it is best to palpate with your finger pads because they are more comfortable for the client. Fingertips can be pokey and uncomfortable. However, with deeper palpations, including the abdominal belly of the psoas major, you pretty much have to lead with your fingertips. But if you can, slightly modify the angle of entry of your fingers, you can flatten out your contact to be somewhat toward your finger pads instead of purely leading with your fingertips.

Work with the client’s breath. The abdominal belly of the psoas major is quite deep, so the client is often sensitive to its palpation. This is especially true if this muscle has never been palpated before. Therefore, it is very important to help the client relax by working with their breathing. Ask the client to breathe in, then as the client exhales, slowly sink in toward the muscle.

Sink in slowly. Whenever you are palpating a deep muscle, it is a good idea to sink in slowly. This allows the client time to accept your palpation pressure.

Approach the muscle in two or three passes. Because the abdominal belly of the psoas major is so deep and the client is often sensitive, do not necessarily try to reach the abdominal belly all at once in one pass. Instead, approach the muscle in two or three passes. If three passes are used, as the client breathes out, sink in slowly, approximately one-third of the way. Then, on the second exhalation, sink in slowly another third of the way. Then on the third exhalation, sink in the rest of the way until you reach the muscle belly.

Ask the client to flex the thigh at the hip joint. Once you believe you have reached the psoas major, you can confirm you are there by asking the client to flex the thigh at the hip joint. This will engage the psoas major without engaging the anterior abdominal wall musculature. However, it is important to ask the client for only a gentle to moderate contraction. Ask them to move the thigh into flexion only 1 inch or less; otherwise, the musculature of the anterior abdominal wall might contract and harden to stabilize the pelvis (anterior abdominal wall muscles create a force of posterior tilt of the pelvis, which stabilizes the pelvis from the anterior tilt force from the hip flexor musculature). If this were to occur, you would not be able to palpate through the anterior abdominal wall to feel the psoas major.

Palpate the entirety of the abdominal belly. The abdominal belly of the psoas major is fairly long, running from T12 all the way to the inguinal ligament. Therefore, you cannot access and assess all of it with just one palpation contact point. For this reason, you will likely need two or three contact points. At your initial point, to access as much of the muscle as possible, direct your force not just posteromedially toward the muscle, but also posteromedially and superiorly toward it and posteromedially and inferiorly toward it, covering a span of approximately 2–3 inches (Image 2). Then, lift your palpating fingers to find a new point of contact, either superior or inferior to your initial point of contact, depending on where you began along the muscle. At this new point, again direct your pressure posteromedial and superior to inferior along a span of 2–3 inches. Depending on how tall the client is (in other words, how long the muscle is), you should be able to access the entire abdominal belly with two or three points of contact.

Supine Position—Abdominal Belly Palpation

Having the client in supine position is likely the position most often used by therapists to palpate the abdominal belly of the psoas major. The client lies supine with a bolster under the knees (Image 3A). It is important to have a bolster that is large enough to slacken the hip flexor musculature so the pelvis falls into posterior tilt sufficiently to slacken the anterior abdominal wall. If you do not have a large bolster, multiple bolsters can be used. If only one small bolster is available, another option is to place that bolster under the fitted sheet, assuming sheets are being used for draping, and place the client’s feet against the bolster. The tension and friction of the fitted sheet should hold the bolster in place and support the position of the client’s lower extremities (Image 3B). If there is no fitted sheet, a long towel (or flat sheet) could be used instead. Place the towel under both sides of the client’s buttocks with the middle of the towel wrapped around the distal anterior legs of the client (Image 3C). The weight of the client’s body will hold the towel in place and the client can relax in this position, allowing a slackened anterior abdominal wall.

The contact point to begin palpation can be anywhere along the course of the abdominal belly of the psoas major. One commonly used guideline is to begin with the palpating fingers halfway between the umbilicus and the anterior superior iliac spine (ASIS) (Image 4). However, this location is not necessarily correct because you need to be lateral to the rectus abdominis, and this muscle is fairly wide in many people. Ask the client to flex their trunk at the spinal joints (an abdominal crunch) while you feel for the lateral border of the rectus abdominis (Image 5A). Once located, drop immediately lateral to it and begin your palpation there. Direct your pressure posteromedially toward the muscle (Image 5B). There is some leeway for the lateral to medial component of your direction given that the psoas major is approximately 2 inches wide.

