Finding the difference
When using the approach wherein we ask the client to contract the target muscle by asking the client to do one of its joint actions , given that most muscles have more than one joint action , the art of muscle palpation is determining which action to choose , or perhaps better put , which oblique-plane joint function to choose given that muscle function does not always fall neatly into cardinal plane joint actions . Working with joint actions for our example , when palpating the hip flexor muscles , given that all the hip flexors do hip joint flexion , it is not useful to ask the client to try to do hip flexion because all of the hip flexors will likely engage , making it difficult to discern our target muscle from the adjacent musculature . What we need is to have the target muscle be the only hard , soft tissue , amidst a sea of soft , soft tissues . Having the target muscle and the adjacent muscles all contract will not accomplish this . Therefore , we need to find a difference between our target muscle and the adjacent muscles . For this reason , we ask for medial rotation when palpating the TFL , we ask for knee extension when palpating the rectus femoris , and we ask for trunk flexion when palpating the psoas major , to cite a few examples . The art of muscle palpation when asking the client to engage the target muscle is learning how to choose the best joint action / oblique-plane function of the target muscle that is most different from the adjacent musculature .
* Images 2-9 demonstrate the client lying on the table supine with their right thigh on the table and their ( lower ) leg hanging off the table ; their left hip and knee joints are flexed with the left foot on the table so that the pelvis is stabilized . The palpation protocol for these muscles could also be done with the client lying supine with both lower extremities on the table .
Image 2 . Palpation of the tensor fasciae latae ( TFL ).
Rectus femoris : Staying close and parallel to the inguinal ligament , drop immediately medial to the TFL and you should be on the rectus femoris . To confirm this , ask the client to extend the leg at the knee joint . This will engage the rectus femoris , but not the nearby TFL or sartorius ( Image 3 ).
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C
Image 3 . Palpation of the rectus femoris .
Sartorius : Drop immediately medial to the rectus femoris and you should be on the sartorius . To confirm , ask the client to laterally rotate and abduct the thigh at the hip joint , and slightly flex the leg at the knee joint . The sartorius will engage and pop , but the adjacent muscles will remain relaxed ( Image 4 ).
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continue palpating medially until I find the psoas major , then return laterally and whatever is between the psoas major and sartorius will be iliacus .
Psoas major : To find the psoas major , we look for the first tissue that is medial to the sartorius that engages with gentle flexion of the trunk at the spinal joints . The psoas major is the only hip flexor that crosses the spinal joints , so this joint action should yield an isolated engagement of the psoas major . Once found , return laterally for the iliacus as previously mentioned ( Image 5 ).
Image 5 . Palpation of the psoas major femoral belly .
Pectineus : Drop immediately medial off the psoas major and you will be on the pectineus . Similar to the iliacus , the pectineus is challenging to have its engagement isolated , so I like to continue palpating medially until I find the adductor longus , then return laterally and whatever is between the adductor longus and psoas major will be pectineus ( Image 6 ).
TFL : Find the ASIS and drop immediately distal and slightly lateral . Now ask the client to medially rotate the thigh at the hip joint , and then gently flex the thigh at the hip joint . The TFL will engage and pop , and we can discern it from the nearby rectus femoris of the quadriceps femoris group , as well as the nearby sartorius ( Image 2 ).
Image 4 . Palpation of the sartorius .
Iliacus : Now drop immediately medial to the sartorius and you should be on the iliacus . The iliacus is challenging to have its engagement isolated ( because its joint actions are essentially identical to those of the adjacent muscles ), so I like to
Image 6 . Palpation of the pectineus .
JATMS | Spring 2024 | 141