Anatomy Myofascial Lower Quarter Worked Out
,Inhoudsopgave
ANATOMY MYOFASCIAL LOWER QUARTER WORKED OUT ............................................................................... 1
ILIOPSOAS MAJOR, ILIOPSOAS MINOR AND ILIACUS ........................................................................................ 4
M. ILIOPSOAS MAJOR ............................................................................................................................................. 5
M. ILIOPSOAS MINOR ............................................................................................................................................. 7
M. ILIACUS ............................................................................................................................................................ 8
THE M. LEVATOR ANI ....................................................................................................................................... 9
M. ISCHIOCOCCYGEUS ........................................................................................................................................... 10
M. ILIOCOCCYGEUS ............................................................................................................................................... 10
M. PUBOCOCCYGEUS ............................................................................................................................................ 10
M. GLUTEUS MAXIMUS .................................................................................................................................. 12
M. GLUTEUS MEDIUS AND M. GLUTEUS MINIMUS ......................................................................................... 15
M. GLUTEUS MEDIUS ‘LUMBAGO MUSCLE’ .............................................................................................................. 15
M. GLUTEUS MINIMUS ......................................................................................................................................... 18
M. TENSOR FASCIA LATAE...................................................................................................................................... 21
M. PIRIFORMIS .................................................................................................................................................... 23
SHORT LATERAL ROTATORS ........................................................................................................................... 25
M. OBTURATOR INTERNUS..................................................................................................................................... 26
M. OBTURATOR EXTERNUS .................................................................................................................................... 27
M. GEMELLUS INFERIOR ........................................................................................................................................ 28
M. GEMELLUS SUPERIOR ....................................................................................................................................... 28
M. QUADRATUS FEMORIS ...................................................................................................................................... 29
HAMSTRINGS ................................................................................................................................................. 30
HAMSTRING STRETCH ............................................................................................................................................ 30
M. BICEPS FEMORIS (LONG AND SHORT HEAD) .............................................................................................. 31
M. SEMIMEMBRANOSUS................................................................................................................................ 34
M. SEMITENDINOSUS ..................................................................................................................................... 37
M. SARTORIUS ............................................................................................................................................... 39
M. QUADRICEPS ............................................................................................................................................. 42
M. RECTUS FEMORIS............................................................................................................................................. 42
M. VASTUS LATERALIS ........................................................................................................................................... 44
M. VASTUS INTERMEDIUS ...................................................................................................................................... 47
M. VASTUS MEDIALIS ........................................................................................................................................... 49
VASTUS MEDIALIS OBLIQUE ................................................................................................................................... 51
ADDUCTOR MUSCLES ..................................................................................................................................... 52
M. PECTINEUS ..................................................................................................................................................... 52
FEMORAL TRIANGLE .............................................................................................................................................. 54
.......................................................................................................................................................................... 54
.......................................................................................................................................................................... 54
ADDUCTOR BREVIS ............................................................................................................................................... 55
M. ADDUCTOR LONGUS......................................................................................................................................... 57
M. ADDUCTOR MAGNUS ................................................................................................................................ 59
M. GRACILIS ........................................................................................................................................................ 62
ANTERIOR COMPARTMENT OF THE LEG ......................................................................................................... 64
, M. TIBIALIS ANTERIOR .......................................................................................................................................... 64
M. EXTENSOR DIGITORUM LONGUS......................................................................................................................... 67
