LOWER EXTREMITYKINESIOLOGY
Prepared by
DENNIS N. MUÑOZ, RN, RM, PTRP, MANDENNIS N. MUÑOZ, RN, RM, PTRP, MAN
CHAPTER 7
The Hip Joint and Pelvic Girdle
Bones
Bones of the IlliumBones of the IschiumBones of the PubisBones of the SacrumBones of the CoccyxBones of the Femur
Lumbar Spine Movements
FlexionExtensionLateral FlexionLateral Rotation
Pelvic Movements
Anterior Rotation (sagital plane)Posterior Rotation (sagital planeLateral Rotation (frontal plane)Transverse Rotation (horizontal plane)
Hip Movements
FlexionExtensionAbductionAdduction Internal RotationExternal RotationCircumduction
Iliopsoas Muscle(composed of)
Iliacus and Psoas major and minor
Information
ORIGIN—iliacus inner surface of ilium. ORIGIN—psoas major and minor lower
borders of the transverse processes (L1-5), sides of the bodies of T12, the lumbar vertebrae (L1-5), intervertebral fibrocartilages, and base of sacrum.
INSERTION—Iliacus and psoas major lesser trochanter of the femur and shaft just below.
Information, cont.
INSERTION– psoas minor pectineal line and iliopectineal eminence.
3rd Class Lever– Axis (Hip joint)– Force (the muscle)– Resistance (the leg, in both movements)
Actions
Flexion of the Hip External Rotation of
the Hip
#2 is the Psoas #1 is the Iliacus
Palpation
Impossible to palpate except with almost complete relaxation of the rectus abdominis muscle.
Innervation
Lumbar nerve and femoral nerve (L2-4) from the Lumbar Plexus
This diagram shows the femoral nerve (in yellow with a red arrow) in relation to other muscles and veins.
Synergists
Synergists:– Flexion: Sartorius, Rectus femoris, Tensor
fasciae latae, Pectineus– External rotation: Sartorius, six deep lateral
rotator muscles, Gluteus medius, Gluteus maximus, Biceps femoris, Adductor magnus
Antagonists
Antagonists– Flexion (extension of the hip): Gluteus
maximus, Semitendinosus, Semimembranosus, Biceps femoris
– Ext. rotation (internal rotation of hip): Gluteus minimus, Gluteus medius, Semitendinosus, Semimembranosus, Pectineus
Strengthening Exercise and Stretches
The iliopsoas muscle is powerful in actions such as raising the legs from the floor while in the supine position.
The muscle may be strengthened by supporting the arms on a dip bar and then flexing the hips to lift the legs. To decrease resistance, flex the knees into a tucked position.
Stretching the Iliopsoas
The hip must be extended so that the femur is behind the plane of the body. Full knee flexion must be avoided. Slight additional stretch may be applied by internally rotating the hip while it is extended.
Exercises
Weighted Leg RaiseVertical Leg Raise
Hanging Leg Raise Lever Hip Flexion
Stretches
PNF
Self-stretch
Sports
RunningBaseball (stealing a base, pitching from the
“stretch”)GymnasticsBicycling
Gymnastics
Cycling
Baseball pitcher
Running
SartoriusSartorius
Origin- anterior
superior iliac spine and
notch just below the spine
Insertion- anterior medial condyle of the tibia
Sartorius
Palpation- easiest to palpate at the anterior superior spine of the ilium
Innervation- Femoral Nerve
Synergists Antagonists Hip flexion
– iliopsoas– pectineus– rectus femoris
Knee flexion– semitendinosus– semimembranosus– biceps femoris– gracilis– popliteus– gastrocnemius
External rotation of hip joint– iliopsoas– six deep lateral rotator muscles– gluteus medius & maximus– biceps femoris– adductor brevis & magnus
Hip flexion– gluteus maximus
– biceps femoris
– semitendinosus
– semimembranosus
– six deep external rotators Knee flexion
– rectus femoris
– vastus medialis, intermedius, & lateralis
External rotation of hip joint– gluteus minimus
– semitendinosus
– semimembranosus
– pectineus
– gracilis
Levers when resistance is on posterior side of ankle with
knee flexion– axis: knee joint
– force: anterior medial condyle of tibia
• 3rd Class Lever
when resistance is at the knee or thigh with hip flexion or external rotation– axis: hip joint
– force: anterior medial condyle of tibia
• 2nd Class Lever
Actions
Flexion of the hipFlexion of the kneeExternal rotation of the thigh as it flexes the
hip and the knee
Strengthening Exercises
Leg lifts (either tucked or straight legs)– support arms on parallel or dip bars and flex hips to lift
the legs Leg Curls
– in a supine position, flex knees to lift ankles Knee Raises
– lift resistance placed on anterior of the knee Sitting Exercise
– put ankle weight on externally rotate hip while flexing knee and hip to raise ankle superior to opposite knee
Leg Lifts Leg Curls
Knee Raises SittingExercise
Stretches
Hip Extension, Adduction, and Internal Rotation Have a partner passively
take your hip into – extreme extension
– extreme adduction
– extreme internal rotation
Sporting Activities
Ballet- pliesBaseball & Softball - steping of the plate to
catch a ballSwimming- breast stroke
RECTUS FEMORIS
QUADRICEPS
1) RECTUS FEMORIS
2) VASTUS LATERALIS
3) VASTUS INTERMEDIUS
4) VASTUS MEDIALIS
ORIGINAnterior inferior iliac spine of the ilium and
groove (posterior) above the acetabulum
INSERTIONSuperior aspect of the patella and patellar
tendon to the tibial tuberosity
CLASS LEVERThird Class Lever Axis = hip joint/knee joint Force = insertion (patella) Resistance = weight at
feet (squat, leg press, etc.) or mid-shin (knee extension
Second Class Lever
Axis = hip joint Force = insertion
(patella) Resistance = mid-
thigh/quad (hip flexion)
DOES WHAT?
ACTIONFlexion of the hipExtension of the knee
APPLICATIONSYNERGISTS
SartoriusTensor Fascia LataeVastus LateralisVastus MediusVastus Intermedius
ANTAGONISTSHamstringsGluteus
Maximus
PALPATIONINNERVATION
Femoral nerveL2L3L4
PALPATIONAny place on the
anterior surface of the femur
EXERCISES Leg press Lunge Leg Extension Step-up Squat
Front Squat Full Squat Hack Squat Safety Squat
LEG PRESS
SQUATS
LUNGE
STEP-UP
HIP FLEXION
PLYOMETRICSBOX JUMPS
STRETCHESLying quad stretchStanding quad stretchSquat quad stretchLunge stretch
KNEE BACK
SITTING SQUAT
LUNGE STRETCH
SPORTING ACTIVITIES
Volleyball (jumping and digging)Baseball/Softball Catchers (positional
stance)Basketball (jumping)Track (Running, Long and High Jump)Soccer (kicking the ball)
TensorFasciaeLatae
Tensor fasciae latae
Origin
-Anterior iliac crest and surface
of the ilium just below the crest
Tensor fasciae latae
Insertion
-1/4th of the way down the thigh into the illotibal tract, which in turn inserts onto Gerdy’s tubercle of the anterolateral tibal condyle
Tensor fasciae latae
Action
-Abduction of the hip
-Flexion of the hip
-Tendency to rotate the hip internally as it flexes
Tensor fasciae latae
Synergists (Flexion of the Hip)-Rectus femoris-Sartorious-Ilipsoas
Synergist (Abduction of the Hip)-Gluteus Minimus-Gluteus Medius
Tensor fasciae latae
Antagonist (Extension of the Hip)
-Gluteus Maximus
-Semitendinosus
-Semimembranosus
-Biceps Femoris
Tensor fasciae latae
Antagonist (Adduction of the hip)
-Adductor brevis
-Adductor longus
-Adductor magnus
-Pectineus
Levers (Second class lever)Axis is at the origin on the ilium
Resistance is on the thigh
Force is at the insertion point
(Third class lever)Axis is at the origin on the ilium
Force is at the insertion point
Resistance is at the feet
Tensor fasciae latae
Tensor fasciae latae
Palpation
-Slightly in front of the greater trochanter
Innervation
-Superior gluteal nerve (L4-5, S1)
Tensor fasciae lataeExercises
-Abduction of the hip-Cable hip abduction-Lever standing hip abduction
-Flexion of the hip-Lever hip flexion-Cable lying leg raise
-Cable leg raise
Cable Hip Abduction
Standing Lever Hip Abduction
Lever Hip Flexion
Cable Lying Leg Raise
Cable Leg Raise
StretchesStanding Ibiotibal Stretch
StretchesWall Ibiotibal Stretch
Sports
Basketball-Defensive slide (Abduction of hip)-lay-up (Flexion of hip)
Soccer-Juggling a ball (Flexion of the hip)
Baseball-windup of a pitcher (Flexion and Abduction)
The Six Deep Lateral Rotator Muscles
Piriformis Gemellus superior Gemellus inferior Obturator externus Obturator internus Quadratus femoris
Origin
Anterior sacrum
Posterior portions of the ischium
Obturator foramen
Insertion
Superior and posterior aspect of the greater trochanter
Nerve Innervation
Piriformis– 1st or 2nd sacral nerve
Gemellus superior– sacral nerve (L5-S2)
Gemellus inferior– branches from sacral
plexus (L4-S2)
Obturator exernus– obturator nerve (L3-4)
Obturator internus– branches from sacral
plexus (L4-S2)
Quadratus femoris– branches from sacral
plexus (L4-S1)
Palpation
Action/Lever
External rotation of the hip
3rd class Lever– Axis = hip– Force = insertion– Resistance = leg
Synergists
Iliopsoas
Sartorius
Gluteus medius – posterior fibers
Gluteus maximus
Biceps femoris
Adductor brevis
Adductor mangus
Antagonists
Tensor fasciae latae
Gluteus minimus
Gluteus medius– anterior fibers
Semitendinosus
Semimembranosus
Pectineus
Gracilis
Exercises
Using a theraband– keep one foot planted on the ground while
forcefully turning the body and the opposite leg away from the planted foot.
