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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  Hip flexion
– iliopsoas – gluteus maximus
– pectineus – biceps femoris
– rectus femoris – semitendinosus
 Knee flexion
– semimembranosus
– semitendinosus
– six deep external rotators
– semimembranosus
 Knee flexion
– biceps femoris
– gracilis – rectus femoris
– popliteus – vastus medialis, intermedius,
– gastrocnemius & lateralis
 External rotation of hip joint
– iliopsoas  External rotation of hip joint
– six deep lateral rotator muscles – gluteus minimus
– gluteus medius & maximus – semitendinosus
– biceps femoris – semimembranosus
– adductor brevis & magnus – 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 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 ❁ Second Class
❁ Axis = hip joint/knee joint
Lever
❁ Force = insertion (patella)
❁ Axis = hip joint
❁ Resistance = weight at
feet (squat, leg press, etc.) ❁ Force = insertion
or mid-shin (knee (patella)
extension ❁ Resistance = mid-
thigh/quad (hip
flexion)
DOES WHAT?
❁ACTION
✰Flexion of the hip
✰Extension of the knee
APPLICATION
❁ SYNERGISTS ❁ ANTAGONISTS
✰Sartorius ✰Hamstrings
✰Tensor Fascia
✰Gluteus
Latae
Maximus
✰Vastus Lateralis
✰Vastus Medius
✰Vastus Intermedius
PALPATION
❁ INNERVATION ❁ PALPATION
✰Femoral nerve ✰Any place on the
✹L2 anterior surface
✹L3 of the femur
✹L4
EXERCISES
❁ Leg press
❁ Lunge
❁ Leg Extension
❁ Step-up
❁ Squat
✰Front Squat
✰Full Squat
✰Hack Squat
✰Safety Squat
LEG PRESS
SQUATS
LUNGE
STEP-UP
HIP FLEXION
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  Obturator exernus
– 1st or 2nd sacral nerve – obturator nerve (L3-4)
 Gemellus superior  Obturator internus
– sacral nerve (L5-S2) – branches from sacral
 Gemellus inferior plexus (L4-S2)
– branches from sacral  Quadratus femoris
plexus (L4-S2) – 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  Biceps femoris

 Sartorius  Adductor brevis

 Gluteus medius  Adductor mangus


– posterior fibers

 Gluteus maximus
Antagonists
 Tensor fasciae latae  Semimembranosus

 Gluteus minimus  Pectineus

 Gluteus medius  Gracilis


– anterior fibers

 Semitendinosus
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  Dance
– batting
– pitching  Track & Field
– discus
 Basketball – shotput
– pivoting
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 INSERTION
 Posterior one-fourth of  Oblique ridge on the
the crest of the ilium lateral surface of the
 Posterior surface of greater trochanter and
the sacrum and coccyx the iliotibial band of
near the ilium, and the fasciae latae
fascia of the lumbar
area
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  External Rotation
Semitendinosus Piriformis
Semimembranosus Gemellus superior
Biceps femoris Gemellus inferior
Obturator externus
Obturator internus
Quadratus femoris
Gluteus Medius
Adductor brevis
Antagonist
 Extension  External Rotation
Rectus femoris Semitendinosus
Iliopsoas Semimembranosus
Sartorius Pectineus
Tensor faciae latae Gracilis
Pectineus
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 Lying Glute
Stretch
– 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.
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 Origin of 
short head: 
lower half of 
linea aspera 
and lateral 
condyloid 
Insertion for  ridge
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 hip


 Flexion of the knee
 External rotation of the hip
 External rotation of the knee
Synergists

HIP EXTENSION: HIP EXTERNAL ROTATION:
Gluteus Maximus Gluteus Maximus
Semimembranosus Posterior fibers of Gluteus medius
Semitendinosus Adductor Magnus
Lateral Rotators Adductor Brevis
Lateral Rotators
Sartorius
Iliopsoas
Synergists
KNEE FLEXION: EXTERNAL ROTATION 
OF THE KNEE:
Sartorius
Iliopsoas (femur)
Semitendinosus
Sartorius (thigh)
Semimembranosus
Gracilis
Antagonists

HIP EXTENSION: HIP EXTERNAL ROTATION:
Iliopsoas Anterior fibers of Gluteus medius
Pectineus Gluteus minimus
Rectus femoris Semimembranosus
Sartorius Semitendinosus
Tensor Fascia Latae Gracilis
Pectineus
Antagonists