With the guidelines listed above, approach the muscle in two or three passes, working with the client’s breath, and sinking in slowly. Once you believe you have reached the muscle, confirm this by asking the client to perform a very small contraction of flexion of the thigh at the hip joint, feeling for the psoas major to noticeably harden under your fingertips (Image 6). Then, palpate as much of the muscle as can be reached from superior to inferior, and repeat this at other contact points along the muscle as necessary to assess the entire abdominal belly.

There are many advantages to the supine palpation position: the client is often in this position, you can use body weight to a fair degree, it is easy to locate the lateral border of the rectus abdominis because trunk flexion is against gravity, and it is easy to engage the psoas major because flexion of the thigh is against gravity. However, the disadvantage of the supine palpation position is that if the client has a large amount of abdominal fat, it will be between your palpating fingers and the psoas major, blocking your ability to easily sink in and reach the muscle.

Side-Lying Position—Abdominal Belly Palpation

Side-lying position is often recommended for palpation of the abdominal belly of the psoas major because if the client has a lot of abdominal fat, then the fat falls down toward the table and away from your palpating fingers. Still, a pure side-lying position presents certain logistical challenges. If you stand behind the client, then the direction of your force into the client is not in line with your core, and there is no efficient use of body weight (Image 7A). Both of these factors are improved if you stand in front of the client. However, now the anterior side of your pelvis is close to the client’s face and this positioning might be deemed unprofessional, and therefore not appropriate (Image 7B).

If you do choose to palpate the abdominal belly of the psoas major with the client in side-lying position, then observe the guidelines listed above. Contact lateral to the rectus abdominis, work with the client’s breath, and sink in slowly, approaching the muscle in two or three passes. When you believe you have arrived at the muscle, ask the client to perform a gentle/moderate contraction of flexion of the thigh at the hip joint and feel for the psoas major to contract and palpably harden. Once you are confident you are on the muscle, palpate the entirety of the abdominal belly, assessing for the health of its tissue.

Draping for the Abdominal Belly

Draping is extremely important for professional modesty and client comfort. For clarity of visualization, the photos throughout this article show the client wearing clothing. However, appropriate draping techniques for the abdominal belly of the psoas major for a male and female client are shown here.

¾ Side-Lying Position—Abdominal Belly Palpation

All of the disadvantages to a pure side-lying position can be eliminated, and advantages gained, if you modify the position to be a ¾ side-lying position that is halfway between side-lying and supine (Image 8A). This position, although not commonly used in the world of massage and manual therapy, can be very effective for palpation of the abdominal belly of the psoas major. First, you still have the abdominal fat falling out of your way to allow for easier access into the muscle with heavier clients. But now, you can not only place your core in line with the force of the palpation pressure, but you can place your body weight directly above the client so you can simply drop down with body weight to sink through the anterior abdominal wall tissue toward the psoas major.

To support the client in this position, place a bolster behind their back so they can rest their body weight against it (Image 8B). If you do not have an appropriately sized or shaped bolster for this, you can place your knee on the table and have them rest their trunk against your distal thigh; placing the knee/thigh against their posterior superior iliac spine (PSIS) is a good stable contact point to support their body. To begin the palpation, place your palpating fingers approximately halfway between the ASIS and umbilicus, and then find the lateral border of the rectus abdominis by having the client actively flex the trunk at the spinal joints. In this position, flexion of the trunk is partially against gravity, so is usually sufficiently resisted by body weight to contract and harden the rectus abdominis enough to allow you to accurately locate its lateral border.

With your palpating fingers in the correct location, perform the protocol to find the abdominal belly, working with the client’s breath and sinking in slowly, approaching it in two to three passes. Once you believe you have reached the muscle, ask the client to actively perform gentle to moderate flexion of the thigh at the hip joint. However, because the ¾ side-lying position does not offer as much resistance of gravity to flexion of the thigh, it might be necessary for you to add a small amount of resistance. This can be done with one of your hands, but if you want to use your other hand to support your palpating fingers, then both hands are needed for the palpation. A creative solution might be to place your foot on the table and use your leg to offer resistance against the anterior surface of the client’s thigh (Image 8C).

