psecrets of the psoas lab handout - academy of...
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Psecrets of The PsoasLab Handout
Thieme,Atlas of Anatomy, General Anatomy and Musculoskeletal System
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Thomas Test
Negative Test Positive Test
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Thomas Test (modified)
• Tests for:
• Iliopsoas tightness• Rectus femoris• Tensor fascia lata• Iliotibial band
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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
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Counterstrain
• Psoas Tender Point Location
• 2/3 of the distance from the ASIS towards the midline and slightly superior
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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
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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
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Muscle Energy (ME)
• Acute
• Reciprocal inhibition
• Chronic
• Direct Isometric
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MFR and Mixed technique
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Abnormal Gluteus Firing
• Test hip extension firing
pattern• 1) Hamstring
• 2) Gluteus
• 3) Contralateral Quadratus
Lumborum
• 4) Ipsilateral Quadratus
Lumborum
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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
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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
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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
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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.