an increased lumbar lordosis and posterior pelvic
tilt. Gait analysis may reveal a shortened stride on the affected
side and conducting a functional squat test may
cause pain or indicate hip flexor weakness.40,41 Strength
testing of psoas major can be conducted in numerous
ways (generally supine) as long as the patient resists the
examiner’s attempt to extend the hip.4,42–44 Assessment
of active and passive hip ranges of motion is important,
particularly active flexion and extension and passive extension
(generally performed with the patient prone).45
Palpation can be conducted with the patient either supine
or side-lying44,45 but should likely involve the examiner
flexing the hip to 30° and palpating the psoas major muscle
medial to the anterior superior iliac spine and deeper
into the abdomen. When the examiner feels they are palpating
the psoas major muscle, having the patient flex
their hip against resistance should allow the examiner to
feel the psoas major contract. The examiner must consider
patient comfort when palpating the psoas major as it
may be extremely tender, ticklish, or more invasive than
the patient’s comfort level allows. Still, reproduction of
the patient’s pain on palpation of the psoas major muscle
belly with tightness and tenderness are strong indicators
of psoas major myofasciopathy.40 The psoas major mus