Psoas Adjustment

Figure 1. Testing psoas

Figure 1. Testing psoas

By: Wayne Henry Zemelka, DC

Examination

In order to verify a psoas problem you can muscle test the patient (to determine the weak muscle), keeping in mind that both sides may be affected. Place the patient supine as shown in Fig. 1. Have the patient raise the leg, turning the toes outward, and resist the pressure applied by the doctor, while stabilizing the opposite ilium as shown. A weak psoas limits the ability of the patient to resist against the pressure you apply, indicating a weak psoas on that side.

The psoas can also be involved with lumbar and pelvic instability, and if the patient has a history of pelvic and lower limb injury it may contribute to the psoas problem. The cyclic events taking place in the body can be triggered by many things; therefore, a thorough case history is important. The need to know on the part of the doctor is paramount in the information “Data List” that you compile to base your decision on where to adjust.

Figure 2. Locate psoas muscle

Figure 2. Locate psoas muscle

Locate the belly of the psoas by palpating for the crest of the ilium, and move medially to about 1 ½ inches from the iliac crest (Fig. 2). Once you have determined that a psoas problem exists place the patient supine so that the sacrum is resting on the pelvic drop piece, or use an SOT board under the patient (Fig. 3). Activate both the lumbar and pelvic drop pieces and set the tension control to the weight of the patient. Using the SOT board simplifies the procedure of patient placement. Just be sure to have the head piece elevated to support the patient’s head.

Procedure

After weighing the patient in the supine position and setting the lumbar and pelvic drop pieces for light tension, locate the psoas at about the level medially from the crest of the ilium. Using the broad pisiform area of the hand, proceed to thrust lightly 3 or 4 times in quick succession into the belly of the psoas (Fig. 4). After the adjustment you can post check for a strengthening of the muscle by doing the muscle test on both legs as described earlier.

Figure 3. Support pelvis and sacrum

Figure 3. Support pelvis and sacrum

Adjusting Set-up

TABLE – L & P drop pieces

P.P. – Supine

D.S. – Straight away

C.P. – Broad Pisiform

C.H. – Superior

S.H. – Toggle grip/Knuckles over thumb

S.C.P. – Belly of Psoas

L.O.C. – A-P straight down

Torque – None

When you find a lumbar problem it is a good idea to check for psoas involvement (Fig. 5), especially if the patient has a history of pelvic or leg problems or injury. The fact that the psoas attaches to the trochanter can contribute to instability in the entire lower limb. Furthermore, those problems in the foot, ankle, and knee may contribute to instability in the pelvic and lumbar region.

Figure 4. Adjustment of psoas

Figure 4. Adjustment of psoas

The piriformis—which also attaches to the femur, as well as gluteus medius and quadratus femoris, to mention a few of the muscles that may be involved in a “Pain Syndrome” of this region—may contribute to pelvic and lumbar instability. This is why in Segmental Drop Adjusting we have adopted additional specific adjusting procedures for the pelvic region.

The instability that you may find in the pelvis and lumbars may also be aggravated by problems arising from unstable conditions in the feet. Research studies have shown that problems of the feet contribute to instability that affects the Kinetic Chain originating in the feet.

Pelvic alignment is dependent upon the symmetry of the lower extremities, and the foundation for the entire body is affected by weakness in the three arches of the feet. Correct alignment of the feet is therefore of paramount importance to maintaining normal musculoskeletal structure and function for the entire body. Most of the intrinsic and extrinsic muscles of the foot are innervated by the Tibial Nerve and/or its extensions, the Lateral and Medial Plantar Nerve representing cord levels L3, L4, L5, S1, S2, and S3. This neurological inhibition can also affect the associated muscles innervated by those same cord levels, i.e., the iliopsoas, the hip adductors, and the quadriceps and hamstrings.1

With these problems it is imperative that you examine the feet to determine the type of custom-made, flexible orthotics that are needed to correct the unstable condition. Complete information and products are available from Foot Levelers.

Figure 5. Proper patient placement

Figure 5. Proper patient placement

Reference

1. Austin WM. Structural support and enhanced muscle function. Practical Research Studies 1998; 7(4):1-4.

About the Author

Dr. Wayne Henry Zemelka is a 1975 graduate of Palmer College of Chiropractic. He was Faculty President for six years in the 1980’s, during which time he built and operated the Media Production Department for Television and Video and was instrumental in production of classroom instruction videos and operation of the Printing Department. “Dr. Z” also taught in the Technique Department, Business Management and Continuing Education. In 1997 he was elected once more as Faculty President. He retired from Palmer in 1998.