M. EXTENSOR HALLUCIS LONGUS ............................................................................................................................ 70
M. FIBULARIS TERTIUS .......................................................................................................................................... 72
LATERAL AND SUPERFICIAL POSTERIOR COMPARTMENT ............................................................................... 74
M. FIBULARIS LONGUS (PERONEUS) ........................................................................................................................ 74
M. FIBULARIS BREVIS (PERONEUS) .......................................................................................................................... 77
M. GASTROCNEMIUS ............................................................................................................................................ 79
M. SOLEUS .......................................................................................................................................................... 82
M. PLANTARIS ..................................................................................................................................................... 85
DEEP POSTERIOR COMPARTMENT OF THE LEG .............................................................................................. 87
M. POPLITEUS...................................................................................................................................................... 87
M. TIBIALIS POSTERIOR ......................................................................................................................................... 90
M. FLEXOR DIGITORUM LONGUS............................................................................................................................. 94
M. FLEXOR HALLUCIS LONGUS ................................................................................................................................ 97
INTRINSIC FOOT MUSCLES ............................................................................................................................ 100
NORMAL FOOT MECHANICS DURING GAIT.............................................................................................................. 100
BASICS OF GAIT................................................................................................................................................... 101
PLANTAR FASCIITIS.............................................................................................................................................. 102
PERPETUATORS OF TRPS IN THE INTRINSIC FOOT MUSCLES ......................................................................................... 102
INTRINSIC FOOT MUSCLES ............................................................................................................................ 103
M. EXTENSOR DIGITORUM BREVIS & M. EXTENSOR HALLUCIS BREVIS ........................................................................ 103
M. ABDUCTOR HALLUCIS ..................................................................................................................................... 105
M. ABDUCTOR DIGITI MINIMI .............................................................................................................................. 107
M. FLEXOR DIGITORUM BREVIS ............................................................................................................................ 109
M. QUADRATUS PLANTAE (FLEXOR DIGITORUM ACCESSORIES) .................................................................................. 111
LUMBRICAL (FOOT) ............................................................................................................................................. 113
M. FLEXOR DIGITI MINIMI BREVIS......................................................................................................................... 114
M. FLEXOR HALLUCIS BREVIS................................................................................................................................ 115
M. ADDUCTOR HALLUCIS ..................................................................................................................................... 117
M. DORSAL INTEROSSEI (FOOT) ............................................................................................................................ 119
M. PLANTAR INTEROSSEI (FOOT) .......................................................................................................................... 120
KINESIOTAPING ............................................................................................................................................ 121
1. SENSORY RECEPTOR ACTIVATION ....................................................................................................................... 121
2. PROPRIOCEPTIVE SUPPORT ............................................................................................................................... 122
, Iliopsoas Major, Iliopsoas Minor and Iliacus
• The M. Psoas Major/ M. Iliopsoas is a combined name for three muscles.
1. M. Iliopsoas Major
2. M. Iliopsoas Minor
3. M. Iliacus
, M. Iliopsoas Major
• Psoas Major has several sites of abdominal attachment. Posteriorly, the attachments
are to the Anterior surfaces and lower border of the Transverse processes of all the
Lumbar Vertebrae.
- The upper four Lumbar Intervertebral Foramina bear important relation to these
attachments of the muscle.
- The Foramina lie Anterior to the Transverse processes (The Posterior attachments)
and Posterior to the vertebral bodies, disc and tendinous arches (Anterior
attachments).
Origin
- The muscle is arising from these attachments is referred to as the Posterior mass
- The muscle also has an Anterior mass. It consists of two different sets of
attachments.
- The first part gives slips of muscle attached to the bodies of two adjoining
Vertebrae and their Intervertebral disc (from the 12th Thoracic Vertebrae and the
Thoracolumbar Disc to the body of the 5th Lumbar Vertebrae)
- The second part is a series of Tendinous arches extending across the narrow parts
of the bodies of the five Lumbar Vertebrae between these slips.
Insertion
- The muscle travels down to insert in the Lesser Trochanter of the Femur.
Nerve supply
Lumbar plexus ventral rami L1 – L3 (Femoral and Lateral Femoral Cutaneous N. entrapment
possible as Iliopsoas Major tendon exits the Pelvis)
Actions
- Flexion and lateral rotation of the thigh
- Flexion of the upper Lumbar Vertebrae
- Extension of the lower Lumbar Vertebrae
Muscle test; Patient in supine position, flexes, externally rotates and abducts the straight
leg. Doctor pushes the leg down and out, whilst stabilizing the opposite side of the pelvis.
,Clinical Gems;
1. Suggestion that Iliopsoas Major TrP may be a factor in failed back surgery due to lack
of hip extension and altered gait
2. Unilateral TrP in Iliopsoas tend to feel ‘Low Back Pain’ that runs up and down the
spine. Bilateral TrPs tends to be felt across the back as in ‘Quadratus Lumborum’ and
Rectus Abdominis TrPs.