Exercises
Exercises
Using a theraband– Attach one end of the theraband to a foot– Use theraband as resistance as you externally
rotate the hip
Exercises
Stretches
While standing, maximally internally rotate the hip while rotating the torso in an opposite direction
While lying on your back, bend at the knee and adduct one leg while a partner slightly raises your foot (to internally rotate the hip)
Stretches
Applications
Baseball– batting
– pitching
Basketball– pivoting
Dance
Track & Field– discus
– shotput
Applications
Applications
gluteus minimus
gluteus minimus
Origin– Lateral surface of the ilium just below the
origin of the gluteus medius
gluteus minimus
Insertion– Anterior surface of the greater trochanter of the
femur
gluteus minimus
Innervation– Superior gluteal nerve (L4-5, S1)
gluteus minimus
Unable to be palpated– Lies deep to gluteus medius & maximus
gluteus minimus
Lever Class– Third class lever
gluteus minimus
Actions– Abduction of the hip– Internal rotation as the femur abducts
gluteus minimus
Synergists– Abduction
• Tensor fasciae latae
• Gluteus medius
gluteus minimus
Synergists– Internal rotation
• Gluteus medius (anterior fibers)
• Semitendinosus
• Semimembranosuspectineus
• Gracilis
gluteus minimus
Antagonists– Adduction
• Gluteus maximus (lower fibers)
• Adductor brevis, longus, and magnus
• Pectineus
• Gracilis
gluteus minimus
Antagonists – External rotation
• Iliopsoas• Sartorius• Gluteus medius & maximus• Biceps femoris• Adductor brevis & magnus
– Piriformis, gemellus superior & inferior, obturator externus & internus, quadratus femoris
• Six deep external rotators
gluteus minimus
Strengthening exercises
gluteus minimus
gluteus minimus
Stretches– Extreme hip adduction with slight external
rotation
gluteus minimus
Sporting activities– Running, skipping– Activity involving weight transition from one
foot to the other
GLUTEUS MEDIUS
GLUTEUS MEDIUS
ORIGIN– Lateral surface of the ilium just
below the crest.INSERTION
– Posterior and middle surfaces of the greater trochanter of the femur
GLUTEUS MEDIUS
Actions– Abduction of the hip
– External Rotation of the hip as it abducts (posterior fibers)
– Internal rotation of the hip
GLUTEUS MEDIUS
Palpation– above the greater trochanter
Innervation– superior gluteal nerve (L4-S1)
Lever– third class lever
GLUTEUS MEDIUS
Synergists– Gluteus minimus (hip abduction)
– Tensor fascia latae (hip abduction)
– Gluteus maximus (hip external rotation)
– 6 deep lateral rotators (hip external rotation)
– Biceps
– Gluteus minimus (hip internal rotation)
– Semitendonosis (hip internal rotation)
– Semimembranosus (hip internal rotation)
GLUTEUS MEDIUS
Antagonists– Adductors (adduction)– Biceps femoris (external rotation)– Gluteus Maximus (external rotation)– 6 deep lateral rotators (external rotation)– Semitendonosis (internal rotation)– Semimembranosus (internal rotation)
GLUTEUS MEDIUS
Exercises– Hip Abduction machine– Lateral lunges– Lateral step ups– Squats etc.
External Rotation Exercise
Externally rotate the leg against resistance.
Hip Abduction Machine
Abduction of the hip against resistance
GLUTEUS MEDIUS
Stretches– The hip should be placed in extreme adduction
in front of the opposite leg with the foot internally rotated (posterior fibers).
– The hip should be placed in extreme adduction behind the opposite leg with the foot
externally rotated (anterior fibers).
Gluteus Medius Stretch
With the involved leg adducted in front or behind the opposite leg, lean the opposite direction
Application
Trendelenburgs TestPush Off from a base or pitching rubberGluteus medius is also a great stabilizer of
the hip for proprioception (balance) of the leg during any exercise
Slide step in baskeballPush off in the shot put
Application
Application
GLUTEUS MAXIMUS
ORIGIN Posterior one-fourth of
the crest of the ilium Posterior surface of
the sacrum and coccyx near the ilium, and fascia of the lumbar area
Oblique ridge on the lateral surface of the greater trochanter and the iliotibial band of the fasciae latae
INSERTION
ACTIONSExtension of the hipExternal rotation of the hipLower fibers-assist is adduction
Nerve InnervationInferior gluteal nerve (L5, S1-2)
PalpationWide area on the posterior surface of the pelvis
ExtensionSemitendinosusSemimembranosusBiceps femoris
External RotationPiriformis
Gemellus superior
Gemellus inferior
Obturator externus
Obturator internus
Quadratus femoris
Gluteus Medius
Adductor brevis
Synergists
AntagonistExtensionRectus femoris
Iliopsoas
Sartorius
Tensor faciae latae
Pectineus
External RotationSemitendinosus
Semimembranosus
Pectineus
Gracilis
Lever3rd classAxis - Hip JointForce - Oblique ridge on the lateral surface
of the greater trochanter and the iliotibial band of the fasciae latae
Resistance – at foot, or leg
Streches– Lie on floor or mat.
Bend knees with feet on floor. Cross lower leg over thigh of other leg. Grasp back of thigh of lower leg with both hands.
– Pull leg toward torso. Hold stretch for 20 seconds. Repeat with opposite leg.
Lying Glute Stretch
~Sit on chair or bench and cross lower leg over thigh of opposite leg. Place hand on top of inside of knee.
~Lean forward. Hold stretch for 20 seconds. Repeat with opposite leg.
Seated Glute Stretch
ExercisesSafety Barbell Squat
From a rack with safety barbell at upper chest height, position bar over the shoulders. Dismount bar from rack.
Grasp rack while descending until thighs are just past parallel to floor. Stand with the assistance of the arms, extending knees and hips until legs are straight. Repeat.
Barbell Deadlift
– With feet flat beneath bar squat down and grasp bar with a shoulder width or slightly wider over hand or mixed grip.
– Lift bar by extending hips and knees to full extension. Pull shoulders back at top of lift if rounded. Return and repeat.