Precautions for Abdominal Belly Palpation

A certain amount of caution is advised when palpating the abdominal belly of the psoas major. If you direct your pressure too far medially, you may contact the abdominal aorta, which lies directly over the anterior bodies of the lumbar spine. But for an experienced therapist with sensitive touch, this should not be a major concern because if you approach the muscle slowly, you will feel the pulse of the aorta and know to change your direction to be slightly more lateral. Another precaution for palpation of the abdominal belly is any visceral condition of the intestines, such as gas, irritable bowel syndrome, or Crohn’s disease. Further, when palpating the right-sided abdominal belly, be aware of the possibility of an inflamed appendix. If there is any doubt about the presence of a visceral condition that contraindicates psoas major palpation, written permission from the client’s physician should be received before proceeding with palpation.

Palpate Over a Thin Layer of Cloth

As a general rule, I believe it is best to palpate directly on the client’s skin because having any layer of cloth, whether it is clothing, a sheet, or a towel, is one more layer to palpate and feel through to locate and assess the target muscle. However, with any muscle that must be approached with your fingertips instead of finger pads, having a thin layer of cloth, preferably cotton, is a good idea because palpation with fingertips means leading with your fingernails, and even short and smooth fingernails can be uncomfortable for the client if you sink deep into their tissues. For deep muscles, including the psoas major abdominal belly, palpating through a thin layer of cloth is recommended so that your nails are blunted and the client can be more comfortable and relaxed.

Seated Position—Abdominal Belly Palpation

A seated position is not the most common position used to palpate the abdominal belly of the psoas major, but at times can be valuable to employ. This is because it is probably the best position in which to slacken the client’s anterior abdominal wall. With the client’s thighs in 90 degrees of flexion, the pelvis can easily fall into posterior tilt, allowing the trunk to flex and slacken the anterior abdominal wall. Further, you can invite the client to slouch, further flexing the trunk and further slackening the anterior abdominal wall. Even though it is not common for clients to have a tight anterior abdominal wall, when a tight anterior abdominal wall is present, it is valuable to be able to slacken and sink through it; the seated position often is best at accomplishing this.

The client is seated with their feet flat on the floor for stability and you stand in front and to the side of the client. Depending on the height of the table, you might choose to place one knee on the table (Image 9A). Because the direction of force is horizontal, there is no use of gravity/body weight, so it is extremely important to place your (upper) arm/elbow against your trunk, so you can generate the force from your core. As with all psoas major abdominal belly palpation protocols, contact the client immediately lateral to the rectus abdominis and direct your force posteromedially, work with the client’s breathing, and sink in slowly toward the muscle. When you believe you have reached the psoas major, ask the client to make a small engagement of the muscle by flexing the thigh at the hip joint. This is accomplished by simply asking the client to lift their foot from the floor an inch or so (Image 9B). If you are on the psoas major, you will feel it contract and harden (Image 9C).

The disadvantage to a seated position, beyond having no component of gravity/body weight, is that it can be stressful for your contact fingers. To minimize this, it is extremely important to stabilize your upper extremity by keeping your elbow against your core and generating the force by shifting the core of your body toward the client. 

Standing Position—Abdominal Belly Palpation

Perhaps the most unusual position to palpate the psoas major is standing. This position uses the client’s body weight and movement of their body to generate the palpation force into the musculature. The advantage to this approach is that the client is in control of the force into the muscle, because instead of you sinking your fingers in toward the muscle, the client sinks down into your palpating fingers.

The client stands with their feet approximately one foot from the wall, with their hips and knees bent. Because the force of the palpation will be somewhat inferior to superior, you need to have one knee on the floor so that your core is low. It is helpful to place a cushion under your knee for comfort. Both sides of the psoas major can be palpated at the same time. Your contacts are immediately lateral to the rectus abdominis muscles with your force directed both posteromedially and superiorly. Ask the client to breathe in. Then, as the client breathes out, ask them to slowly drop down toward the floor by increasing hip and knee joint flexion, sinking the psoas major muscles toward your palpating fingers (Image 10). It is important to ask the client to sink down slowly, staying within their comfort range for pressure into the muscles.

The major disadvantage to the standing palpation position is that it is not easy on the therapist biomechanically. There is no body weight behind your contacts, and your elbows must be out, increasing the leverage force that is transmitted into your shoulder joints. However, for clients who like to have control of palpation pressure, a standing position can be very successful.

Prone Position—Abdominal Belly Palpation

We finish our exploration of the various positions in which to palpate the abdominal belly of the psoas major with the prone position. I will admit that the first time a workshop participant showed me prone position for psoas work, I was skeptical about its usefulness, but I have come to find that it can be an extremely valuable position to palpate and work the abdominal belly of the psoas major because it is often the most comfortable position for the client. And if the client is comfortable, they will be relaxed. This is important when palpating a deep muscle like the psoas major that can otherwise be uncomfortable for so many clients.

