Yim Physio Near Me: hip adductor

แสดงบทความที่มีป้ายกำกับ hip adductor แสดงบทความทั้งหมด

วันศุกร์ที่ 17 มิถุนายน พ.ศ. 2565

9 options to stretch posterior fibers of hip adductor with physiotherapist

Sketing on ice e.g. race and hockey is potential to develop adductor magnus tight or injury
(Ref: https://www.sportsinjurybulletin.com/adductor-magnus-tales-of-tightness/)

All hip adductors work at the hip joint to adduct and forward bend but only one muscle provides flexion and extension function. This muscle is an adductor magnus that has anterior fibers to assist in flexion, while posterior fibers to assist in extension.

“The way to stretch extensor muscles needs to reverse the direction that flexes the hip joint”.

9 options to stretch posterior fibers of hip adductor

Exercise #1: Sumo (Horse stance): Both leg toe out, then squat, bend torso forward for more stretch.

Exercise #2: Lizard pose: Target leg is fore - leg and outerward to hand

Exercise #3: Butterfly pose: Place both plantar together, then keep knee close to floor as postible as you can. Bend torso forward for more stretch.

Exercise #4: Long sitting hip abduction: Bend torso forward that touch the floor away as far as possible for more stretch. Keep knee straight.

Exercise #5: Kneeling lateral lunge

Exercise #6: Prone frog

Exercise #7: Supine lizard

Exercise #8: Happy baby

Exercise #9: Supine wall hip abduction

The adductor magnus is the largest of the hip adductors and the third largest among all of the muscles in the lower limb, is only smaller than the quadriceps femoris and the gluteus maximus. It is a fan - shaped muscle and located in the deepest of medial thigh muscles. It is rarely injured, opposite, the adductor longus is the most commonly injured muscle.

Fan - shape
(Ref: https://www.istockphoto.com/)

The adductor magnus derived tendon at inferior pubic rami, ramus of ischium (anterior fiber), and ischial tuberosity (posterior fibers). Because of this proximity to the ischial tuberosity, some even consider the ischial portion of the adductor magnus to be part of the hamstring muscle group. Muscle fibers of adductor magnus are closely related to the origin of semimembranosus and the fiber orientation of adductor magnus is similar with hamstring, so it is intimately related to the proximal hamstring musculature. The insertion is at medial to gluteal tuberosity, middle of linea aspera, medial supracondylar line, and adductor tubercle of medial condyle of femur. Muscle fibers of adductor magnus are closely related to the origin of semimembranosus and the fiber orientation of adductor magnus is similar with hamstring

The adductor magnus derived tendon at inferior pubic rami, ramus of ischium (anterior fiber) which represented by blue and ischial tuberosity (posterior fibers) which represented by red.
(Ref: https://www.researchgate.net/publication/283718715_The_adductor_magnus_mini-hamstring_MRI_appearance_and_potential_pitfalls/download)

According to anatomically, it is the most complex adductor muscle, which plays a role in the flexion and extension movements of the hip joint and stabilizes the posteromedial compartment of hip joint.

Its attachment not only complicates only the proximal part but also distal part that the adductor magnus has been divided into a “adductor” part and “hamstrings” part. The pubofemoral muscle fibers/adductor parts are directed horizontally that insert along the plane between the greater trochanter and linea aspera. The ischiofemoral fibers/hamstring part have vertical and lateral fibers that insert onto the linea aspera and adductor tubercle. The adductor tubercle is a bony protuberance, situated just cranial to the medial epicondyle of femur and is the caudal most point of the medial supracondylar line serving as the insertion point of the ischiofemoral portion of the adductor magnus muscle (hamstring).

Hip adductor magnus:
pubofemoral muscle fibers/adductor parts (purple), ischiofemoral fibers/hamstring part (red)
(Ref: https://www.researchgate.net/publication/283718715_The_adductor_magnus_mini-hamstring_MRI_appearance_and_potential_pitfalls/download)

The adductor magnus musculotendinous junction occurs approximately at the level of the junction of the middle and distal thirds of the femur. The distal tendon has a long course to its insertion onto the adductor tubercle. There are many ligamentous and tendinous attachments in close proximity to the adductor magnus insertion onto the adductor tubercle; e.g. the medial patellofemoral ligament (MPFL), the posterior oblique ligament originates slightly posteroinferiorly to the AT and is directed caudally, blending distally with the semimembranosus tendon, the gastrocnemius tubercle is located distal and posterior to adductor tubercle that giving attachment to the medial head of gastrocnemius, the medial collateral ligament (MCL).