Dumbbell Lunge
– Stand with dumbbells grasped to sides. – Lunge forward with first leg. Land on heal then
forefoot. Lower body by flexing knee and hip of front leg until knee of rear leg is almost in contact with floor. Return to original standing position by forcibly extending the hip and knee of the forward leg. Repeat by alternating lunge with opposite leg.
Sports
BaseballTrack- running, jumpingHopping SkippingGymnastics
Semitendinosus
Origin and Insertion
O, Ischial Tuberosity
I, Upper anterior medial surface of the tibia
Actions
Extension of the hip Flexion of the knee Internal rotation of the hip Internal rotation of the knee
Innervation
This muscle is innervated by the sciatic nerve-the tibial division(L5, S1-2)
Lever Class
This is an example of a third-class lever• A-the knee joint
• R-the posterior side of the lower leg and/or foot
• F-the insertion point
Synergist Muscles
Semimembranosus Gracilis Sartorius
Antagonists
Rectus Abdominus Obliques Iliopsoas Tibialis Anterior
Strengthening Exercises
Sitting Leg Curls Lying Leg Curls Dead-Lifts
Lying Leg Curl
Seated Leg Curl
Dead-Lift
Stretches
Common hamstring stretches also stretch the semitendinosus. To stretch it maximally, extend the knee while flexing the externally rotated and slightly abducted hip.
Sports
TrackBasketballFootball Jumping and Running Sports
Semimembranosus
Origin
Ischial tuberosity
Insertion
Posteromedial surface of the medial tibial condyle
Innervation
Sciatic Nerve – tibial division (L5, S1-2)
Palpation
Covered by other musclesTendon can be felt on the medial side of the
posterior aspect of the tibia
Actions
Extension of the hipFlexion of the knee Internal rotation of the hip Internal rotation of the knee
Levers
Third class lever for knee flexion and hip extension
Axis – knee joint or hip jointResistance – weight of the lower legForce – insertion of muscle at the medial
condyle of the tibia
Antagonists
Flexion of the hip – Iliopsoas, Sartorius, Rectus Femoris, Tensor fasciae latae, Pectineus
Extension of the knee – Quadriceps musclesExternal rotation – Iliopsoas, sartorius, deep
lateral rotator muscles, biceps femoris, gluteus maximus
Synergists
Extension of the hip – Gluteus maximus, Semitendinosus, Biceps femoris
Flexion of the knee – Sartorius, Semitendinosus, Biceps femoris, Gracilis, Popliteus
Internal rotation – Popliteus, Semitendinosus, Gluteus medius, Pectineus, Gracilis
Prone Leg Curl
Seated Leg Curl
Straight Leg Deadlift
Lying Single Leg Stretch
Standing Hamstring Stretch
Activities
All exercises involving runningPreparatory phase for kicking a soccer ball
or football Jumping – long jump, triple jumpHeel pass in soccer
Biceps Femoris
Origin/Insertion
Origin of short head: lower half of linea aspera and lateral condyloid ridge
Origin of the long head: ischial tuberosity
Insertion for both heads: lateral condyle of the tibia and head of fibula
Palpation
Lateral posterior side of the femur, near the knee
Innervation
Actions
Extension of the hipFlexion of the kneeExternal rotation of the hipExternal rotation of the knee
Synergists
HIP EXTENSION:
Gluteus Maximus
Semimembranosus
Semitendinosus
Lateral Rotators
HIP EXTERNAL ROTATION:
Gluteus Maximus
Posterior fibers of Gluteus medius
Adductor Magnus
Adductor Brevis
Lateral Rotators
Sartorius
Iliopsoas
Synergists
KNEE FLEXION:
Sartorius
Semitendinosus
Semimembranosus
Gracilis
EXTERNAL ROTATION OF THE KNEE:
Iliopsoas (femur)
Sartorius (thigh)
Antagonists
HIP EXTENSION:
Iliopsoas
Pectineus
Rectus femoris
Sartorius
Tensor Fascia Latae
HIP EXTERNAL ROTATION:
Anterior fibers of Gluteus medius
Gluteus minimus
Semimembranosus
Semitendinosus
Gracilis
Pectineus
Antagonists
KNEE FLEXION:
Rectus femoris
EXTERNAL ROTATION OF KNEE:
Semimembranosus
Semitendinosus
How to Stretch the Biceps Femoris
Stand while adducting the hip slightly, bend down, and reach as far as possible. This is the best known stretch for the Biceps Femoris
How to stretchthe Biceps Femoris
With the help of a partner, hold opposite leg down on the ground,and push the leg being stretched as far as it can go, keeping the knee straight
How to stretchthe Biceps Femoris
PNF STRETCHING
CONTRACT-RELAX : Begins with passive stretch of the hamstrings held at the point of mild discomfort for 10 seconds. The athlete extends the hip against resistance from partner so a concentric muscle contraction occurs, for about 6 seconds. The athlete then relaxes and the leg is pushed slightly farther in passive hip flexion, and held for 30 seconds.
HOLD/RELAX/AGONIST CONTRACTION: Same as contract/relax method, only during the passive flexion the agonists (the quadriceps) are contracted.
How does PNF work?
Facilitation of Autogenic and Reciprocal Inhibition….
Autogenic Inhibition: actively contracting a muscle immediately before a passive stretch of that same muscle. Tension built up during the contraction stimulates the Golgi Tendon Organs, causing a reflexive relaxation of the muscle during the passive stretch.
Reciprocal Inhibition: Simultaneous contracting of the muscle opposing the muscle being stretched. Tension in the contracting muscle stimulates GTO and causes simultaneous reflexive relaxation of the stretched muscle.
Strengthening the Biceps Femoris
Straight Leg Dead Lift:
With the knees in slight flexion, you lower your body down, causing an eccentric contraction of the hamstrings, and when coming back up, concentrically contracting them.
Strengthening the Biceps Femoris
Hip Extension Machine: With the use of this specific machine, the knees are in flexion and the objective is to extend the hips
In most weight rooms you will find a standing 4-way hip machine, in which you place the resistance at about thigh level and extend the leg backwards
Strengthening the Biceps Femoris
Supine leg curls/knee flexion
Strengthening the Biceps Femoris
Squats: Going down, as with the dead lift, you are eccentrically contracting the hamstrings, while going up you are concentrically contracting them
Strengthening the Biceps Femoris
Hip Extension using a ball
start
finish
Strengthening the Biceps Femoris
Prone Leg Curl: Notice that the feet are turned in slightly . To maximize the workout for the Biceps Femoris you would turn the feet outward (external rotation of the knee).
What Lever is it?
F: Lateral condyle of the tibia and head of fibula
R: At the thigh in hip extension
A: Hip
SECOND CLASS LEVER
F: Lateral condyle of the tibia and head of fibula
A: Knee
R: At the ankles in knee flexion/leg curls
THIRD CLASS LEVER
Sports that utilize theBiceps Femoris
JUST ABOUT ALL OF THEM!!!
Any sport that involves running, kicking, jumping, skipping or hopping is using the Biceps Femoris. This can range from basketball to volleyball, soccer to track and field, and so on….
