Hips and Thighs

Chapter 9 Hips and Thighs



outline



Muscles of the Hip and Thigh


Gluteal Group

Deep Lateral Rotators

Hip Flexors

Muscles of the Thigh


Quadriceps

Hamstrings

Adductors

Balancing the Hip


Psoas

Quadriceps

Deep Six

Knee Joint


objectives




1. Describe the musculoskeletal design of the pelvic girdle.


2. Define and identify the muscles of the hip.


3. Demonstrate techniques for the psoas muscle.


4. Explain and identify common disorders of the hips and thighs.



Key terms


acetabulum


borders


deep lateral rotators


deep six muscles


ergonomics


gait assessment


hyperkyphosis


hyperlordosis


iliotibial band disorder


iliotibial (IT) band or tract


lower crossed syndrome


patellofemoral dysfunction


pelvis


postural muscles


postural positioning


posture assessment


sciatica


stability


tensor fascia latae (TFL)


thoracolumbar fascia


The pelvis, a crucial region of the body, is the area where the lower extremities attach to the axial skeleton through the sacroiliac (SI) joint. The pelvis houses parts of the digestive system and the urinary and reproductive systems. The lower extremities, the trunk, and the spinal column can influence the movements and position of the pelvis, and the positioning of the pelvis can influence the movements and positioning of the lower extremities, the trunk, and the spinal column. Deep postural muscles in this area work hard to maintain spinal stability and proper positioning. This region also contains muscles that can be difficult to access because of the depth at which they are located. Tightness in these muscles can pull the body out of its ideal position. For example, tightness in the gluteal or deep lateral rotator muscles can cause the hip to laterally rotate. This lateral rotation commonly results in a shift of the sacrum, which hikes the hip on the affected side. If there is tightness bilaterally, this may result in a posterior pelvic tilt, which can lead to a flat back or a decrease in the lordotic curvature of the lumbar vertebrae. This flat back syndrome may be a precursor to hyperkyphosis of the thoracic area. Because of this tension in the gluteal and “deep six” musculature, clients may experience low back pain and possibly even headaches.



Muscles of the hip and thigh



Gluteal group


On the posterior aspect of the pelvis are the gluteal muscles. Working superficial to deep and posterior to lateral, there are three gluteal muscles: gluteus maximus, gluteus medius, and the gluteus minimus. These muscles help stabilize the upper body, aid in locomotion, and extend the hip. Originating from the sacrum, the gluteus maximus is a key muscle that ties the leg to the pelvis (Figure 9-1).


image

Figure 9-1 Gluteal muscles.


(From Muscolino JE: The muscle and bone palpation manual with trigger points, referral patterns, and stretching, St Louis, 2009, Mosby.)


Although the iliotibial (IT) band or tract runs the length of the lateral thigh, we are including it as part of the hip because it acts as one of the insertion points of the gluteus maximus. The IT band also acts as an attachment site for the tensor fascia latae (TFL). The TFL is a hip abductor and has an important role as a hip stabilizer (Figure 9-2).


image

Figure 9-2 Tensor fascia latae and iliotibial band.


(From Muscolino JE: The muscle and bone palpation manual with trigger points, referral patterns, and stretching, St Louis, 2009, Mosby.)



Deep lateral rotators


The deep lateral rotators, often referred to as the deep six muscles, are a group of six muscles that lie under the gluteal group. These muscles play an important role in stabilizing the pelvis and rotation of the hip. These muscles are the piriformis, gemellus superior, obturator internus, gemellus inferior, obturator externus, and quadratus femoris. This small group of muscles is a major culprit in low back and leg pain. The piriformis muscle originates from the anterior surface of the sacrum and attaches to the greater trochanter of the femur. It uses the femur as a counterbalance to maintain spinal positioning through the sacrum. Because of its positioning, the tendency to become tight and compress the sciatic nerve is common. The quadratus femoris originates from the ischial tuberosity and is often tight and tender to touch when worked (Figure 9-3).


image

Figure 9-3 Deep six muscles: Piriformis, Gemellus Superior, Obturator Internus, Gemellus Inferior, Obturator Externus, and Quadratus Femoris.


(From Muscolino JE: The muscle and bone palpation manual with trigger points, referral patterns, and stretching, St Louis, 2009, Mosby.)



Hip flexors


The hip flexors help balance the posterior pelvic muscles. Three key muscles often become tight and shortened as a result of activities of daily living. These are the iliacus, psoas major, and the rectus femoris. The iliacus and the psoas major are often referred to as the iliopsoas because they share the same insertion at the lesser trochanter of the femur. The psoas minor inserts on the superior ramus of the pubis bone and mainly supports the natural lordotic curvature of the spine, but is only found in about 40% of the population. The psoas major originates on the anterior surface of the lumbar vertebrae and runs over the pubis bone and inserts into the lesser trochanter of the femur. This muscle not only helps to flex the hip, but also has an effect on the lordotic curvature of the lumbar vertebrae. The rectus femoris has a proximal attachment at the acetabulum and inserts into the tibial tuberosity. This long muscle plays a role in both hip flexion and leg extension (Figure 9-4).


image image

Figure 9-4 Hip flexors.


(From Muscolino JE: The muscle and bone palpation manual with trigger points, referral patterns, and stretching, St Louis, 2009, Mosby.)


When these muscles are under constant tension because of ergonomics and habitual postural positioning, they may become tight and shortened. This can result in pulling forward on the lumbar vertebrae, creating hyperlordosis and causing the pelvis to tilt anteriorly. This is commonly seen in people who maintain a seated position for a prolonged period such as office workers, computer programmers, and others who find themselves sitting at a desk for hours every day. It is important to provide education on proper ergonomics, movement, and self-care to these individuals.


Working in the pelvic region is not easy for many therapists and clients. There are cautions and borders that need to be addressed and talked through before addressing these muscles. There are emotional and comfort aspects about working in the lower pelvic region. Some clients find this area too personal or private to allow the therapist’s hands in this area. Other considerations are the internal organs such as the intestines, uterus, kidneys, and bladder. As the iliacus and psoas travel under the inguinal ligament and insert into the lesser trochanter of the femur, there is also the femoral triangle, which needs to be worked around. Body positioning can be useful to help access these muscles in a less invasive way while protecting the comfort of the client.



Muscles of the thigh


For the purposes of this text, when referring to the thigh we are referring to the musculature of the upper portion of the leg, between the hip and the knee. These muscles play important roles in the leg and hip positioning. Leg position and leg lengths can have a dramatic effect on the pelvic alignment, which affects the spinal alignment. An internally or externally rotated hip can have an effect not only on the pelvic position, but also on the client’s gait. A thorough assessment helps determine which muscles are tight or restricted; working from the feet up to the pelvis may help determine the focus of the session (Figure 9-5).


image image

Figure 9-5 Muscles of the thigh (anterior and posterior).


(From Muscolino JE: The muscle and bone palpation manual with trigger points, referral patterns, and stretching, St Louis, 2009, Mosby.)

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Jun 4, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Hips and Thighs
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