You are on page 1of 530

LOWER EXTREMITY KINESIOLOGY Prepared by

DENNIS N. MUÑOZ, RN, RM, PTRP, MAN

CHAPTER 7
The Hip Joint and Pelvic Girdle

Bones
 Bones of the Illium  Bones of the Ischium  Bones of the Pubis  Bones of the Sacrum  Bones of the Coccyx  Bones of the Femur

Lumbar Spine Movements
 Flexion  Extension  Lateral Flexion  Lateral Rotation

Pelvic Movements
 Anterior Rotation (sagital plane)  Posterior Rotation (sagital plane  Lateral Rotation (frontal plane)  Transverse Rotation (horizontal plane)

Hip Movements
 Flexion  Extension  Abduction  Adduction  Internal Rotation  External Rotation  Circumduction

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

Vertical Leg Raise

Weighted Leg Raise

Hanging Leg Raise

Lever Hip Flexion

Stretches
PNF

Self-stretch

Sports
 Running  Baseball (stealing a base, pitching from the

“stretch”)  Gymnastics  Bicycling

Gymnastics

Cycling

Baseball pitcher

Running

Sartorius
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 – 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

 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

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 hip  Flexion of the knee  External 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- plies  Baseball & Softball - steping of the plate to

catch a ball  Swimming- breast stroke

RECTUS FEMORIS

QUADRICEPS
1) RECTUS FEMORIS 2) VASTUS LATERALIS 3) VASTUS INTERMEDIUS 4) VASTUS MEDIALIS

ORIGIN
` Anterior inferior iliac spine of the ilium and

groove (posterior) above the acetabulum

INSERTION
` Superior aspect of the patella and patellar

tendon to the tibial tuberosity

CLASS LEVER
` Third Class Lever
` Axis = hip joint/knee joint ` Force = insertion (patella) ` Resistance = weight at

` Second Class

Lever
` Axis = hip joint ` Force = insertion

feet (squat, leg press, etc.) or mid-shin (knee extension

(patella) ` Resistance = midthigh/quad (hip flexion)

DOES WHAT?
`ACTION CFlexion of the hip CExtension of the knee

APPLICATION
` SYNERGISTS CSartorius CTensor Fascia Latae CVastus Lateralis CVastus Medius CVastus Intermedius

` ANTAGONISTS CHamstrings CGluteus Maximus

PALPATION
` INNERVATION CFemoral nerve
RL2 RL3 RL4

` PALPATION CAny place on the anterior surface of the femur

EXERCISES
` Leg press ` Lunge ` Leg Extension ` Step-up ` Squat CFront Squat CFull Squat CHack Squat CSafety Squat

LEG PRESS

SQUATS

LUNGE

STEP-UP

HIP FLEXION

PLYOMETRICS
BOX JUMPS

STRETCHES
` Lying quad stretch ` Standing quad stretch ` Squat quad stretch ` Lunge 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)

Tensor Fasciae Latae

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

Tensor fasciae latae
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
Palpation -Slightly in front of the greater
trochanter

Innervation
-Superior gluteal nerve (L4-5, S1)

Tensor fasciae latae
Exercises
-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

Stretches

Standing Ibiotibal Stretch

Stretches
Wall 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 Test  Push Off from a base or pitching rubber  Gluteus medius is also a great stabilizer of

the hip for proprioception (balance) of the leg during any exercise  Slide step in baskeball  Push off in the shot put

Application

Application

GLUTEUS MAXIMUS

ORIGIN
 Posterior one-fourth of

INSERTION
 Oblique ridge on the

the crest of the ilium  Posterior surface of the sacrum and coccyx near the ilium, and fascia of the lumbar area

lateral surface of the greater trochanter and the iliotibial band of the fasciae latae

ACTIONS
 Extension of the hip  External rotation of the hip  Lower fibers-assist is adduction

Nerve Innervation
Inferior gluteal nerve (L5, S1-2)

Palpation
Wide area on the posterior surface of the pelvis

Synergists
 Extension
Semitendinosus Semimembranosus Biceps femoris

 External Rotation
Piriformis Gemellus superior Gemellus inferior Obturator externus Obturator internus Quadratus femoris Gluteus Medius Adductor brevis

Antagonist
 Extension
Rectus femoris Iliopsoas Sartorius Tensor faciae latae Pectineus

 External Rotation
Semitendinosus Semimembranosus Pectineus Gracilis

Lever
 3rd class  Axis - Hip Joint  Force - 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

Seated 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.

Exercises
Safety 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.