3. Iliopsoas TrPs do not cause pain on deep inspiration/coughing, QL TrPs do
4. TrPs in Psoas may be associated with spinal manipulable lesions around the Thoraco-
Lumbar junction
5. Patients with ‘Patello Femoral Pain’ should be asses for tight Iliopsoas Major (may be
part of clinical picture)
Trigger points referral (TrPs)
, M. Iliopsoas Minor
• Psoas Minor is often absent, but when present, lies Anterior to Psoas Major.
Origin
- Arises bodies of T12 & L1 and Disc
between them.
Insertion
- As a long flat tendon attached on
the Pectineal line, Iliopectineal
eminence and laterally to the Iliac
Fascia.
Nerve supply
Lumbar Plexus ventral rami L1
Actions
Flexion of the trunk
Muscle test
Same as Iliopsoas Major
Trigger point referral
Same as Iliopsoas Major
Clinical Gems;
- Travell & Simons report on a Psoas Minor Syndrome where an overly taught Psoas
Minor mimics appendicitis. A taught band is palpable on the right in the lower
Quadrant of the Abdomen, that produces the patient’s pain.
, M. Iliacus
• Is a Triangular sheet of
muscle. It reaches as far
as the Anterior Superior
and Anterior Inferior Iliac
Spines, received few
fibers from the upper part
of the capsule of the Hip
joint. Most of its fibers
converge in to the lateral
side of the strong Psoas
Major tendon.
Origin
- 2/3 of the concavity of
the Iliac Fossa
- Inner lip of the Iliac crest
- The Ventral Sacroiliac and Iliolumbar ligaments
- The upper surface of the Lateral part of the Sacrum
Insertion
Inserts in the Lesser Trochanter of the Femur
Nerve supply
Femoral N. L2-L3
Actions
Flexion and External rotation of the thigh
Muscle test
Same as Psoas Major
Trigger points referral; Same as Psoas Major
,Inhoudsopgave
ANATOMY MYOFASCIAL LOWER QUARTER WORKED OUT ............................................................................... 1
ILIOPSOAS MAJOR, ILIOPSOAS MINOR AND ILIACUS ........................................................................................ 4
M. ILIOPSOAS MAJOR ............................................................................................................................................. 5
M. ILIOPSOAS MINOR ............................................................................................................................................. 7
M. ILIACUS ............................................................................................................................................................ 8
THE M. LEVATOR ANI ....................................................................................................................................... 9
M. ISCHIOCOCCYGEUS ........................................................................................................................................... 10
M. ILIOCOCCYGEUS ............................................................................................................................................... 10
M. PUBOCOCCYGEUS ............................................................................................................................................ 10
M. GLUTEUS MAXIMUS .................................................................................................................................. 12
M. GLUTEUS MEDIUS AND M. GLUTEUS MINIMUS ......................................................................................... 15
M. GLUTEUS MEDIUS ‘LUMBAGO MUSCLE’ .............................................................................................................. 15
M. GLUTEUS MINIMUS ......................................................................................................................................... 18
M. TENSOR FASCIA LATAE...................................................................................................................................... 21
M. PIRIFORMIS .................................................................................................................................................... 23
SHORT LATERAL ROTATORS ........................................................................................................................... 25
M. OBTURATOR INTERNUS..................................................................................................................................... 26
M. OBTURATOR EXTERNUS .................................................................................................................................... 27
M. GEMELLUS INFERIOR ........................................................................................................................................ 28
M. GEMELLUS SUPERIOR ....................................................................................................................................... 28
M. QUADRATUS FEMORIS ...................................................................................................................................... 29
HAMSTRINGS ................................................................................................................................................. 30
HAMSTRING STRETCH ............................................................................................................................................ 30
M. BICEPS FEMORIS (LONG AND SHORT HEAD) .............................................................................................. 31
M. SEMIMEMBRANOSUS................................................................................................................................ 34
M. SEMITENDINOSUS ..................................................................................................................................... 37
M. SARTORIUS ............................................................................................................................................... 39
M. QUADRICEPS ............................................................................................................................................. 42
M. RECTUS FEMORIS............................................................................................................................................. 42
M. VASTUS LATERALIS ........................................................................................................................................... 44
M. VASTUS INTERMEDIUS ...................................................................................................................................... 47
M. VASTUS MEDIALIS ........................................................................................................................................... 49
VASTUS MEDIALIS OBLIQUE ................................................................................................................................... 51
ADDUCTOR MUSCLES ..................................................................................................................................... 52