KNEE FLEXION: EXTERNAL 
ROTATION OF KNEE:
Rectus femoris
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
 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 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 Insertion
 Anterior pubis just  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 Synergist
 Gluteus medius  Adductor brevis
 Gluteus minimus  Adductor magnus
 Tensor fasciae latae  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  Antagonists
– Gracilis – Gluteus Medius
– Adductor longus – Gluteus Minimus
– Adductor Brevis – Tensor Fasciae Latae
– Adductor Magnus
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), 4-
vastus medialis)
Antagonists
 Hamstrings—Biceps
femoris,
semimembranosus,
semitendinosus
 Popliteus
Palpation

 Cannot be palpated; deep to the rectus


femoris.
Sports
 Running  Tennis
 Football  Lacrosse
 Soccer  Rowing
 Baseball  Track

 Rugby  Basketball
 Volleyball
 Walking
 Gymnastics
 Swimming
 Anything with knee
 Diving
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 Antagonist
(Plantar Flexion) (Plantar Flexion)
-Soleus -Peroneus teritius
-Peroneus longus -Extensor digitorum
longus
-Peroneus brevis
-Tibialis anterior
-Tibialis posterior
Gastrocnemius
Synergist Antagonist
(Knee Flexion) (Knee Flexion)
-Popliteus -Rectus femoris
-Vastus lateralis
-Gracilis
-Vastus intermedius
-Hamstring Muscles
-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  Antagonists
– Gastrocnemius – Peroneus tertius
– Peroneus longus – Extensor digitorum
– Peroneus brevis longus
– Tibialis posterior – Extensor hallucis
– Flexor digitorum longus
longus – Tibialis anterior
– Flexor hallucis longus
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) (Dorsal Flexion)
-Gastrocnemius -Peroneus teritus
-Soleus -Extensor digitorum
-Peroneus longus longus
-Peroneus brevis -Tibialis anterior
-Tibialis Posterior
Plantaris Muscle
 Synergists  Antagonist
(Knee Flexion) (Knee Extension)
-Gastrocnemius -Rectus Femoris
-Popliteus -Vastus Laterialis
-Gracilis -Vastus Intermedius
-Hamstring Muscles -Vastus medialis
Plantaris Muscle
 Exercises
-Barbell Standing Calf Raise
-Dumbbell Single Calf Raise
-Lever Seated Calf Extension
-Lever Standing Calf Raise
Barbell Standing Calf Raise
Dumbbell Single Leg Calf Raise
Lever Seated Calf Extension
Lever Standing Calf Raise
Plantaris Muscle
Stretches
-Floor Board Calf Stretch
-Calf Step Stretch
-Wall Stretch
Floor Board Calf Stretch
Calf Step Stretch
Wall Stretch
Plantaris Muscle
 Sports & Activities
-Jumping
-Running
-Basketball
-Jump Rope
-Volleyball
Peroneus Longus
Peroneus Longus

 Origin
– Head and upper two-thirds of the lateral surface
of the fibula
Peroneus Longus

 Insertion
– Undersurfaces of the medial cuneiform and first
metatarsal bones
Peroneus Longus

 Innervation
– Superficial peroneal nerve (L4-5, S1)
Peroneus Longus

 Third-class lever
– Axis- ankle joint (talocrural joint)
– Force- insertion point at the medial cuneiform
and first metatarsal
– Resistance- the resistance of the ground or
object foot is against
Peroneus Longus

 Palpation
– Upper lateral side of the tibia, just
posterolateral from the tibialis anterior and the
extensor digitorum longus
Peroneus Longus

 Actions
– Eversion of the foot
– Plantar flexion of the ankle
Peroneus Longus

 Synergists
– Eversion
• Peroneus brevis
• Peroneus tertius
• Extensor digitorum longus
Peroneus Longus

 Synergists
– Plantar flexion of ankle
• Gastrocnemius
• Soleus
• Peroneus brevis
• Tibialis posterior
• Flexor digitorum
• Flexor hallucis longus
Peroneus Longus

 Antagonists
– Inversion
• Tibialis anterior
• Tibialis posterior
• Flexor digitorum longus
• Flexor hallucis longus
• Extensor hallucis longus
Peroneus Longus

 Antagonists
– Dorsiflexion
• Peroneus tertius
• Extensor digitorum longus
• Extensor hallucis longus
• Tibialis anterior
Peroneus Longus