Adductor Brevis
Create muscles of the inner thigh with adductor longus and adductor magnus
Origin
Front of the inferior pubic ramus just below the origin of the adductor longus
Insertion
Lower two-thirds of the pectineal line of the femur and the upper half of the medial lip of the linea aspera
Nerve Innervation
Obturator nerve (L3-4)– Largest nerve formed from anterior divisions of
lumbar plexus
Palpation
Cannot be palpatedDeep to adductor longus
Action
Adduction of the hip External rotation as it
adducts the hip– As when one crosses
their legs while seated
Synergists
Hip Adductors– Adductor longus (2)– Adductor magnus (3)– Lower fibers of gluteus maximus– Gracilis– Pectineus
External Rotators of the Hip– Adductor magnus– Iliopsoas– Sartorius– 6 deep lateral rotator muscles– Gluteus maximus– Biceps femoris
Antagonists
Hip Abductors– Tensor fasciae latae– Gluteus minimus– Gluteus medius
Internal Rotators of the hip– Tensor fasciae latae– Gluteus minimus– Gluteus medius– Semitendinosus– Semimembranosus– Pectineus– Gracilis
Lever
Third class lever– Axis= hip joint (acetabular femoral joint)
– Force= insertion on lower two-thirds of the pectineal line of the femur and the upper half of the medial lip of the linea aspera
– Resistance= weight of leg, resistence on ankle or lower thigh
Exercises
Cable hip adductionSeated Hip adductionStanding hip adductionWeighted Leg Cross
– Ankle weight resistance, cross leg to maximize both adduction and external rotation
Cable Hip Adduction
Seated Hip Adduction
Standing Hip Adduction
Stretches
Kneeling Groin Lying Groin Lying Wall Groin Seated Groin Side Lunge Squatting Groin
Kneeling Groin
Seated Groin
Lying Groin
Lying Wall Groin
Side Lunge
Squatting Groin
Sports
Swim– Elementary back stroke– Breast stroke
Ballet/DanceBaseball pitching motion
Elementary Back Stroke
Breast Stroke
BalletBaseball
ADDUCTOR LONGUS
Nerve Innervation
Obturator nerve (L3-4)
Origin Insertion
Anterior pubis just below its crest
Middle third of the linea aspera
3rd Class Lever
Axis: Hip JointForce: Insertion at linea asperaResistance: Weight at medial side of knee
or leg.
Palpation
Just below the pubic bone on the medial side.
Actions
Adduction of the hip and assists in flexion of the hip.
Antagonist Synergist
Gluteus medius Gluteus minimus Tensor fasciae latae
Adductor brevis Adductor magnus Pectineus Gracilis
Exercises
Leg scissors: Legs are abducted when weight or manual resistance is applied against the medial side of the leg, resisting abduction.
Stretches
Slide left or right: Legs are wider than shoulder length apart then you slowly slide down abducting one leg.
Sporting Activities
Baseball: pitching, base running, ect.Basketball: defenseTennis
Pectineus Muscle
Pectineus Muscle
Origin– Space 1 inch wide on the front of the pubis just
above the crest. Insertion
– Rough line leading from the lesser trochanter down to the linea aspera.
Innervation– Femoral nerve (L2-4)
Pectineus Muscle
Palpation– Angle between the pubic bone and the femur
(hard to distinguish between adductor longus muscle.)
3rd Class Lever
Pectineus Muscle
Actions– Flexion of the hip– Adduction of the hip– Internal rotation of the hip
Pectineus
Synergists– Gracilis
– Adductor longus
– Adductor Brevis
– Adductor Magnus
Antagonists– Gluteus Medius
– Gluteus Minimus
– Tensor Fasciae Latae
Strengthening Exercises
Cable hip adduction Seated adduction
Stretching Exercises
Seated Groin Stretch Side Lunge
Applications
Soccer Basketball
Gracilis
Actions
Adduction of the hip Flexion of the knee Internal rotation of the
hip
Origin and Insertion
Origin: Anteromedial edge of the descending ramus of the pubis
Insertion: Anterior medial surface of the tibia below the condyle
Innervation & Palpation
Innervation: Obturator nerve (L2-4)
Palpation: Medial side of the thigh 2 to 3 inches below the pubic bone
Levers
2nd class lever:
Axis = hip joint
Resistance = inner thigh
Force = insertion at tibia 3rd class lever:
Axis = hip joint
Force = insertion at tibia
Resistance = at ankles
Synergists
For knee flexion: sartorius, semitendinosus, semimembranosus, biceps femoris, popliteus
For internal hip rotation: gluteus minimus, gluteus medius (anterior), semitendinosus, semimembranosus, pectineus, tensor fasciae latae
For adduction: gluteus maximus (lower), adductor brevis, adductor longus, adductor magnus, pectineus
Antagonists
Knee extension: quads (rectus femoris, vastus intermedius, vastus lateralis, vastus medialis)
External hip rotation: sartorius, 6 deep lateral rotators, gluteus medius (posterior), gluteus maximus, biceps femoris, adductor brevis, adductor magnus
Abduction: gluteus minimus, gluteus medius, tensor fasciae latae
Strengthening
Cable hip adductionSeated hip adductionStanding hip adduction
Cable Hip Adduction
Seated Hip Adduction*
* Knee could also be extended!
Standing Hip Adduction
Stretches
Lying groinLying wall groinSeated groin (a.k.a. butterfly)Side lungeSquatting groin
Lying Groin
Lying Wall Groin
Butterfly
Side Lunge
Squatting Groin
Sports & Activities
Horseback ridingBreaststroke kick in swimmingBasketball – defensive slidesSoccer – kickingRunning
KINESIOLOGYPOPLITEUS MUSCLE
11/08/01
POPLITEUS MUSCLE
ORIGIN– posterior surface of
the lateral condyle of the femur
•Insertion
–upper posterior medial surface of the tibia
CLASS LEVER3RD CLASS LEVER
– AXIS = knee joint
– FORCE = insertion (upper posterior medial surface of the tibia)
– RESISTANCE = weight on lower leg when performing flexion and internal rotation
CHARACTERISTICS
ACTIONS– flexion of the knee– internal rotation of the knee
*PALPATION– cannot be palpated
~INNERVATION– tibial nerve (L5, S1)
POPLITEUS PICTURES
EXERCISESLEG CURLSBAR HANGS WITH KNEE FLEXEDLEG CURLS WITH ANKLE WEIGHTS INTERNAL ROTATION WITH ANKLE
WEIGHTS (move leg from neutral to internal and back)
LEG CURLS
BAR HANGS
STRETCHESPassive full knee extension without
flexing the hip
Passive maximum external rotation with the knee flexed approximately 20 to 30 degrees
KNEE EXTENSION
KNEE FLEXED 20-30 DEGREES WITH FULL EXTERNAL ROTATION
SPORTING ACTIVITIES
Gymnastics = pointing the toes internally rotates the knee
Ballet = turns and positions Divers = internal rotation in dives Any sports with running, walking, and jumping Track = form running (butt kicks, grapevines, etc.)
APPLICATIONSOnly true flexor of the leg at the knee
Provides posterolateral stability to the knee
Assists the medial hamstrings in internal rotation of the lower leg at the knee
Vastus Lateralis (externus)
Largest of the quadricep muscle group
Vertical jump is easiest test to indicate strength and power of the quads
Vastus Lateralis Insertion
– Lateral border of the patella and patellar tendon to the tibial tuberosity
Origin– Intertrochanteric line, anterior and inferior borders of
the greater trochanter, gluteal tuberosity, upper half of the linea aspera and the entire lateral intermuscular septum
Vastus Lateralis Muscle location relates to muscle function Antagonists – Posterior with knee flexion
– Biceps femoris
– Semimembranosus
– Semitendonosus
– Sartorius
– Gracilis
– Popliteus
– Gastrocnemius
Synergists – Anterior with knee extension– Rectus femoris
– Vastus medialis
– Vastus intermedius
Vastus Lateralis
Palpation – Anterior lateral aspect of the thigh
With it’s location…….– Slightly superior lateral pull on the patella– Blamed for common lateral patellar dislocation
Vastus Lateralis
1st class lever
Innervation– Femoral nerve (L2-4)– Arterial supply from lateral femoral artery
Vastus Lateralis
All of the vasti muscles function in knee extension with the rectus femoris
All are used in walking and running while keeping the knee straight.– So almost every sport uses this muscle group
Vastus Lateralis
Strengthened through knee extension against resistance
Vastus Lateralis
Stretching occurs by maximally flexing the knee by pulling the heel to the glutes
Vastus Intermedius
Quadriceps Group
Information
Origin—Upper two-thirds of the anterior surface of the femur.
Insertion—Upper border of the patella and patellar tendon to the tibial tuberosity.
Lever—1st Class (Force=muscle, Axis=knee, Resistance=weight at ankles)
Action—Extension of the knee. Also aids in keeping the patella in place.
Relation to other muscles
The vasti muscles are used primarily when the hip is flexed.
The vastus intermedius is in between the medius and lateralis and deep to the rectus femoris.