M. PECTINEUS ..................................................................................................................................................... 52
FEMORAL TRIANGLE .............................................................................................................................................. 54
.......................................................................................................................................................................... 54
.......................................................................................................................................................................... 54
ADDUCTOR BREVIS ............................................................................................................................................... 55
M. ADDUCTOR LONGUS......................................................................................................................................... 57
M. ADDUCTOR MAGNUS ................................................................................................................................ 59
M. GRACILIS ........................................................................................................................................................ 62
ANTERIOR COMPARTMENT OF THE LEG ......................................................................................................... 64
, M. TIBIALIS ANTERIOR .......................................................................................................................................... 64
M. EXTENSOR DIGITORUM LONGUS......................................................................................................................... 67
M. EXTENSOR HALLUCIS LONGUS ............................................................................................................................ 70
M. FIBULARIS TERTIUS .......................................................................................................................................... 72
LATERAL AND SUPERFICIAL POSTERIOR COMPARTMENT ............................................................................... 74
M. FIBULARIS LONGUS (PERONEUS) ........................................................................................................................ 74
M. FIBULARIS BREVIS (PERONEUS) .......................................................................................................................... 77
M. GASTROCNEMIUS ............................................................................................................................................ 79
M. SOLEUS .......................................................................................................................................................... 82
M. PLANTARIS ..................................................................................................................................................... 85
DEEP POSTERIOR COMPARTMENT OF THE LEG .............................................................................................. 87
M. POPLITEUS...................................................................................................................................................... 87
M. TIBIALIS POSTERIOR ......................................................................................................................................... 90
M. FLEXOR DIGITORUM LONGUS............................................................................................................................. 94
M. FLEXOR HALLUCIS LONGUS ................................................................................................................................ 97
INTRINSIC FOOT MUSCLES ............................................................................................................................ 100
NORMAL FOOT MECHANICS DURING GAIT.............................................................................................................. 100
BASICS OF GAIT................................................................................................................................................... 101
PLANTAR FASCIITIS.............................................................................................................................................. 102
PERPETUATORS OF TRPS IN THE INTRINSIC FOOT MUSCLES ......................................................................................... 102
INTRINSIC FOOT MUSCLES ............................................................................................................................ 103
M. EXTENSOR DIGITORUM BREVIS & M. EXTENSOR HALLUCIS BREVIS ........................................................................ 103
M. ABDUCTOR HALLUCIS ..................................................................................................................................... 105
M. ABDUCTOR DIGITI MINIMI .............................................................................................................................. 107
M. FLEXOR DIGITORUM BREVIS ............................................................................................................................ 109
M. QUADRATUS PLANTAE (FLEXOR DIGITORUM ACCESSORIES) .................................................................................. 111
LUMBRICAL (FOOT) ............................................................................................................................................. 113
M. FLEXOR DIGITI MINIMI BREVIS......................................................................................................................... 114
M. FLEXOR HALLUCIS BREVIS................................................................................................................................ 115
M. ADDUCTOR HALLUCIS ..................................................................................................................................... 117
M. DORSAL INTEROSSEI (FOOT) ............................................................................................................................ 119
M. PLANTAR INTEROSSEI (FOOT) .......................................................................................................................... 120
KINESIOTAPING ............................................................................................................................................ 121
1. SENSORY RECEPTOR ACTIVATION ....................................................................................................................... 121
2. PROPRIOCEPTIVE SUPPORT ............................................................................................................................... 122
, Iliopsoas Major, Iliopsoas Minor and Iliacus
• The M. Psoas Major/ M. Iliopsoas is a combined name for three muscles.