 Strengthening exercises
Peroneus Longus

 Stretches
– Extreme passive inversion and dorsiflexion of
the foot while the knee is flexed
Peroneus Longus
 Sporting activities
– Involved in any activity involving running or
walking, especially in activities involving a
quick transition from one foot to the other.
• Football
• Basketball
• Hockey
• baseball
Peroneus Brevis Muscle
Peroneus Brevis Muscle
 ORIGIN
– Lower 2/3 of the lateral
surface of the fibula
Peroneus Brevis Muscle
 Insertion
– Tuberosity of the 5th
metatarsal bone
Peroneus Brevis Muscle
 Actions
– Eversion of the foot
– Plantar flexion of the ankle
 Innervation
– Superficial peroneal nerve
 Palpation
– Tendon of the muscle at the proximal end of the
5th metatarsal
Peroneus Brevis Muscle

 Lever
– Third Class Lever
• axis: ankle or subtalar joint
• force: base of the 5th metatarsal
• Resistance: weight of the foot or resistance of the
floor when cutting and push-off.
Peroneus Brevis Muscle

 Exercises
– Eversion with theraband
– Plantar Flexion
• seated calf raises
• standing calf raises
Peroneus Brevis Muscle

 Stretches
– Manual inversion of the ankle with slight dorsi-
flexion
Peroneus Brevis Muscle
 Applications
– Stabilization of the ankle from inversion
– Jumping and Running
• any sport
– Cutting to the opposite direction
• basketball
• baseball and softball
• football
• tennis
Peroneus
Tertius

Do you have a
Peroneus Tertius?
Origin- distal third of
the anterior fibula

Insertion- base of the


fifth metatarsal
Action- eversion of the foot
dorsal flexion of the ankle

Palpation- lateral to the extensor digitorum


longus tendon on the anterolateral aspect

Innervation- deep peroneal nerve (L4-5,


S1)
3rd class lever
Axis- ankle joint
Force- insertion which is the base of the fifth
metatarsal
Resistance- at the toes
Synergists

Dorsiflexors Evertors
Tibialis anterior Peroneus longus
Extensor digitorun longus Peroneus brevis
Extensor hallucis longus Extensor digitorum longus
Antagonists
Plantar flexors Invertors
Gastrocnemius Tibialis anterior
Flexor digitorum longus Tibialis posterior
Peroneus longus Flexor digitorum longus
Peroneus brevis Flexor hallucis longus
Plantaris
Soleus
Tibialis posterior
Stretch
take foot into
extreme
inversion and
plantar flexion
Strengthening
Below: 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 + 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 Insertion
 Posterior surface of  Lower inner surfaces
the upper half of the of the navicular and
interosseus membrane cuneiform bones and
and adjacent surfaces bases of the 2nd-5th
of the tibia and fibula. 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 Synergist
 Tibalis anterior(PF)  Tibalis anterior(In.)
 Extensor halluc  Tibialis posterior
longus(PF)  Flexor hallucis longus
 Peroneus tertius(In. &  Peroneus longus,
PF) brevis(PF)
 Extensor dititorum  Gastrocnemius
longus  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  Inversion of the foot
ankle – Flexor digitorum
– Flexor digitorum longus
longus – Flexor hallucis longus
– Flexor hallucis longus – Tibialis anterior
– Peroneus brevis – Extensor hallucis
– Peroneus longus longus (weak)
– Soleus
– gastrocnemius
Antagonists
 Dorsal flexion of the  Eversion of the foot
ankle – Extensor digitorum
– Tibialis anterior longus
– Extensor hallucis – Peroneus tertius
longus – Peroneus brevis
– Extensor digitorum – Peroneus longus
longus
– Peroneus tertius
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  Second Class lever in
flexion of the great toe
plantar flexion of the
Axis: Interpahlangeal or
metatarsophalangeal ankle
joint of big toe Axis: is the ankle
Force: base of the phalanx
of large toes
Resistance: at mid foot
Resistance: Base of the big Force: base of distal
toe phalanx of large toe
Synergists and Antagonists

 Synergists  Antagonists
Plantar Flexion Plantar Flexion
Gastrocnemius Tibialis anterior
Flexor digitorum longus Peroneus tertuis
Peroneus longus Extensor digitorum longus
Peroneus brevis Extensor hallucis longus
Planaris Flexion of the big toe
Soeus Extensor hallucis longus
Tibialis posterior Inversion
Inversion Peroneus longus
Tibialis posterior Peroneus brevis
Flexor difitorum longus Peroneus tertius
Tibialis anterior Extensor digitorum longus
Extensor halllucis 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 (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  Antagonists
– External Obliques – Erector Spinae muscles
– Internal Obliques – Obliques (to the
– Quadratus Lumborum 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  Innervation
– Lateral side of – Intercostal
the abdomen, nerves (T8-12),
either right or iliohypogastric
left 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.