Innervation and blood supply
Innervated by the Femoral Nerve (#2)
Arterial supply—from the Lateral circumflex femoral artery
The knee joint
QT = Quadriceps TendonP = Patella PT = Patella Tendon
tibia
femur
SynergistsRectus femoris, vastus
medialis, vastus lateralis (1-rectus femoris, 2-vastus
lateralis, 3-vastus intermedius (deep), 4-vastus medialis)
AntagonistsHamstrings—Biceps
femoris, semimembranosus, semitendinosus
Popliteus
Palpation
Cannot be palpated; deep to the rectus femoris.
Sports
Running Football Soccer Baseball Rugby Walking Swimming Diving
Tennis Lacrosse Rowing Track Basketball Volleyball Gymnastics Anything with knee
extension!!
StretchesProne quad stretch
Standing quad stretch
Exercises
SquatsLungesSeated knee extension (best)
Squat
Lunge
Front View Side View
Seated Knee Extension
Gastrocnemius
Gastrocnemius
OriginMedial Head: posterior surface of the medial femoral condyleLateral Head: posterior surface of the lateral femoral condyle
InsertionPosterior surface of the calcaneus (Achilles tendon)
Gastrocnemius
Palpation
- Upper posterior aspect of the lower leg
-Easiest muscle in the lower extremity to palpate
Gastrocnemius
Second Class LeverAxis-ball of the footResistance-body weight at the tibal articulationForce-at the insertion point (achilles tendon)
Gastrocnemius
Action
-Plantar flexion of the ankle
-Flexion of the knee
Innervation
-Tibial Nerve ( S1, 2)
Gastrocnemius
Synergist
(Plantar Flexion)
-Soleus
-Peroneus longus
-Peroneus brevis
-Tibialis posterior
Antagonist (Plantar Flexion)
-Peroneus teritius
-Extensor digitorum longus
-Tibialis anterior
Gastrocnemius
Synergist
(Knee Flexion)-Popliteus
-Gracilis
-Hamstring Muscles
Antagonist(Knee Flexion)
-Rectus femoris-Vastus lateralis-Vastus intermedius-Vastus medialis
Gastrocnemius
Exercises
-Barbell standing calf raise
-Dumbbell single leg calf raise
-Calf press
-Donkey calf raise
-Sled lying calf press
Barbell Standing Calf Raise
Dumbbell Single Leg Calf Raise
Calf Press
Donkey Calf Raise
Sled Lying Calf Press
Gastrocnemius
Stretches
-Floor board straight calf stretch
-Step straight calf stretch
-Wall straight calf stretch
Floor Board Straight Calf Stretch
Step Straight Calf Stretch
Wall Straight Calf Stretch
Gastrocnemius
Sports & Activities
-Running
-Basketball (Free throw)
-Jump Rope
-Volleyball
SOLEUS
Soleus
Origin– Posterior surface of the
proximal fibula and proximal 2/3 of the posterior tibial surface
Insertion– Posterior surface of the
calcaneus (Achilles tendon)
Soleus
Nerve innervation– Tibial nerve (S1-2)
Palpation– Posteriorly under the
gastrocnemius muscle on the lateral side of the lower leg
Soleus
Action– Plantar flexion of ankle
Lever– 3rd class lever
• Axis = ankle
• Resistance = weight at foot or dispersed to foot
• Force = insertion (posterior calcaneus)
Soleus
Synergists– Gastrocnemius
– Peroneus longus
– Peroneus brevis
– Tibialis posterior
– Flexor digitorum longus
– Flexor hallucis longus
Antagonists– Peroneus tertius
– Extensor digitorum longus
– Extensor hallucis longus
– Tibialis anterior
Soleus
ExercisesLever Standing Calf Raise
• Place shoulders under padded lever. Position toes and balls of feet on calf block with arches and heels extending off. Grasp handles or sides of padded lever. Stand erect by extending hips and knees.
• Raise heels by extending ankles as high as possible. Lower heels by bending ankles until calves are stretched.
Soleus
Soleus
Dumbbell standing calf raise– Grasp dumbbells with both hands at sides.
Stand at the edge of box with balls of feet on the box and arch and heel off.
– Raise heels by extending ankles as high as possible. Lower heels by bending ankles until calves are stretched.
Soleus
Soleus
Seated calf raise (best exercise)• Sit at machine with knees under the lever. Place
toes and ball of foot on the bar below the lever, leaving the arch and heel hanging over the edge.
• Lower heels by bending ankles until calves are stretched. Raise heels by extending ankles as high as possible.
Soleus
Soleus
Weighted donkey calf raise• Place toes and balls of feet on calf block with arches
and heels extending off. With arms on supports, bend over at hips with torso parallel to floor. Straighten knees. Allow training partner to mount hips or lower back from bench.
• Raise heels by extending ankles as high as possible. Lower heels by bending ankles until calves are stretched.
Soleus
Soleus
StretchesFloor board bent knee
– Face wall with both knees slightly bent. Position fore foot on wall with heel on floor.
– Straighten knee of rear leg and lean body toward wall. Hold stretch for 20 seconds. Repeat with opposite leg.
Soleus
Soleus
Wall bent knee– Place both hands on wall with arms extended. Lean
against wall with one leg bent forward and the other leg extended back. Bend rear knee slightly, positioned foot directly forward, and place heal to floor.
– Lower knee until just before heel raises. Hold stretch for 20 seconds. Repeat with opposite leg.
Soleus
Soleus
Step straight leg– Position toes and balls of feet on stair step or
calf block with arches and heels extending off.
– With knees straight, shift body weight to one foot. Hold stretch for 20 seconds. Repeat with opposite leg.
Soleus
Soleus
ApplicationAny sport that involves
walking/running/jumping– Track and field– Baseball/Softball– Tennis– Gymnastics– Diving
Soleus
Soleus
Plantaris Muscle
Plantaris Muscle
Origin-Lateral supracondylar line of distal
femur (above the lateral head of the gastrocnemius)
Insertion-Middle 1/3 of the posterior calcaneal
surface, medial to the Achilles tendon
Plantaris Muscle
First class Lever
Resistance- on the ball of the foot
Axis- top of the ankle
Force- at the insertion point, on the Achilles tendon
Plantaris Muscle
Innervation
-Tibial nerve (L5, S1, S2)
Action
-Plantar flexion of ankle
-Weak flexion of the knee
Plantaris Muscle
Synergists
(Plantar Flexion)
-Gastrocnemius
-Soleus
-Peroneus longus
-Peroneus brevis
-Tibialis Posterior
Antagonist
(Dorsal Flexion)
-Peroneus teritus
-Extensor digitorum longus
-Tibialis anterior
Plantaris Muscle
Synergists
(Knee Flexion)
-Gastrocnemius
-Popliteus
-Gracilis
-Hamstring Muscles
Antagonist
(Knee Extension)
-Rectus Femoris
-Vastus Laterialis
-Vastus Intermedius
-Vastus medialis
Plantaris Muscle
Exercises
-Barbell Standing Calf Raise
-Dumbbell Single Calf Raise
-Lever Seated Calf Extension
-Lever Standing Calf Raise
Barbell Standing Calf Raise
Dumbbell Single Leg Calf Raise
Lever Seated Calf Extension
Lever Standing Calf Raise
Plantaris Muscle
Stretches
-Floor Board Calf Stretch
-Calf Step Stretch
-Wall Stretch
Floor Board Calf Stretch
Calf Step Stretch
Wall Stretch
Plantaris Muscle
Sports & Activities
-Jumping
-Running
-Basketball
-Jump Rope
-Volleyball
Peroneus Longus
Peroneus Longus
Origin– Head and upper two-thirds of the lateral surface
of the fibula
Peroneus Longus
Insertion– Undersurfaces of the medial cuneiform and first
metatarsal bones
Peroneus Longus
Innervation– Superficial peroneal nerve (L4-5, S1)
Peroneus Longus
Third-class lever– Axis- ankle joint (talocrural joint)– Force- insertion point at the medial cuneiform
and first metatarsal– Resistance- the resistance of the ground or
object foot is against
Peroneus Longus
Palpation– Upper lateral side of the tibia, just
posterolateral from the tibialis anterior and the extensor digitorum longus
Peroneus Longus
Actions– Eversion of the foot– Plantar flexion of the ankle
Peroneus Longus
Synergists– Eversion
• Peroneus brevis
• Peroneus tertius
• Extensor digitorum longus
Peroneus Longus
Synergists– Plantar flexion of ankle
• Gastrocnemius
• Soleus
• Peroneus brevis
• Tibialis posterior
• Flexor digitorum
• Flexor hallucis longus
Peroneus Longus
Antagonists– Inversion
• Tibialis anterior
• Tibialis posterior
• Flexor digitorum longus
• Flexor hallucis longus
• Extensor hallucis longus
Peroneus Longus
Antagonists– Dorsiflexion
• Peroneus tertius
• Extensor digitorum longus
• Extensor hallucis longus
• Tibialis anterior
Peroneus Longus
Strengthening exercises
Peroneus Longus
Stretches– Extreme passive inversion and dorsiflexion of
the foot while the knee is flexed
Peroneus Longus
Sporting activities– Involved in any activity involving running or
walking, especially in activities involving a quick transition from one foot to the other.