The client’s positioning is critical here—have them lie prone on the table with their trunk far to the lateral side of the table. This is very important because you want to position your elbow below the level of the table to be able to generate the force “upward” (anterior to posterior), as well as medially into the psoas major, with your wrist joint in a stacked, neutral anatomic position. Place one knee on the floor with a cushion under it for comfort, and place your elbow against your core so that your upper extremity is stabilized and can generate the force upward into the client. Place either your other hand or forearm on the client’s PSIS (Image 11A). Contacting immediately lateral to the rectus abdominis with palpating fingers, ask the client to breathe in; then, as the client breathes out, slowly and gently push upward, sinking in toward the muscle (Image 11B). Do not push past the point of initial contact with the psoas major.

Instead, working with the client’s breath, on their next exhalation, gently use your elbow to rock their pelvis toward you, gently pushing the psoas major’s abdominal belly down into your palpation fingers. Bringing the muscle into your fingers, combined with the rocking motion, tends to be much more soothing and comfortable for most clients. You can modify the client position by gently dropping the client’s thigh down off the side of the table into flexion. This drops the client’s pelvis and trunk down toward the floor, increasing the pressure of the psoas major abdominal belly into your palpating fingers (Image 11C).

There are many challenges to palpating the abdominal belly of the psoas major with the client prone. If the client is overweight, the abdominal fat can block your entry toward the muscle, so this position is not recommended for heavy clients. Prone position is also challenging both to finding the lateral border of the rectus abdominis and to asking the client to flex the thigh at the hip joint to engage the psoas major. If you are not proficient at both finding the rectus abdominis and knowing you are on the psoas major when you have reached it, prone position is not recommended. And, because we have no flexion of the thigh at the hip joint and no flexion of the trunk at the spinal joints, you cannot slacken the client’s anterior abdominal wall, so this position will likely not be successful if the client has a tight anterior abdominal wall. Biomechanically, the therapist has no body weight behind the contact, so most of your force must be generated by a transfer of force from your trunk/core. Finally, it can be stressful for your wrist and fingers, so it is extremely important to keep these joints stacked in neutral anatomic position. But, for all these challenges, once you are experienced at palpating the psoas major’s abdominal belly, this position can be an extremely rewarding protocol to add to your skill set because the movement involved tends to relax the client.

Comparison of Abdominal Belly Palpation Positions

Being an excellent clinical orthopedic manual therapist involves having many assessment and treatment tools in your proverbial toolbox. As we can see, there are many choices when it comes to palpation assessment of the abdominal belly of the psoas major. There is no one palpation position that will work perfectly for every client. Instead, armed with knowledge of the many possible positions, you can choose the best palpation position for the client on the table at that moment. I recommend you give each of these palpation positions a try. Each one has its advantages and disadvantages. Supine position is the palpation position most well known and most often used. But you might be surprised at how effective some of the other positions can be, especially ¾ side-lying and prone. Table 1 compares and contrasts these positions, considering the strengths and weaknesses for each position for each of the components involved in psoas major abdominal belly palpation.

Femoral Belly Palpation

The psoas major is often described as being tendon after it passes deep to the inguinal ligament to enter the thigh on its way to attach onto the lesser trochanter of the femur. But as anyone who has spent time in a cadaver lab or viewed cadaveric photos or video knows, the psoas major is still muscle belly all the way until it reaches the lesser trochanter itself. So, we can describe it as having a femoral belly (Image 12). The most obvious difference between palpation of the abdominal and femoral bellies of the psoas major is the location of your palpation fingers. For the femoral belly, you need to be immediately distal to the inguinal ligament. But palpating the femoral belly also requires a different approach to contract the muscle. This is primarily because you cannot use flexion of the thigh at the hip joint to engage the femoral belly because this joint action would engage all the adjacent hip flexor muscles, making discernment of the psoas major from these other muscles impossible. For this reason, you need to find another way to engage the psoas major and make it the only hard, soft tissue amidst a sea of soft, soft tissues.

