Lower Extremity Kinesiology

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

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


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


Action

-Abduction of the hip

-Flexion of the hip

-Tendency to rotate the hip internally as it flexes


Synergists (Flexion of the Hip)-Rectus femoris-Sartorious-Ilipsoas

Synergist (Abduction of the Hip)-Gluteus Minimus-Gluteus Medius


Antagonist (Extension of the Hip)

-Gluteus Maximus

-Semitendinosus

-Semimembranosus

-Biceps Femoris


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



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


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

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

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


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.


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


Supine leg curls/knee flexion


Squats: Going down, as with the dead lift, you are eccentrically contracting the hamstrings, while going up you are concentrically contracting them


Hip Extension using a ball

start

finish


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


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: 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)

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

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


• 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


ORIGIN– Lower 2/3 of the

lateral surface of the fibula


Insertion– Tuberosity of the 5th

metatarsal bone


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


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.


Exercises– Eversion with theraband– Plantar Flexion

• seated calf raises

• standing calf raises


Stretches– Manual inversion of the ankle with slight dorsi-

flexion


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


Eversion• Peroneus longus

• Peroneus brevus


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

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


– Peroneus brevis

– Peroneus longus

– Soleus

– gastrocnemius

Inversion of the foot– Flexor digitorum

longus


– Tibialis anterior

– Extensor hallucis longus (weak)

Antagonists

Dorsal flexion of the ankle– Tibialis anterior


– Extensor digitorum longus


Eversion of the foot– Extensor digitorum

longus


– 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: 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


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:

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


Rotation to the right (right side)– Right internal oblique

Antagonists

Lumbar lateral flexion to the right (left side)– Right internal oblique– Right erector spinae


Rotation to the left (left side)– Left internal oblique


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


Cannot be palpated

INNVERVATION– Intercostal nerves (T7-12)– Iliohypogastric nerve (T12, L1)– Iliolinguinal nerve (L1)


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


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


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.

Lower Extremity Kinesiology

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