• Football• Basketball• Hockey• baseball
Peroneus Brevis Muscle
Peroneus Brevis Muscle
ORIGIN– Lower 2/3 of the
lateral surface of the fibula
Peroneus Brevis Muscle
Insertion– Tuberosity of the 5th
metatarsal bone
Peroneus Brevis Muscle
Actions– Eversion of the foot– Plantar flexion of the ankle
Innervation– Superficial peroneal nerve
Palpation– Tendon of the muscle at the proximal end of the
5th metatarsal
Peroneus Brevis Muscle
Lever– Third Class Lever
• axis: ankle or subtalar joint
• force: base of the 5th metatarsal
• Resistance: weight of the foot or resistance of the floor when cutting and push-off.
Peroneus Brevis Muscle
Exercises– Eversion with theraband– Plantar Flexion
• seated calf raises
• standing calf raises
Peroneus Brevis Muscle
Stretches– Manual inversion of the ankle with slight dorsi-
flexion
Peroneus Brevis Muscle
Applications– Stabilization of the ankle from inversion– Jumping and Running
• any sport
– Cutting to the opposite direction• basketball• baseball and softball• football• tennis
Peroneus Tertius
Do you have a Peroneus Tertius?
Origin- distal third of the anterior fibula
Insertion- base of the fifth metatarsal
Action- eversion of the foot dorsal flexion of the ankle
Palpation- lateral to the extensor digitorum longus tendon on the anterolateral aspect
Innervation- deep peroneal nerve (L4-5, S1)
3rd class leverAxis- ankle joint
Force- insertion which is the base of the fifth metatarsal
Resistance- at the toes
Synergists
DorsiflexorsTibialis anterior
Extensor digitorun longus
Extensor hallucis longus
EvertorsPeroneus longus
Peroneus brevis
Extensor digitorum longus
Antagonists
Plantar flexorsGastrocnemius
Flexor digitorum longus
Peroneus longus
Peroneus brevis
Plantaris
Soleus
Tibialis posterior
InvertorsTibialis anterior
Tibialis posterior
Flexor digitorum longus
Flexor hallucis longus
Stretch
take foot into extreme inversion and plantar flexion
StrengtheningBelow: use thera-band for resistance while you do eversion
Above: use thera-band for resistance while you do dorsiflexion
Applications
Walking
Running
Basketball
Baseball
Extrensor Digitorum Longus
Origin + InsertionO, Lateral condyle of the tibia, head of the fibula, and upper 2/3 of
the anterior surface of the fibula.
I, Tops of the middle and distal phalanges of the fou lesser toes
Actions Extension of the four lesser toes
Dorsal Flexion of the ankle
Eversion of the foot
InnervationDeep peroneal nerve (L4-5, S1)
Lever ClassThis is a second-class lever.
• Axis-Ankle joint
• Resistance-Down on the foot
• Force-Insertion point on middle and distal phalanges of the four lesser toes.
Synergist MusclesDorsal Flexion
– Tibialis Anterior
– Peroneus tertius
– Extensor hallucis longus
Eversion• Peroneus longus
• Peroneus brevus
• Peroneus tertius
AntagonistsPlantar Flexors
– Gastrocnemius
– Flexors
– Soleus
– Tibialis Posterior
Strengthening ExercisesTheraband Extensions Reverse Calf Raises
StretchesTake the lesser four toes into flexion while
the foot is inverted and plantar flexed.
Sporting ActivitiesEvery running and jumping exercises.
Extensor Hallucis Longus
Origin
Middle two-thirds of the medial surface of the anterior fibula
Insertion
Dorsal surface on the base of the proximal and distal phalanx of the great toe (hallux)
Innervation
Deep peroneal nerve – L4-5, S1
Palpation
Dorsal surface of the great toeDeep to the tibialis anterior and extensor
digitorum longus – cannot be palpated
Actions
Dorsiflexion of the ankleExtension of the great toe (hallux)Weak inversion of the foot
Levers
Hallux extension – Third class lever– Axis – interphangeal joint– Force – insertion at distal phalanx– Resistance – weight of distal phalanx
Levers
Dorsiflexion – Second Class lever– Force – insertion at distal phalanx– Resistance – top of foot near metatarsals– Axis – ankle
Theraband Dorsiflexion
Reverse Calf Raise
Reverse Calf Raise
Stretch
Full flexion of the halluxPlantar flexion of the foot Eversion of the foot
Stretch
Activities
Flicking the ball upward in soccerRunning – returning the foot to unflexed
positionAuto racing – easing up on the acceleratorSkateboarding or surfing – keeping balance
Flexor Digitorum Longus
Nerve Innervation
Tibial Nerve (L5,S1)
Origin Insertion
Posterior surface of the upper half of the interosseus membrane and adjacent surfaces of the tibia and fibula.
Lower inner surfaces of the navicular and cuneiform bones and bases of the 2nd-5th metatarsal bones.
3rd Class Lever
Axis: movement of the foot
Force:Insertion
Resistance: Body weight
Actions
Plantar flexion of the ankle.Flexion of the four lesser toes Inversion of the foot.
Palpation
Cannot be palpated (deep to the soleus)
Antagonist Synergist
Tibalis anterior(PF) Extensor halluc
longus(PF) Peroneus tertius(In. &
PF) Extensor dititorum
longus
Tibalis anterior(In.) Tibialis posterior Flexor hallucis longus Peroneus longus,
brevis(PF) Gastrocnemius Soleus
Exercises
Calf raises(standing and sitting)Power CleansPush-pressPolyometerics
Stretches
Stair stretchWall stretchBest stretch is when the toes are extremely
extended and the foot is everted and dorsiflexed.(knee flexed)
Sporting Activities
Any sport running or jumping(includes pretty much all sports)
BasketballFootballTrackEct.
Tibialis Posterior
Origin
Posterior surface of the upper half of the interosseus membrane and adjacent surfaces of the tibia and fibula
Insertion
Lower inner surface of the navicular and cuneiform bones (lateral, intermediate, and medial)
Bases of the second, third, fourth, and fifth metatarsal bones (plantar side)
Actions
Plantar flexion of the ankle
Inversion of the foot
Synergists
Plantar flexion of the ankle– Flexor digitorum
longus
– Flexor hallucis longus
– Peroneus brevis
– Peroneus longus
– Soleus
– gastrocnemius
Inversion of the foot– Flexor digitorum
longus
– Flexor hallucis longus
– Tibialis anterior
– Extensor hallucis longus (weak)
Antagonists
Dorsal flexion of the ankle– Tibialis anterior
– Extensor hallucis longus
– Extensor digitorum longus
– Peroneus tertius
Eversion of the foot– Extensor digitorum
longus
– Peroneus tertius
– Peroneus brevis
– Peroneus longus
Palpation
Cannot be palpatedDeep to larger muscles of the posterior,
inferior lower extremities such as:– Gastrocnemius– Soleus
Innervation
Tibial nerve (L5, S1)
Lever
3rd Class– Axis= ankle joint (talocrural joint)
– Force= muscle insertion on lower inner surfaces of the navicular and cuneiform bones and 2nd, 3rd, 4th, and 5th metatarsal bones
– Resistance= ball of foot (plantar flexion or inversion with theraband)
Exercises
Heel raises Inversion against resistance (theraband or weight)
Stretches
Passively taking the foot into extreme eversion and dorsiflexion while the knee is flexed.
