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The top of the sartorius muscle attaches to the anterior superior iliac crest. Anterior is the portion toward the front of the body, superior is the part toward the head, and iliac crest is the top border of the ilium. The muscle crosses the upper leg to attach to the tibia, also known as the shin bone. The femoral nerve supplies the sartorius muscle with nerves. The sartorius muscle aids in knee and hip flexion and rotation of the thigh and tibia.
At the very least, the tension and/or spasm in muscles that cross over the hip and attach onto the pelvis can contribute to imbalance, in terms of how strong and flexible each muscle group is in relation to the others. But muscle imbalance in the hips and the spine may make for pain, limitation and/or posture problems. It can also increase the healing challenge put to you by an existing injury or condition, for example, scoliosis.
My exercise of choice here is floor-slide mountain climbers. You will need some furniture moving pads, Valslides, or something similar that will slide smoothly on your floor. Paper plates even work well in a pinch. Put your feet on the sliders and move into a push-up position. To perform the movement, simply pull one knee at a time up toward your chest, going as high as you can while keeping your foot on the slider. You can alternate legs with each rep or do sets of one leg at a time. Don't expect it to be easy.
To stretch your quadriceps at the hip, the idea is to do the opposite movement to flexion, i.e., extension. You can perform extension moves at the hip while standing, lying on your side, lying prone (on your stomach) and kneeling. Even basic stretches done at a pain-free level where you can feel a small bit of challenge, and that are held continuously for approximately 30 seconds may translate to better posture and less back pain.
The patient generally presents with leg stiffness, weakness in the hip flexors, and impaired foot dorsiflexion in the second through fourth decades, although symptoms may be apparent in infancy or not until late adulthood. The gait disturbance progresses insidiously and continuously. Patients may also have paresthesia and mildly decreased vibratory sense below the knees and urinary urgency and incontinence late in the disease. On neurological examination, generally there are no abnormalities of the corticobulbar tracts or upper extremities, except possibly brisk deep tendon reflexes. In the lower extremities, deep tendon reflexes are pathologically increased and there is decreased hip flexion and ankle dorsiflexion. Crossed adductor reflexes, ankle clonus (Video 82, Cross‐Adductor Reflex; Video 84, Sustained Clonus), and extensor plantar responses are present. Hoffman's and Tromner's signs, as well as pes cavus, may be present. Occasionally, slight dysmetria may be seen on finger‐to‐nose testing in patients with long‐standing disease.
The iliopsoas muscle is the prime hip flexor and shortening may affect the lower back, pelvis, and/or hip joint. Caution should be taken during this release due to the sensitive area in which the therapist's hand pushes, i.e. proximity to the appendix, possible abdominal aortic abnormalities, potential tissue weaknesses predisposing to inguinal hernias, ovarian conditions, or general irritation/inflammation of the gastrointestinal system; hence, this release may occasionally be replaced by the regular therapeutic stretch presented in Chapter 7 (see Fig. 7.14).
Keep adjusting your position until you find a hot spot ("A what? I don't know what you're ... Oh! My God! There one is!"), and then hold that position for at least 30 seconds. Your first impulse will be to tense up when you feel tenderness, but it's important that you relax and continue to move around the area. Keep it up, and don't hurry. The more slowly and more often you can do this, the better.
You can roll on just about anything. I've used several different types of foam rollers, a Rumble Roller, lacrosse balls, PVC pipe, a number of weird stick-shaped things. I've also been getting great results using the Body Wrench, an awesome device that is basically a combination of all of the above. I have found that different materials are suitable for different areas on different bodies, so feel free to experiment and find what works best for you.
The pectineus is an accessory hip flexor. This short muscle originates from the front of the pelvis, crosses the hip joint and inserts near the top of the thighbone. In addition to hip flexion, the pectineus works with other muscles to move your thigh inward. The pectineus may be involved in groin strains, which occur commonly among players of sports that require rapid acceleration and position changes.
If most inner-thigh openers feel too easy (and your ankles and knees are injury-free), try Frog Pose. Get down on all fours, with palms on the floor and your knees on blankets or a mat (roll your mat lengthwise, like a tortilla, and place it under your knees for more comfort). Slowly widen your knees until you feel a comfortable stretch in your inner thighs, keeping the inside of each calf and foot in contact with the floor. Make sure to keep your ankles in line with your knees. Lower down to your forearms. Stay here for at least 30 seconds.
The tensor fascia latae originates from the front of the hip and inserts into a long fibrous band called the iliotibial tract on the outside of the thigh. This muscle supports hip flexion, leg rotation and outward movement of the thigh. Tensor fasciae latae syndrome, also known as iliotibial band syndrome, is an inflammatory condition that most commonly develops in distance runners. Inflammation arises when the muscle and band repetitively rub against the outer head of the thighbone, frequently causing a painful snapping sensation in the hip. Treatment typically involves anti-inflammatory medication and hip-strengthening and range-of-motion exercises. Good running shoes can help prevent tensor fasciae latae syndrome by promoting proper hip, knee and ankle alignment.
The psoas, our primary hip flexor, is usually the weakest of the five flexors, and the other four hip flexors have to work more as a result. To test if this is the case for you, lift one knee well above 90 degrees and hold it there, ensuring that you do not compensate by moving your pelvis or leaning forward. If holding this for more than a few seconds is painful or impossible for you, your psoas suck. You are going to have serious trouble squatting to parallel or lower if these muscles can't do their job properly.
Our hip flexors serve many vital functions. The goal of the hip flexor is to make it easy to for joints to move through their full range of motion smoothly. They’re responsible for important aspects of motion, like our ability to bend, run, or kick. Without our hip flexors, controlling the movement of our legs would be virtually impossible. Our hip flexors also work to stabilize the joints of the hips and lower body.
Now that we smoothed out that old tissue and dislodged a few fossilized nasties, let's see what we can do about improving extensibility. The couch stretch is one of the most effective movements you can do for opening up your hip to the end range of motion. Adopt a kneeling position in front of something that you can use to hold your foot up (i.e., a couch). Your back knee should be completely flexed, meaning your heel is as close as possible to your butt.
Frequently, I find that these individuals have increased TONE (resting muscle tension) due to poor core stabilization. In response to this dysfunction, the body increases tone in the hip flexors to help create some stabilization. In treating these individuals, I want to decrease tone of these muscles and then follow that up with specific exercises that help them develop better core control.
The illiacus attaches on the upper portion of the femur and begins on the inside crest of the illium (inside of the pelvis), where the psoas attaches all the way through the transverse processes of the lumbar spine, even binding into the discs directly. The rectus femoris begins at the base of the anterior superior illiac spine, and attaches all the way down to the knee cap, whereas the sartorius starts in the same place as the rectus femoris, but attaches on the medial aspect of the knee, blending with the MCL and portions of the hamstrings.
The iliotibial band is a thickening of the fascia lata, the deep fascia of the thigh. Think of it as a thick long ligament like structure that connects the hip to the lower leg along the outside of the thigh. Tightness in the iliotibial band can cause patellofemoral pain, trochanteric bursitis, and friction syndromes at the knee. This is a hip stretch I commonly prescribe to runners and people suffering from knee pain.