Adductor tubercle is superior to femur medial epicondyle
where adductor magnus and many soft tissues attach.
(Ref: Huleatt J., Geeslin A., LaPrade R. (2014) Special Considerations for Multiple-Ligament Knee Injuries. In: Doral M., Karlsson J. (eds) Sports Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36801-1_112-2)

Electromyography (EMG) studies have investigated the gluteus maximus (Gmax), hamstring and the adductor magnus muscles as the primary hip extensors during prone hip extension. The results of this study support the hypothesis that during prone hip extension exercise, the adductor magnus would have statistically similar activity with the Gmax, medial hamstring, and lateral hamstring. Therefore, the adductor magnus can work in hip extension as same as Gmax and hamstring muscles.

Referring to its function, I gave massage and stretching on the hamstring and adductor magnus in one patient with a flat back. Due to, shortening of hamstring and abdominal muscle involve flat back posture. The outcome showed an increase of lumbar lordosis that satisfied me. However, I will observe this method in the future carefully.

Adductor magnus is medial hamstring neighbor
(Ref: https://loveyogaanatomy.com/sitbone-pain-from-yoga-asana/)

To prevent hip adductor disorders needs to strengthen this muscle especially who are prolonged sitting worker, and stretch them with the same as the other muscles: 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 following demonstrated VIDEO.

Reference:

http://physiosports.com.au/wp-content/uploads/2015/07/takizawa-2012-why-add-magnus-muscle-is-large.pdf

https://www.researchgate.net/publication/290210457_Anatomy_of_the_Adductor_Magnus_Origin_Implications_for_Proximal_Hamstring_Injuries

https://www.thieme-connect.com/products/ejournals/pdf/10.4103/ijri.IJRI_523_19.pdf

https://www.researchgate.net/publication/324118428_Comparison_of_hip_extensor_muscle_activity_including_the_adductor_magnus_during_three_prone_hip_extension_exercises

https://www.jospt.org/doi/epdf/10.2519/jospt.2010.3025

https://www.researchgate.net/publication/51823221_A_review_of_the_anatomy_of_the_hip_abductor_muscles_gluteus_medius_gluteus_minimus_and_tensor_fascia_lata

https://core.ac.uk/download/pdf/270251533.pdf

https://aassjournal.com/article-1-1057-en.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714133/pdf/10.1177_2325967115625055.pdf

https://www.researchgate.net/publication/317366152_Assessment_and_management_of_adductor_strain

วันพุธที่ 15 มิถุนายน พ.ศ. 2565

Physiotherapy with 7 options to stretch hip adductor anterior fibers

Hip adductor strain groin pain in soccer
(Ref: https://www.limpinleapoutphysiotherapy.com.au/blog1/groin-pain-in-soccer-players)

There are several musculoskeletal disorders involve groin pain, for example, osteitis pubis, Insertional adductor and rectus abdominis tendinopathy, Apophyseal avulsion fractures, Femoroacetabular impingement (FAI) syndrome that hip adductors strain is one of the most common injuries in athletes.

Normally, groin injuries make up 2% – 5% of all sport ‑ induced injuries, of which adductor strain is the usual musculoskeletal etiology of the pain. The most common sports that put athletes at risk for adductor strains are football, soccer, hockey, basketball, tennis, figure skating, baseball, horseback riding, karate, softball, and cricket.

Hip adductors strain have risk multifactorial; include, different forms of sports, high level of play, age and core stability, previous hip adductor injury, hip adductor - to - abductor strength imbalance, and adductor tightness.

Anterior thigh view with hip adductor are in medial side
(Ref: https://www.britannica.com/science/quadriceps-femoris-muscle)

Hip adductor muscles shortening affected pelvic tilt posture both of anterior - posterior plane and lateral plane. The position is one of lateral pelvic tilt, with the pelvis so high on the side of contracture in standing. Legs alignment would be changed because of this deformity. Tightness of secondary hip flexors, such as adductor brevis, gracilis, and anterior fibers of the gluteus minimus, would, in theory, contribute to an excessive anterior pelvic tilt and exaggerated lumbar lordosis.

Some hip adductor fibers which arise from the anterior surface of pubic will assist to flex the hip joint. By the way, all of them contract to adduct and internally rotate the hip joint.

