Lumbar & Pelvic Paplation week 11 12 PDF

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Visual analysis to palpating the lumbar and pelvic regions...

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LUMBAR & PEL PELVIC VIC P PALP ALP ALPA ATION WEEK 11 08/MAY/2019

OVERVIEW In today’s lab we are going to cover the muscles of the lumbar spine and pelvis. PA LPA TION ON THE LLUMBAR UMBAR SPINE PALPA LPATION Name How to Palpate? Quadratus Lumborum Origin (Posteromedial Iliac crest): Iliolumbar ligament and adjacent to the iliac crest Insertion (Inferomedial border): Of the medial half of the lower border of the 12th rib and anterior tubercles of the transverse processes of all lumbar vertebrae. Action: Ipsilateral side flexion. Lumbar extension. Fixes 12th rib on deep inspiration to give a fixed origin for the diaphragm. prevent the pelvis dropping on the none weight baring side during single leg stance. Nerve supply: Anterior Primary Rami of the Subcoastal nerve and the upper three or 4 lumbar nerves.) Thoracic Vertebrae 12 to lumbar 1-4) Palpation: First step: The client should be in a prone position Second step: The therapist stands to the side of the client. Third step (1): Ask the client to move their right or left hip towards the ribcage (to any side your palpating the patient). Third step (2): Or ask the patient to lie down side on uninvolved side. Raise the arm above the head to elevate the ribcage and drop the knee of the involved patient side behind the other knee onto the table. Fourth step (1): The therapist places palpating hand just lateral to the lateral border of the erector spinae in the lumbar region. Fourth step (2): Palpate the space between the iliac crest and the 12th rib. Fifth step (1): Support hand is sometimes used directly on the palpating hand for support. Sixth step (1,2): Locate the 12th rib and lumbar (1-4).

Gluteus maximus

Origin: Posterior gluteal line of the ilium, tendon of the Sacrospinalis, dorsal surface of the sacrum, coccyx and Sacrotuberous ligament. Insertion: Gluteal tuberosity of the femur and iliotibial tract of fascia latae. Action: Extension of the femur, lateral stabilization of the hip. Inferior fibers can assist with adduction and lateral rotation of the femur. Superior fibers can assist with abduction and medial rotation of the femur. Nerve supply: Inferior Gluteal Nerve (Lumbar 5 to Sacrum 2) Palpation: Step two: As the patient to be in a prone position, lying with on knee joint fled to 90 degree (Anatomical terminology inversion potion of the ankle). Step three: Apply maximum resistance to the posterior surface of the thigh and ask for hip extension.

Gluteus Medius

Origin: Outer surface of the ilium from the iliac crest and posterior gluteal line. Insertion: Superolateral surface of the greater trochanter Action: Abduction of the hip. Anterior fibers assist with femoral medial rotation. Posterior fibers assist with lateral rotation. Stabilize the pelvis on the femur during single leg stance. Nerve supply: Superior Gluteal Nerve: Lumbar (L4- L5), Sacrum (S1) Palpation: Step one Step two (2): Ask the patient to lie on their side. Place the hands between the iliac crest and the greater trochanter of the femur. Step three (2): Ask the patient to abduct the femur. Origin: Anterior surface of the sacrum between and Lateral to anterior sacral foramen, capsule of sacroiliac articulation, margin of the greater sciatic foramen and sacrotuberous ligament Insertion: Superior border of the greater trochanter of the femur. Action: Extension and Lateral rotation of the hip in hip extension or

Piriformis Iliopsoas

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neutral. medial rotation and abduction in 90° of hip flexion. Nerve Supply Supply: Sacral plexus, L5, S1, S2 Pal Palpation pation pation: Step two: Ask the patient to lie on their side on uninvolved side with hip flexed to 90°. Palpate in a line from the greater trochanter to the palpable border of the sacrum. Step three: Ask patient to be in a prone. Knee flexed to 90°. Palpate in a line from greater trochanter to palpable border of the sacrum. medial and Lateral rotation of the hip can be used to confirm palpation. Iliopsoas

Origin Adjacent margins of the bodies of the vertebra and discs and anterior medial transverse processes from the body of T12 to the body of L5. Insertion Tip and posterior aspect of lesser trochanter of the femur Action Flexion of the hip and lumbar spine Nerve Supply Anterior rami of L1-L3/4 Pal Palpation: pation: Ask the model to be lay on a supine position with the hip and knee flexion, feet resting on table. Therapist places fingers 2 inches Lateral to umbilicus on Lateral edge of rectus abdominis. Pressure is applied towards to spinal column. The patient can perform hip flexion to confirm palpation. Iliopsoas tendon palpated Lateral to femoral artery inferior to inguinal ligament

Tensor Fasciae Latea

Origin: Lateral aspect of crest of ilium between anterior superior iliac spine and tubercle of the crest. Insertion: Iliotibial tract of fascia latae Action: Allows Abduction and medial Rotation of the hip. Nerve supply: Superior Gluteal nerve

ilium

Origin: Upper and posterior two thirds of the iliac fossa, ala of the

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sacrum and anterior sacroiliac ligament. Insertion: Lesser trochanter of the femur. A few fibers attach to the hip joint capsule Action: Hip Flexion. When the origin and insertion are reversed so the lower point is fixed iliacus is a lumbar flexor and anteriorly tilts the pelvis. Nerve Supply: Femoral nerve Pal Palpation: pation: Anterior aspect of ilium just medial to the ASIS.