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
 Baseball  Track- running, jumping  Hopping  Skipping  Gymnastics

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
 Track  Basketball  Football  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 muscles  Tendon can be felt on the medial side of the

posterior aspect of the tibia

Actions
 Extension of the hip  Flexion 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 joint  Resistance – weight of the lower leg  Force – 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 muscles  External 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 running  Preparatory phase for kicking a soccer ball

or football  Jumping – long jump, triple jump  Heel pass in soccer

Biceps Femoris

Origin/Insertion
Origin of  the long  head:  ischial  tuberosity

Insertion for  both heads:  lateral condyle  of the tibia and  head of fibula

Origin of  short head:  lower half of  linea aspera  and lateral  condyloid  ridge

Palpation

 Lateral posterior side of the

femur, near the knee

Innervation

Actions
 Extension of the hip  Flexion of the knee  External rotation of the hip  External 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 stretch the 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 stretch the 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 4­way 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
start Hip Extension using a ball

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 the Biceps 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 palpated  Deep 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 Adductor magnus Iliopsoas Sartorius 6 deep lateral rotator muscles Gluteus maximus Biceps femoris

 External Rotators of the Hip

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 – Resistance= weight of leg, resistence on
ankle or lower thigh

pectineal line of the femur and the upper half of the medial lip of the linea aspera

Exercises
 Cable hip adduction  Seated Hip adduction  Standing hip adduction  Weighted 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

Seated Groin Kneeling Groin

Lying Wall Groin Lying Groin

Squatting Groin Side Lunge

Sports
 Swim
– Elementary back stroke – Breast stroke

 Ballet/Dance  Baseball pitching motion

Breast Stroke

Elementary Back Stroke

Ballet Baseball

ADDUCTOR LONGUS

Nerve Innervation
 Obturator nerve (L3-4)

Origin
 Anterior pubis just

Insertion
 Middle third of the

below its crest

linea aspera

3rd Class Lever
 Axis: Hip Joint  Force: Insertion at linea aspera  Resistance: 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
 Gluteus medius  Gluteus minimus  Tensor fasciae latae

Synergist
 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: defense  Tennis

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 adduction  Seated hip adduction  Standing hip adduction

Cable Hip Adduction

Seated Hip Adduction*

* Knee could also be extended!

Standing Hip Adduction

Stretches
 Lying groin  Lying wall groin  Seated groin (a.k.a. butterfly)  Side lunge  Squatting groin

Lying Groin

Lying Wall Groin

Butterfly

Side Lunge

Squatting Groin

Sports & Activities
 Horseback riding  Breaststroke kick in swimming  Basketball – defensive slides  Soccer – kicking  Running

KINESIOLOGY
POPLITEUS 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 LEVER
 3RD 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

CHARACTERISTI CS
 ACTIONS
– flexion of the knee – internal rotation of the knee

*PALPATION
– cannot be palpated

~INNERVATION
– tibial nerve (L5, S1)

POPLITEUS PICTURES

EXERCISES
 LEG CURLS  BAR HANGS WITH KNEE FLEXED  LEG CURLS WITH ANKLE WEIGHTS  INTERNAL ROTATION WITH ANKLE

WEIGHTS (move leg from neutral to internal and back)

LEG CURLS

BAR HANGS

STRETCHES
 Passive 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.)

APPLICATIONS
 Only 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

femur

QT = Quadriceps Tendon P = Patella PT = Patella Tendon

tibia

Synergists
 Rectus femoris, vastus

medialis, vastus lateralis  (1-rectus femoris, 2-vastus lateralis, 3-vastus intermedius (deep), 4vastus medialis)

Antagonists
 Hamstrings—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!!

Stretches  Prone quad stretch

 Standing quad stretch

Exercises
 Squats  Lunges  Seated knee extension (best)

Squat

Lunge

Front View

Side View

Seated Knee Extension

Gastrocnemius

Gastrocnemius
Origin
Medial Head: posterior surface of the medial femoral condyle Lateral Head: posterior surface of the lateral femoral condyle

Insertion
Posterior 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 Lever
Axis-ball of the foot Resistance-body weight at the tibal articulation Force-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

S O L E U S

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
Exercises
 Lever 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
 Stretches
 Floor 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
 Application  Any 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  Antagonist

(Plantar Flexion) -Gastrocnemius -Soleus -Peroneus longus -Peroneus brevis -Tibialis Posterior