To engage and palpate the femoral belly of the psoas major, you need to find one of its joint actions that is different from all the joint actions of the adjacent hip flexors—flexion of the trunk at the spinal joints. Of all the hip flexors, only the psoas major crosses the spinal joints, crossing them anteriorly to flex the trunk 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 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 posterior tilt of the pelvis that must be stabilized by a force of anterior tilt. This is accomplished by hip flexors, which are anterior tilters of the pelvis). Once located, follow the femoral belly distally in baby steps, asking the client to do a small trunk flexion abdominal crunch at each step along the way, until you reach the lesser trochanter attachment. Once you believe you have reached the actual lesser trochanter itself, ask the client to relax and feel for the difference between the soft, myofascial tissue and the hard, bony tissue. This assists us in locating the lesser trochanter bone itself. To facilitate this deeper palpation toward the lesser trochanter, it might be necessary to slacken the soft tissue in the region by placing the client’s thigh in a position of passive flexion (Image 15).

Sartorius as a Landmark—Femoral Belly Palpation

Another method for locating the femoral belly of the psoas major is to use the sartorius as a landmark and then palpate medially across the iliacus until you reach the psoas major. To first find the sartorius, locate the client’s ASIS and drop off it immediately distal and slightly medial. This should place your palpating fingers on the sartorius. To confirm you are on the sartorius, ask the client to perform an oblique plane motion of the thigh at the hip joint that is a combination of flexion and lateral rotation, along with flexion of the leg at the knee joint. These are all actions of the sartorius and should nicely engage it (Image 16A). Then, drop immediately medial off the sartorius, and you will be on the iliacus (Image 16B). Palpate along the iliacus in baby steps, moving medially, parallel, and close to the inguinal ligament. At each baby step location, ask the client to perform a gentle/moderate contraction of trunk flexion (abdominal crunch). If you are still on the iliacus, you should not feel the musculature under your palpating fingers contract and harden because the iliacus does not engage with trunk flexion. But once you reach the psoas major, you should feel it contract and harden when the client flexes the trunk at the spinal joints. You can then confirm you are on the psoas major by feeling for its rounded contour as explained above. Then, continue with the palpation protocol as above.

Adductor Longus as a Landmark—Femoral Belly Palpation

Another method for palpation of the femoral belly of the psoas major is to use the adductor longus as a landmark. Like the sartorius, the adductor longus is a good landmark for palpation in the proximal thigh because it is so easy to find. Even at rest, the adductor longus’s proximal tendon is usually taut enough that it can be easily located; it is probably the most easily palpable tendon in the proximal thigh (Image 17A). Of course, if needed, you could always ask the client to adduct the thigh at the hip joint and add resistance. This will make the adductor longus proximal tendon engage and be even more readily palpable.

Once located, drop immediately lateral off the adductor longus and you will be on the pectineus (Image 17B). The pectineus sits deeper and feels like it is in a bit of a trough or pocket. Palpate along the pectineus in baby steps, moving laterally, parallel, and close to the inguinal ligament. At each baby step location, ask the client to perform a gentle/moderate abdominal crunch. If you are still on the pectineus, you should not feel the musculature under your palpating fingers contract and harden because flexion of the trunk at the spinal joints is not a joint action of the pectineus. But once you reach the psoas major, you should feel it contract and harden with a trunk flexion abdominal crunch movement. You can then confirm you are on the psoas major by feeling for its rounded contour as explained above. Then, continue with the palpation protocol as above.

Side-lying Position—Femoral Belly Palpation

The lesser trochanter attachment of the femoral belly can sometimes be successfully palpated with the client in side-lying position. To palpate the right-side femoral belly, the client lies on their right side with the right thigh in partial flexion at the hip joint and the right leg flexed at the knee joint. The other (left) lower extremity is flexed approximately 90 degrees at the hip and knee joints and supported by a bolster so as to not be in the way. You first need to find the gracilis as your landmark. This is done by asking the client to attempt to further flex the right leg at the knee joint against your resistance. You can offer resistance with a hand. Or, as shown in Image 18A, you can offer resistance using your leg; this allows both of your hands to be free for the palpation, allowing you to support your palpating fingers with the fingers of the other hand. This is helpful because the lesser trochanter is fairly deep and will require a moderate amount of force to reach it. Once you’ve located the gracilis, drop immediately off it posteriorly and you will be on the adductor magnus. The lesser trochanter attachment of the psoas major is deep to the adductor magnus, so you need to slowly but firmly sink in through the adductor magnus, reaching for the lesser trochanter (Image 18B). Confirm you have reached the psoas major’s distal attachment on the lesser trochanter, either by feeling for the hard bony lesser trochanter itself, or by asking the client to flex the trunk at the spinal joints and feel for psoas major engagement; resistance can be given if you can comfortably place your hand against the sternum of the client. 

Conclusion