Muscle landmarks

Surface Landmarks

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Quadratus Lumborum (QL) Attachments

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Iliopsoas Attachments

Gluteus maximus Attachments

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Gluteus Medius

Piriformis Iliopsoas

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Iliopsoas

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Tensor Fasciae Latea

PA LPA TION ON THE QUADRA TUS LUMBORUM PALPA LPATION QUADRATUS Quadratus Diagram Lumboru m

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Description

Petrissage

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Petrissage  Lifting & kneading of skin, subcutaneous tissue, & muscles–  Repeated grasping, pressure, lifting and rolling of muscle tissue with the thumbs and fingers  As if “kneading” the muscles  Performed from the distal to proximal portion of the muscle, Performed with fingers or hand  Kneading performed either parallel or perpendicular to the muscle fibres  Little lubrication is required Petr Petrissage issage o Kneading o Involves picking up skin between thumb and forefinger, rolling and twisting in opposite directions o Used for deep tissue work

Effleurage

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Effleur Effleura age  Use at the beginning and end of the massage  Stroking of the skin  Performed with palm of hand  Stimulates deep tissues  Performed with fingertips  Stimulates sensory nerves  Superficial, rhythmic stroking  Contours the body or relates to direction of underlying muscles  Deep stroking:  Follows course of veins & lymph vessels Effleur Effleura age o May be performed slowly for relaxation or rapidly to encourage blood flow & stimulate the tissues o Performed in rhythmic manner o One hand should always be in contact w/ skin o Light effleurage is

performed at beginning & end of massage or may be used between petrissage strokes  At beginning – relaxes patient & indicates area to be treated  At end – calms down any irritated areas Technique/ Procedure Effl Effleurage eurage o The therapist provides light or deep strokes of the palms and fingers o Unidirectional circular motions (Distal to proximal) should be made moving towards the heart o Generous lubrication is required Massage Strokes Effleur Effleurage age Stroking divided into light and deep o Can be used as a sedative or to move fluids o Multiple stroking variations exist o Pressure variations o Stroking variation

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Friction Massage

o Superficial tissue manipulation over a small area Technique/ Procedure o Uses the tips of the fingers, thumb, or heel of the hands o A small circular motion of deep pressure is provided o The skin is moved over the underlying tissues o Lubrication is not recommended 5,6,7 Friction Transverse: o Applied with thumbs or fingertips stroking the tissue from opposite directions o Can use elbow, end of rolling pin, etc. for larger areas o Reaches deep tissues o Begin lightly and then move to firmer strokes o Muscle should be placed in relaxed position o Should be avoided in acute conditions o Effective in

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tendonitis or other joint adhesions Friction Massage Indications o Loosen adhesions, aid in edema absorption, reduce local muscular spasm o Produce a reflex effect to remove “knots Contr Contraindications aindications o Acute inflammation 5,6,7 o *Refer to Hoffa contraindications 5,6,7 Friction o Used around joints and in areas where tissue is thin o Areas w/ underlying scarring, adhesions, spasms and fascia o Goal is to stretch underlying tissue, develop friction and increase circulation Masseuse

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Deep Tissue Massage o This type of massage technique is especially good for treating

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specific areas of the body. The masseuse will typically use their elbows or the knuckles on their fingers, working with slow, deep movements across the fibre of the muscle and across tendons. This will restrict and release blood to the muscle, reenergising the tissue with fresh oxygen, and remove more complex knots in the muscle fibres. The primary aim of a deep-tissue massage therapy is to alter the fascia and the musculature to help aid with physical recovery. Although various massage motions are utilized within deep-tissue massage, the intensity is always maintained between a relatively more extreme ranges to target specific areas thoroughly. Although the whole body is

slightly pressed, yet the focus is kept on best bringing about effects on the body parts that will aid with physical recovery, e.g. for chronic back pains, the Vertebrae especially the lower back will be given the maximum massage time. o ‘Linear Friction’ is utilized as the primary stroke by all professional deep-tissue massage therapists. o The art of ‘static pressure’ over eventual massage therapy helps muscles adopt a relatively balanced posture; therefore, eliminating any chronic pains caused due to incorrect positioning. o Professional massage therapists very often make the use of their elbows or knuckles to apply consistently high-

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intensity massage for eliminating knots formed within the body. This helps with stripping the messages via massage motions all the way to the bones of clients. o

Upper Limb Palpation WEEK 12 08/MAY/2019

Name Deltoid Muscle

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How to palpate? Pro Proximal: ximal: Lateral clavicle, acromion process, and the spine of the scapula Distal: Deltoid tuberosity of the humerus Action: 1. Abducts the arm at the shoulder joint (entire muscle 2. Flexes the arm at the shoulder joint (anterior deltoid 3. Extends the arm at the shoulder joint (posterior deltoid) 4. Medially rotates the arm at the shoulder joint (anterior deltoid 5. Laterally rotates the arm at the shoulder joint (posterior deltoid) Nerve supply: Axillary nerve: Pal Palpation pation of the Deltoid Step one: Have client seated Step two: Middle deltoid: Place palpating

hand just proximal to the deltoid tuberosity. Have client actively abduct the arm Step three: Anterior deltoid: Place hand on anterior shoulder. Have client actively horizontally flex the arm at the shoulder joint Step four: Posterior deltoid: Place palpating hand just inferior to the spine of the scapula. Have client actively horizontally extend the arm at the shoulder joint

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To find videos how to palpate (watch this): https://www.facebook.com/Learnmuscles/posts/palpation-note-tensor-fasciae-lataethe-tfl-issuperficial-and-easy-to-palpateit-/10153728475679104/

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