Physiotherapy with 5 options of the sartorius stretching exercise which we always neglect.

Ref: https://www.yoganatomy.com/sartorius-muscle/

 

The incidence of upper thigh injuries include the adductor (23%), hamstring (12– 37%) or quadriceps (19%), whilst  sartorius muscle injuries occur in 31–46%. The pathogenesis of muscle injuries is divided into extrinsic and intrinsic injuries. 

Intrinsic injuries are caused by contraction or elongation of the muscle that mainly involve type II muscle fibers which rapidly contract. It extends between two joints, contracts eccentrically and has a fusiform muscle fiber arrangement, leading to destruction of the internal muscle fiber. There are 3 grade injuries categories based on the extent of the lesion: grade I involves a few muscle fibers within a bundle; grade 2 involves up to three/fourths of the affected muscle portion; and grade 3 involves more than three/fourths, and the lesion may then involve the entire muscle belly.

Extrinsic injuries include factors such as contusions and penetrating wounds that can involve all types of muscle fibers.

5 options of the sartorius stretching exercise

Exercise #1: Sartorius stand wall stretch: Hands are on the wall for maintain balance. Step target leg backward, then adduct as behind front leg, then medial rotation as toe in, then move pelvic forward.

Exercise #2: Sartorius stand leg curl stretch: Bend target knee with hand support, then situate target shin laterally, then extend hip joint without arch lower back.

Exercise #3: Sartorius semi side lying stretch: Lying on the side to the opposite side of the target leg that makes the target leg is behind. Target leg was pushed by hand forward. Then rotate the torso to mid line again. 

Exercise #4: Sartorius side lying stretch: Shin should be lateral to thigh in the end of pose setting.

Exercise #5: Sartorius supine stretch: For beginners, you should supine on the elbow. For advances, you can lie on the back. 

I hardly have seen patients with sartorius injury. Most of my rare cases always complained e.g. proximal anteromedial tibia pain which was pes anserine, VMO pain, fore - thigh pain, proximal lateral groin pain, MCL pain. I had to evaluate carefully to clear the root curse and site of injury. 

One sample case, He was overlapped by one soccer player on the leg  while his knee was bending. He went to see a doctor and he was diagnosed with a knee tendon or ligament injury. A few days later, he came and saw me at physio clinic for more investigation and needed some advice. After subjective examination and physical evaluation, they indicated sartorius tendon more than MCL. To answer the question was how long should he rest? I investigated him by sonography, then the injured site demonstrated grade I. So, we can say his injury was the result of an extrinsic factor.

One author found that injuries of the sartorius muscle most often occur in the area of proximal and distal attachment. At the proximal part, common activity of the sartorius muscle and TFL can cause ASIS avulsion that may be observed. At distal insertion, frequently repetitive movements leading to micro injuries and tissue loads in this area are met. In the result of this, inflammations of bursa anserina, tendon strains and rupture may take place in what was pes anserinus. Such injuries happen to: i.a. athletes, runners, jumpers and football players.

Pes anserine bursitis site
(Ref: http://therundoctor.com/pes-anserine-bursitis/)

The sartorius muscle is the longest muscle in humans. Its name derives from a Latin word “sartor” that did mean “a tailor”. 

The sartorius muscle is situated superficially, moreover, it is distinguished by an original shape and a course. It has got a transverse section in the shape of a triangle with the base upturned. The proximal tendon of the sartorius arises from the anterior superior iliac spine. The muscle belly is like an S-shaped running obliquely across the upper anterior third of the thigh in an inferomedial direction and tape twists around the anterior to the medial surface of the thigh. The belly of the sartorius constitutes the anterior wall of the adductor canal. Then the belly turns slantwise forward at the medial epicondyle of femur which together with quadriceps — its medial head — serves as a “trochlea” for the sartorius muscle. Its distal insertion onto the anteromedial proximal tibia as a flat divergent tendon creating in its further section superficial part of the pes anserinus. 

Sartorius muscle
(Ref: https://www.pinterest.com/)

The sartorius muscle is a biarticular muscle or two joint muscles. It is the only muscle of the thigh which bends both hip joint and knee joint. The sartorius is mainly a flexor of the hip  with the accessory function of lateral rotation and abduction of the hip as well as flexion and medial rotation of the knee. So, there are 4 directions of muscle activity including hip flexion, hip abduction, hip lateral rotation, and tibia medial rotation with knee flexion which action is like a cross single leg chair sitting. 

Ref: https://quizlet.com/

Moreover, it has worked as a hip and knee flexor starter that initializes the movement of flexion in both joints from the phase of full extension. Although the sartorius muscle is a weak external rotator and a weak abductor of the hip joint, it plays an important part in stabilization of the pelvis, especially in women. 