7 ways to stretch hip adductors

Exercise #1: stand hip abduction with lateral pelvic shift stretch: spread both legs 2 - 3 times shoulder wide. Then, tilt up the opposite pelvic side of target leg laterally.

Exercise #2: stand lateral lunge stretch: spread both legs 2 - 3 times shoulder wide. Then, bend supported leg like lateral lunge squat to stretch target leg which is opposite side.

Exercise #3: supine frog stretch: For standard stretching, keep both feet together during stretching. For advance stretching, separate both feet away.

Exercise #4: modified lion stretch: keep both feet together during stretching. Control hips in extension postition, not back extension.

Exercise #5: figure of 4 stretch: for more stretch, we needs move knee close to floor as far as possible.

Exercise #6: Half kneeling lateral shift stretch: it is used for stretching leg which is kneeling.

Exercise #7: stand lateral lunge with hip extension stretch: spread both legs 2 - 3 times shoulder wide with hands are on the wall. Then, target leg turn to toe out. And supported leg step forward to prepare squating. Supported leg squat with shift weight forwatd and laterally for position target leg in hip extension, hip external rotation, hip abduction.

A common mechanism of the injury is sudden change of direction or violent external rotation with abduction at hip joint while the foot is planted on ground with eccentric contraction that my patients and I underwent before. The most common hip adductor strain is hip adductor longus.

Once, I got a hip adductor strain during soccer games. It happened very fast, I stepped my right leg to the ball with poor leg position because of fatigue. Then, I stepped my left leg to the right to keep balance and play on. Suddenly, my torso twisted with a "pop sound" at my left hip. I fell on the ground and was carried afterward. I had stopped all my exercise for 4 months.

The five primary hip adductors include the pectineus, gracilis, adductor longus, adductor brevis, and adductor magnus (both anterior and posterior heads). Secondary adductors include the biceps femoris (long head), the gluteus maximus (especially the posterior fibers), quadratus femoris, and obturator externus.

The muscles testing and function textbook which was written by Kendall, stated primary hip adductors anatomy that:

The pectineus arise at the surface of superior ramus of the pubis ventral to pecten between ilioppectineal eminence and pubic tubercle, and inserted at pectineal line of femur distally.

Pectineus muscle
(Ref: https://michael-loehr.com/muscles-of-the-lower-limb/)

The adductor magnus derived tendon at inferior pubic rami, ramus of ischium (anterior fiber), and ischial tuberosity (posterior fibers), then had insertion at medial to gluteal tuberosity, middle of linea aspera, medial supracondylar line, and adductor tubercle of medial condyle of femur.

Hip adductor magnus
(Ref: https://michael-loehr.com/muscles-of-the-lower-limb/)

The origin of adductor brevis was at the outer surface of inferior ramus of pubis, and had distal attachment at distal two thirds of pectineal line, and proximal half of medial lip of linea aspera.

Hip adductor brevis
(Ref: https://michael-loehr.com/muscles-of-the-lower-limb/)

The adductor longus had origin not far from its friends which is the anterior surface of pubis at junction of crest and symphysis, and had insertion at the middle one thirds of medial lip of linea aspera.

Hip adductor longus
(Ref: https://michael-loehr.com/muscles-of-the-lower-limb/)

The gracilis started at the inferior half of symphysis pubis and medial margin of inferior ramus of pubic bone, then passed on medial side of femur to the medial surface of body of tibia, distal to condyle, proximal to insertion of semitendinosus, and lateral to insertion of sartorius. It is only one muscle which is two joint muscle of hip adductor group.

Gracilis
(Ref: https://michael-loehr.com/muscles-of-the-lower-limb/)

All of the above provide adduct hip joints, majorly. The pectineus, adductor brevis, and adductor longus flex the hip joint. The anterior fibers of the adductor magnus which arise from the rami of the pubis and ischium may assist in flexion, while the posterior fibers that arise from the ischial tuberosity may assist in extension. The gracilis, in addition to adducting the hip joint, flexes and medially rotates the knee joint. In addition to hip adduction, these muscles help stabilize the hip and lower limbs during the standing phase of the gait. Therefore, their function consists of hip adduction, hip flexion, hip internal rotation, and some fibers of them assist hip extension.

To prevent hip adductor strain needs to strengthen the hip adductor in eccentric function especially in standing or step in, and stretch them with the same as the other muscles: 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 following demonstrated VIDEO.