Sports
Used in most all sports because it is used when running.*Track
“Shin splints” is the slang term for the chronic condition in which the tibialis posterior, tibialis anterior, and extersor digitorum longus muscles are inflamed, and are often caused by long-distance running or sprints.
Also,*Football stance*Baseball fielding position*Basketball free throws*Ballet*Kicking a soccer ball
Flexor hallucis longus
Origin and Insertion
Origin: the middle two-thirds of the posterior surface of the fibula
Insertion: base of the distal phalanx of the big toe, under the surface
Action of the Flexor hallucis longus
Flexion of the great toes Inversion of the footPlantar flexion of the ankle
Anteromedial to the Achilles tendon near the heel
Palpation
Nerve Innervation
Innervated by the Tibial nerve
(L5, S1-2)
Type of Lever
Third Class Lever in flexion of the great toe
Axis: Interpahlangeal or metatarsophalangeal joint of big toe
Force: base of the phalanx of large toes
Resistance: Base of the big toe
Second Class lever in plantar flexion of the ankle
Axis: is the ankle
Resistance: at mid foot
Force: base of distal phalanx of large toe
Synergists and Antagonists
SynergistsPlantar FlexionGastrocnemiusFlexor digitorum longusPeroneus longusPeroneus brevis PlanarisSoeusTibialis posteriorInversionTibialis posteriorFlexor difitorum longusTibialis anteriorExtensor halllucis longus
AntagonistsPlantar FlexionTibialis anteriorPeroneus tertuisExtensor digitorum longusExtensor hallucis longusFlexion of the big toeExtensor hallucis longusInversionPeroneus longusPeroneus brevisPeroneus tertiusExtensor digitorum longus
Towel Grabs
The heel rests on the floor while the toes extend to grab a flat towel and then flex to pull the towel under the foot. Weight may be placed on the end of the towel.
Shape Pick-ups
During this exercise you must flex the great toe to pick up the shapes.
Other Excercises
Stretches
Stretch by passively taking the great toe into extreme extention while the foot is everted and dorsiflexed.
Activities
WalkingRunning Jumping hopping skipping
Sternocleidomastoid
Sternocleidomastoid
Origin– Manubrium of the sternum, Medial Clavicle
Insertion– Mastoid Process
Sternocleidomastoid
Actions– Both sides: Flexion of the head and neck– Right side: Rotation to the left and lateral
flexion to the right.– Left Side: Rotation to the right and lateral
flexion to the left side.
Sternocleidomastoid
Innervation – Spinal accessory nerve
Palpation– Anterolateral side of the neck, diagonally
between the origin and insertion
Strengthening Exercises
Neck Flexion Neck Lateral Flexion
Stretching
Turn head over shoulder and hold for 20 seconds. Repeat to other side.
Activities
Any activities where head flexion is required.
Splenius Muscles:Splenius Cervicis, Splenius Capitis
Origin & Insertion
Origin: Splenius cervicis: spinous processes of the third – sixth thoracic vertebraeSplenius capitis: lower half of the ligamentum nuchae and the spinous processes of the seventh cervical and the upper three or four thoracic vertebrae
Origin & Insertion
Insertion:
Splenius cervicis: transverse processes of the first three cervical vertebrae
Splenius capitis: mastoid process and occipital bone
Innervation & Palpation
Innervation: Posterior lateral branches of cervical nerves four – eight (C4-8)
Palpation: Cannot be palpated
Actions
Both sides: extension of the head & neckRight side: rotation and lateral flexion to
the rightLeft side: rotation and lateral flexion to the
left
Synergists
Trapezius (upper fibers)Levator scapulaeErector spinaeSternocleidomastoidRectus capitis lateralis, rectus capitis
posterior (major & minor), obliquus capitis superior, semispinalis capitis
Antagonists
Sternocleidomastoid (flexion)Rectus capitis anterior, longus capitis
Exercises
Neck extensions
Exercises
Neck lateral flexions
Exercises
Weighted neck extension
Stretches
Splenius stretch
Stretches
Neck stretch
Sports & Activities
Anything involving extension of the neck or lateral flexion
Splenius capitis is a source for headaches!
Erector Spinae Muscles(Sacrospinalis)
Including:
Iliocostalis, Longissimus, Spinalis
Erector Spinae
Origins: – Iliocostalis: thoracolumbar aponeurosis from
sacrum, posterior ribs.– Longissimus: thoracolumbar aponeurosis from
sacrum, lumbar and thoracic transverse processes.
– Spinalis: ligamentum nuchae, cervical and thoracic spinous processes.
Erector Spinae
Insertion:– Iliocostalis: posterior ribs, cervical transverse
processes.– Longissimus: cervical and thoracic transverse
processes, mastoid process.– Spinalis: cervical and thoracic spinous
processes, occipital bone.
Erector Spinae
Palpation: Lower lumbar region on either side of the spine.
Innervation: Posterior branches of the spinal nerves.
Action: Extension and lateral flexion of the spine.
Erector Spinae
Synergists: – Lateral Flexion: Rectus Abdominis, External
Oblique Abdominal, Internal Oblique Abdominal, Quadratus Lumborum.
Antagonists:– Lumbar Extension: Rectus Abdominis,
External Oblique Abdominal, Internal Oblique Abdominal
Exercises
Dead Lift: bend over, keeping the arms and legs straight, pick up the barbell, and return to the standing position.
Exercises
Back strengthening exercise, can also hold weight in hand for more resistance.
Exercises
Laying prone on the ground, lift your legs and arms up, known as the superman.
Stretches
Maximal flexion of the entire spine stretches the erector spinae muscle group.
Stretches
Flexion of the spine along with lateral flexion to one side accentuates the stretch on the contralateral side.
Rectus Abdominis
Rectus Abdominis
Origin– Crest of the Pubis
Insertion– Cartilage of the 5th-7th
ribs at the xiphoid process
Rectus Abdominis
Nerve Innervation– Intercostal Nerves (T7-
12)
Palpation– Anteromedial surface
of the abdomen, between the rib cage and the pubic bone
Rectus Abdominis
Action– Both sides: Lumbar flexion
– Right side: Lateral flexion to the right
– Left side: Lateral flexion to the left
Lever– 3rd class
• Axis - posterior pelvic rotation
• Force - Origin at crest of pubis
• Resistance - weight of legs
Rectus Abdominis
Synergists– External Obliques
– Internal Obliques
– Quadratus Lumborum
Antagonists– Erector Spinae muscles
– Obliques (to the opposite side of the rectus abdominis)
Rectus Abdominis
ExercisesCable Kneeling Crunch
– Kneel below a high pulley. Grasp cable rope attachment and place wrists against the head. Flex hips slightly and allow the weight to hyperextend the lower back.
– With the hips stationary, flex the waist so the elbows travel toward the middle of the thighs.
Rectus Abdominis
Rectus Abdominis
Incline Sit-Up– Hook feet under padding and lie supine on
incline bench with hips bent.
– Raise the torso from bench by bending the waist and hips. Return until the back of the shoulders contact the padded incline board.
Rectus Abdominis
Rectus Abdominis
Leg Throw-downs– Lay on the ground (supine), and have a partner
stand at your shoulders. Flex hips, raise legs, and posteriorly rotate the pelvis.
– Partner pushes legs back towards the ground, alternating straight and both lateral throws.
Rectus Abdominis
Rectus Abdominis
Vertical Hip Raise• Position body on padded parallel bars with hands on
handles, back on vertical pad, and body weight supported on forearms.
• Raise legs by flexing hips while flexing knees until hips are fully flexed. Continue to raise knees toward shoulders by flexing waist, raising hips from back board. Return until waist, hips, and knees are extended.