In my physiotherapy experience, stretching this muscle was not as easy as many muscles because it did not provide obvious tension. However, the principle to stretch this muscle is the same as the others: stretch to the point where “tightness with pain” or “noticeable tension without pain” will hole at the point for 30 seconds of 3 - 5 reputations as demonstrated VIDEO.

Reference: 

https://www.researchgate.net/publication/266027219_Anatomy_of_sartorius_muscle 

https://theultrasoundjournal.springeropen.com/track/pdf/10.1186/s13089-019-0132-9.pdf 

https://www.orthopaedicmedicineonline.com/downloads/pdf/B9780702031458000843_web.pdf 

Physiotherapy with 6 tips to stretch iliopsoas muscle

Ref: https://www.rowperfect.co.uk/

     

        Hip flexion or anterior hip bending was caused by hip flexor muscles contraction. A group of hip flexor muscles consist of iliopsoas, sartorius, tensor fascia lata, and rectus femoris which work as prime - mover, and, pectineus, adductor longus, adductor brevis, and the most anterior fibers of the adductor magnus and the gluteus (medius and minimus) which work as accessory muscle. 

My experience in the physiotherapy clinic, I have seen tightness in some or all of the hip flexor muscles in patients with IT band syndrome, groin pain, and low back pain. One muscle which differs from others is “iliopsoas” because its origins connect to the spine. 

“To stretch the tightness of iliopsoas is used in my physiotherapy session to improve the symptoms often.” 

6 options to stretch iliopsoas muscle

Exercise #1: Standard half kneeling stretch where the target muscle is on the rear leg. The pose need keep back straight with shift pelvic in front that no need to arch the back.

Exercise #2: Supine leg off the side bed

Exercise #3: Basic Thomas stretch that the target muscle is straight leg

Exercise #4: Advance Thomas stretch that the target muscle is off bed

Exercise #5: Upward - Facing dog pose. The pose need elevation of pelvic.

Exercise #6: Chair stand posterior pelvic tilt

    The iliopsoas is the most powerful of the hip flexors. The function of iliopsoas such as sit up, elevate leg, leg swing during walking, control sitting balance, and control lordotic curve of lumbar spine. 

Ref: https://womencycles.com/blog/

  

    Iliopsoas is a compound muscle which consists of the psoas major and iliacus. The psoas major is placed lateral to the vertebral column. It corresponding intervertebral discs of the last thoracic and all the lumbar vertebrae that originates at  the 12th thoracic vertebrae until to the vertebral body of the lateral surface of the 5th lumbar vertebrae and extends to the transverse process of the lumbar vertebrae 1st to 5th, and, the superior two-thirds of the bony iliac fossa and the iliolumbar and ventral sacroiliac ligaments. It goes down and palpable just deep to the inguinal ligament, where it lies bordered by the sartorius muscle laterally and the femoral artery medially, and, finally attaches to the femur lesser trochanter and the linea aspera medial. 

Ref: https://www.optimaphysio.com/

The iliacus has several points of origin; it starts with the iliac crest, anterior inferior iliac spine, iliolumbar ligament, and anterior sacroiliac ligament. And eventually attaches to femur lesser trochanter and linea aspera medial that seem to be the same tendon of psoas major. 

Ref: https://www.osteopathyny.com/

While sitting or standing, the iliopsoas is constantly active and plays an important role in stabilizing the pelvis and lumbar region along with the erector spinae and quadratus lumborum. Hence shortening or straining of the iliopsoas can cause excessive pelvic anterior tilt or increased spine extension during hip joint motion, thereby acting as a risk factor for low back pain. A shortening of the iliopsoas muscle can result in anterior pelvic tilt and trunk extension. Finally, it is leading to low back pain.

Ref: https://www.pinterest.com/

            Shortening of the iliopsoas muscle was found to be the primary cause of lumbar hyperlordosis and excessive anterior pelvic tilt. This abnormal alignment may inhibit the function of the Transversus Abdominis (TrA). Back muscle guarding from lumbar hyperlordosis resulted from the shortening of the iliopsoas muscle. This is impaired circulation by muscle guarding, leading to increased pain (pain-spasm-pain model). 

Back pain and improved excessive lumbar lordosis angle can be reduced by lengthening the iliopsoas muscle and increasing TrA activation capacity.

The principle of muscle stretching is simple: stretch to the point where “tightness with pain” or “noticeable tension without pain” will hold at the point for 30 seconds of 3 - 5 reputations in one muscle as demonstrated VIDEO. 

Reference: 

https://www.orthopaedicmedicineonline.com/downloads/pdf/B9780702031458000843_web.pdf 

https://www.jptrs.org/journal/view.html?doi=10.14474/ptrs.2021.10.2.225 

https://www.thaiscience.info/journals/Article/JMAT/10971199.pdf