(Dorsal Flexion) -Peroneus teritus -Extensor digitorum longus -Tibialis anterior

Plantaris Muscle
 Synergists  Antagonist

(Knee Flexion) -Gastrocnemius -Popliteus -Gracilis -Hamstring Muscles

(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 dorsiflexion

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 lever
Axis- ankle joint Force- insertion which is the base of the fifth
metatarsal

Resistance- at the toes

Synergists
Dorsiflexors
Tibialis anterior Extensor digitorun longus Extensor hallucis longus

Evertors
Peroneus longus Peroneus brevis Extensor digitorum longus

Antagonists
Plantar flexors
Gastrocnemius Flexor digitorum longus Peroneus longus Peroneus brevis Plantaris Soleus Tibialis posterior

Invertors
Tibialis anterior Tibialis posterior Flexor digitorum longus Flexor hallucis longus

Stretch
take foot into extreme inversion and plantar flexion

Strengthening
Below: use theraband for resistance while you do eversion Above: use theraband for resistance while you do dorsiflexion

Applications
Walking Running Basketball Baseball

Extrensor Digitorum Longus

Origin + Insertion
 O, 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

Innervation
 Deep peroneal nerve (L4-5, S1)

Lever Class
 This 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 Muscles
 Dorsal Flexion
– Tibialis Anterior – Peroneus tertius – Extensor hallucis longus

 Eversion
• Peroneus longus • Peroneus brevus • Peroneus tertius

Antagonists
 Plantar Flexors
– – – – Gastrocnemius Flexors Soleus Tibialis Posterior

Strengthening Exercises
 Theraband Extensions  Reverse Calf Raises

Stretches
 Take the lesser four toes into flexion while

the foot is inverted and plantar flexed.

Sporting Activities
 Every 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 toe  Deep to the tibialis anterior and extensor

digitorum longus – cannot be palpated

Actions
 Dorsiflexion of the ankle  Extension 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 hallux  Plantar flexion of the foot  Eversion of the foot

Stretch

Activities
 Flicking the ball upward in soccer  Running – returning the foot to unflexed

position  Auto racing – easing up on the accelerator  Skateboarding or surfing – keeping balance

Flexor Digitorum Longus

Nerve Innervation
 Tibial Nerve (L5,S1)

Origin
 Posterior surface of

Insertion
 Lower inner surfaces

the upper half of the interosseus membrane and adjacent surfaces of the tibia and fibula.

of the navicular and cuneiform bones and bases of the 2nd-5th metatarsal bones.

3 Class Lever
rd

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
 Tibalis anterior(PF)  Extensor halluc

Synergist
 Tibalis anterior(In.)  Tibialis posterior  Flexor hallucis longus  Peroneus longus,

longus(PF)  Peroneus tertius(In. & PF)  Extensor dititorum longus

brevis(PF)  Gastrocnemius  Soleus

Exercises
 Calf raises(standing and sitting)  Power Cleans  Push-press  Polyometerics

Stretches
 Stair stretch  Wall stretch  Best 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)  Basketball  Football  Track  Ect.

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  Inversion of the foot

ankle

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 palpated  Deep 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 foot  Plantar flexion of the ankle

Palpation
 Anteromedial to the Achilles tendon near

the heel

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
 Synergists

Plantar Flexion Gastrocnemius Flexor digitorum longus Peroneus longus Peroneus brevis Planaris Soeus Tibialis posterior Inversion Tibialis posterior Flexor difitorum longus Tibialis anterior Extensor halllucis longus

 Antagonists

Plantar Flexion Tibialis anterior Peroneus tertuis Extensor digitorum longus Extensor hallucis longus Flexion of the big toe Extensor hallucis longus Inversion Peroneus longus Peroneus brevis Peroneus tertius Extensor 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
 Walking  Running  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 vertebrae Splenius 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 & neck  Right side: rotation and lateral flexion to

the right  Left side: rotation and lateral flexion to the left

Synergists
 Trapezius (upper fibers)  Levator scapulae  Erector spinae  Sternocleidomastoid  Rectus 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 (T712)  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
Exercises
 Cable 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 flexion  Right side: lumbar lateral flexion and

rotation to the right  Left 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 vertebrae  Resistance: 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
 Baseball  Volleyball  Rowing  Basketball

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 left  Left 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 bends  Dumbbell side bends  Twist with machine  Twisting 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

Lying bent leg

Pretzel

Broomstick Twist

Sports
 Baseball
– Throwing, pitching, hitting

 Speed skating  Golf 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 Abdominus
 Also……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.

Origin
Posterior inner lip of the iliac crest

Insertion
Approximately 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.

Related Interests