Rectus Abdominis
Rectus Abdominis
Stretches– Kneeling Ab Stretch
• Kneel on floor or mat with hips straight. Place hands on the back of hips
• Lean torso back by arching back
– The Cobra• Lie prone on mat or floor. Position hands on floor to
sides of shoulders. • Push torso up keeping pelvis on floor.
Rectus Abdominis
Rectus Abdominis
Applications– Diving
– Gymnastics
– Rowing
– Running
– Baseball/Softball
– Basketball
– Football
– Etc...
Internal oblique abdominal muscle
Origin and Insertion
Origin:
Upper half of the inguinal ligament, anterior two-thirds of the crest of the ilium, and the lumbar fascia
Insertion:
Costal cartilages of the eighth, ninth, and tenth ribs and the linea alba
Actions of the Internal oblique abdominal muscle
Both sides: lumbar flexionRight side: lumbar lateral flexion and
rotation to the rightLeft side: lumbar lateral flexion and
rotation to the left
Palpation
Palpated on the lateral side of the abdomen when the external oblique is relaxed
Innervation•Intercostal nerves (T8-12),
•Iliohypogastric nerve (T12, L1)
•Iloinguinal nerve (L1)
Type of Lever
Force: Costal carilages of eighth ninth and tenth ribs, linea alba
Axis: lumbar vertebraeResistance: In your hands or on chest
Third class lever
Synergists and Antagonists
Synergists:
Rectus abdominis, external oblique abdominal,
Antagonists:Erector spinae muscles
Exercises
By touching the left elbow to the right knee the right internal oblique along with the left external oblique rotate at the same time, assisting the rectus abdominis muscle in flexing the trunk to complete the movement
Twisting Crunch
Russian twist
Stretching
Each side of the internal oblique must be stretched individually. The right side is stretched by moving into extreme left lateral flexion and extreme left lumbar rotation combined with extension.
Same thing for the Left side by moving to right.
Activities
BaseballVolleyballRowingBasketball
External Oblique Abdominal
Origin
Borders of the lower eight ribs at the side of the chest, dovetailing with the serratus anterior muscle
Insertion
Anterior half of the crest of the ilium, the inguinal ligament, the crest of the pubis, and the fascia of the rectus abdominis muscle at the lower front
Action
Both sides:– Lumbar flexion
Right side:– Lumbar lateral flexion to the right and rotation
to the leftLeft side:
– lumbar lateral flexion to the left and rotation to the right
Actions
Palpation– Lateral side of
the abdomen, either right or left
Innervation– Intercostal
nerves (T8-12), iliohypogastric nerve (T12, L1), and iliolinguinal nerve (L1)
Lever
First class lever– Axis= flexion at the lumbar vertebrae– Force= insertion at the anterior half of the crest
of the ilium, the inguinal ligament, the crest of the pubis, and the fascia of the rectus abdominis muscle at the lower front
– Resistance= upper body when performing twisting crunches
Synergists
Lumbar flexion– Rectus abdominis– Internal oblique
Rotation to the left (right side)– Left internal oblique
Lumbar lateral flexion to the right (right side)– Right rectus abdominis– Right internal oblique– Right quadratus lumborum– Erector spinae
• Iliocostalis, longissimus, spinallis
Synergists
Lumber lateral flexion to the left (left side)– Left rectus abdominis
– Left internal oblique
– Left quadratus lumborum
– Erector spinae• Iliocostalis, longissimus, spinallis
Rotation to the right (left side)– Right internal oblique
Antagonists
Lumbar extension– Erector spinae
• Iliocostalis, longissimus, spinalis
Antagonists
Lumbar lateral flexion to the left (right side)– Left quadratus lumborum– Left erector spinae
• Iliocostalis, longissimus, spinalis
Rotation to the right (right side)– Right internal oblique
Antagonists
Lumbar lateral flexion to the right (left side)– Right internal oblique– Right erector spinae
• Iliocostalis, longissimus, spinalis
Rotation to the left (left side)– Left internal oblique
Strengthening Exercises
Cable side bendsDumbbell side bendsTwist with machineTwisting crunch
Strengthening
Cable side bends Twisting crunch
Dumbbell side bends Twist with machine
Stretching(Each side of the external oblique must be stretched individually)
To stretch the right side:– Move into extreme left lateral flexion while in lumbar
extension– Move into extreme lumbar rotation to the right while in
lumbar extension To stretch the left side:
– Move into extreme right lateral flexion while in lumbar extension
– Move into extreme lumbar rotation to the left while in lumbar extension
Other Stretches
Broomstick Twist
Lying bent leg Pretzel
Sports
Baseball– Throwing, pitching, hitting
Speed skatingGolf swing
Application
Transversus Abdominus
Known as the 4th abdominal muscle
Chief muscle in forced expiration
Transversus Abdominus INSERTION
– Crest of the pubis and iliopectineal line– Abdominal aponeurosis to the linea alba
ORIGIN– Outer third of the inguinal ligament– Inner rim of the iliac crest– Inner surface of the cartilage of the lower six ribs– Lumbar fascia
Transversus Abdominus
Cannot be palpated
INNVERVATION– Intercostal nerves (T7-12)– Iliohypogastric nerve (T12, L1)– Iliolinguinal nerve (L1)
Transversus Abdominus
Abdominal flattening and forced expulsion of the abdominal contents are the main actions
Also used in postural control but it neither flexes or extends the lumbar spine
The muscle is weakened in individuals with chronic back pain
Transversus Abdominus SYNERGISTS (flattening abdomen)
– Rectus Abdominus
– External Oblique Abdominal
– Internal Oblique Abdominal
SYNERGISTS (expiration)– Internal Intercostals
– Transversus Thoracis
– Subcostales
ANTAGONISTS– Levator Costarum
– Serratus Posterior
Transversus Abdominus
A maximal inspiration held in the abdomen applies stretch
Effective exercise is done by attempting to draw the abdominal contents back towards the spine…– Isometrically in the supine position– While standing
Transversus Abdominus
Bent knee sit-ups Crunches Isometric contractions
Or
Exhaling thoroughly while crouching– i.e. catchers in baseball
Transversus AbdominusAlso……you can simply train this muscle by
pulling your navel to your spine
– Hey Ladies!• Standing and drawing your navel in toward your spine can
eradicate the lower ab pooch!
– Men• If you’re hanging a flabby beer belly, such as JP,
then it will take a little more effort.
OriginPosterior inner lip of the iliac crest
InsertionApproximately one-half the length of the lower border of the twelfth rib and the transverse process of the upper four lumbar vertebrae
Lateral flexion to the side on which it is located
Stabilizes the pelvis and lumbar spine
Can only be palpated on thin individuals
Branches of T12, L1 nerves
Synergists / Antagonist
Lateral flexion
Rectus Abdominis
External Oblique
Internal Oblique
Erector Spinae
Lever?
Sit comfortably, with your spine lengthened. Place a towel or strap under your left foot, and hold the other end in your left hand. Side bend to the left as far as you can, taking up any slack in the strap . This lengthens the right QL. Using the strap to prevent your motion, try to bend up to the right, isometrically contracting the right QL. Deepen the stretch by bending farther to the left.
Lying on your left side, with your back at the edge of the table and your right leg hyperextended and hanging over the edge of the table. Be sure to keep your hips stacked vertically on top of each other. Reach your right arm up over your head. Trainer crosses his arms and places his left hand against your right iliac crest; his right hand is spread wide and placed on the lateral aspect of your rib cage. Your goal is to have him contract the right QL by bringing the hip and the ribs toward each other
SIDELYING LATERAL FLEXION
Starting Position: Sidelying position with bent leg.
Place the fist of your bottom arm at your temple, and lightly rest the top arm on the front of the ball.
Allow the trunk to lateraly flex slightly and round over the ball.
Execution of Exercise: Laterally flex and lift the trunk slowly, pulling the ribcage down toward the hip.
Pause at the top of the movement, and then slowly return to starting position.
Used in any sport because it stabalizes the spine.