1. M. Iliopsoas Major
2. M. Iliopsoas Minor
3. M. Iliacus
, M. Iliopsoas Major
• Psoas Major has several sites of abdominal attachment. Posteriorly, the attachments
are to the Anterior surfaces and lower border of the Transverse processes of all the
Lumbar Vertebrae.
- The upper four Lumbar Intervertebral Foramina bear important relation to these
attachments of the muscle.
- The Foramina lie Anterior to the Transverse processes (The Posterior attachments)
and Posterior to the vertebral bodies, disc and tendinous arches (Anterior
attachments).
Origin
- The muscle is arising from these attachments is referred to as the Posterior mass
- The muscle also has an Anterior mass. It consists of two different sets of
attachments.
- The first part gives slips of muscle attached to the bodies of two adjoining
Vertebrae and their Intervertebral disc (from the 12th Thoracic Vertebrae and the
Thoracolumbar Disc to the body of the 5th Lumbar Vertebrae)
- The second part is a series of Tendinous arches extending across the narrow parts
of the bodies of the five Lumbar Vertebrae between these slips.
Insertion
- The muscle travels down to insert in the Lesser Trochanter of the Femur.
Nerve supply
Lumbar plexus ventral rami L1 – L3 (Femoral and Lateral Femoral Cutaneous N. entrapment
possible as Iliopsoas Major tendon exits the Pelvis)
Actions
- Flexion and lateral rotation of the thigh
- Flexion of the upper Lumbar Vertebrae
- Extension of the lower Lumbar Vertebrae
Muscle test; Patient in supine position, flexes, externally rotates and abducts the straight
leg. Doctor pushes the leg down and out, whilst stabilizing the opposite side of the pelvis.
,Clinical Gems;
1. Suggestion that Iliopsoas Major TrP may be a factor in failed back surgery due to lack
of hip extension and altered gait
2. Unilateral TrP in Iliopsoas tend to feel ‘Low Back Pain’ that runs up and down the
spine. Bilateral TrPs tends to be felt across the back as in ‘Quadratus Lumborum’ and
Rectus Abdominis TrPs.
3. Iliopsoas TrPs do not cause pain on deep inspiration/coughing, QL TrPs do
4. TrPs in Psoas may be associated with spinal manipulable lesions around the Thoraco-
Lumbar junction
5. Patients with ‘Patello Femoral Pain’ should be asses for tight Iliopsoas Major (may be
part of clinical picture)
Trigger points referral (TrPs)
, M. Iliopsoas Minor
• Psoas Minor is often absent, but when present, lies Anterior to Psoas Major.
Origin
- Arises bodies of T12 & L1 and Disc
between them.
Insertion
- As a long flat tendon attached on
the Pectineal line, Iliopectineal
eminence and laterally to the Iliac
Fascia.
Nerve supply
Lumbar Plexus ventral rami L1
Actions
Flexion of the trunk
Muscle test
Same as Iliopsoas Major
Trigger point referral
Same as Iliopsoas Major
Clinical Gems;
- Travell & Simons report on a Psoas Minor Syndrome where an overly taught Psoas
Minor mimics appendicitis. A taught band is palpable on the right in the lower
Quadrant of the Abdomen, that produces the patient’s pain.
, M. Iliacus
• Is a Triangular sheet of
muscle. It reaches as far
as the Anterior Superior
and Anterior Inferior Iliac
Spines, received few
fibers from the upper part
of the capsule of the Hip
joint. Most of its fibers
converge in to the lateral
side of the strong Psoas
Major tendon.
Origin
- 2/3 of the concavity of
the Iliac Fossa
- Inner lip of the Iliac crest
- The Ventral Sacroiliac and Iliolumbar ligaments
- The upper surface of the Lateral part of the Sacrum
Insertion
Inserts in the Lesser Trochanter of the Femur
Nerve supply
Femoral N. L2-L3
Actions
Flexion and External rotation of the thigh
Muscle test
Same as Psoas Major
Trigger points referral; Same as Psoas Major
