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Hip Muscles Cheat Sheet (DRAFT) by

Hip muscles, Trps and how to palpate them

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Iliopsoas

Psoas Major

Origin: TVPs of T12-L4 + lateral aspects of the discs between them
Insertion: Lesser Trochanter of the femur
Nerve: Lumbar plexus - anterior branches of L1-L3 nerves
Action: Flexion of hip, flexion of upper lx, extension of lower lx
- Antagonist - Glut Max

Psoas Major - Palpation

Psoas Major - Trigger Points

- Patients with unilateral iliopsoas TrP tend to feel LBP that runs up and down the spine. Pain from bilateral TrPs tends to be felt across the back as in QL and rectus abdominis TrPs
- Iliopsoas TrPs do not cause pain on deep inspir­ation or coughing whereas QL TrPs do
- TrPs in Psoas may be associated with spinal manipu­lable lesions around the thorac­olumbar junction

Iliopsoas Minor

- Sometimes absent
Origin: lies anterior to psoas major, sides of the bodies of 12th tx and first lx and from the disc inbetween them
Insertion: Pecineal line and iliope­ctineal eminence and laterally to the iliac fascia
NS: Lumbar plexus Ventral rami L1
Action: Flexion of the trunk
Trps same as Psoas Major
Psoas minor syndrome where an overly taught psoas minor mimics append­icitis.
- Taught band on RLQ of the abdomen

Iliacus

- Origin: superior 2/3 of concavitiy of the iliac fossa, inner lip of the iliac crest, ventral SI and iliolumbar ligaments and upper surface of the lateral part of the sacrum
- Insertion: Lesser trochanter of the femur
- NS: Femoral nerve L2-L3
- Action: Flexion and external rotation of the thigh
TrPs same as psoas

Illiacus - Palpation

Levator Ani

Consists of:
- Ischio­coc­cygeus
- Ilioco­ccygeus
- Puboco­ccygeus

Ischio­coc­cygeus

- At poster­osu­perior portion
- Attached to pelvic surface and tip of the iliac spine
- Base attached to lateral margins of coccyx and 5th sacral segment
- Usually tendinous than muscular
- Sometimes fused with sacros­pinous ligament

Ilioco­ccygeus

- Attached to inner surface of ischial spine
- Posterior fibres attached to the tip of the sacrum and coccyx

Puboco­ccygeus

- Attached to the back of the body of the pubis
- Medial fibres run lateral to the urethra and its sphincter (pubop­eri­nea­lis­/pu­bou­ret­hra­lis))
- Forms part of the urethral sphincter - fibres decussate across the midline directly behind urethra
- In males, fibres lie lateral and inferior to the prostrate (levator prostatae) In females the fibres form a sling around the posterior wall of the vagina ( pubova­gin­alis)
NS: 2nd and 3rd sacral spinal segments from pundendal nerve
Action: Lateral compressor of the canals - reinfo­irces external anal sphincter, reduces antero­pos­terior dimension of the ano-ur­oge­nital hiatus

LA -Trps

Glut Max

Gluteus Maximus

Origin: posterior gluteal line of the ilium, aponeu­rosis of ES, dorsal suface of lower part of the sacrum and side of the coccyx, sacrot­uberous ligament and gluteal aponeu­rosis
Insertion: Superf­icial fibres = iliotibial tract of the fascia lata
Deep fibres = gluteal tuberosity
NS: Inferior gluteal nerve L5-S2
Actions: Extends flexed thigh, walking, climbing stairs, lateral rotation of the thigh
Upper fibres abduct the thigh
inactive during standing, swaying forwards at the ankle joints, bending forwards at the hip joints

Glut Max TrPs

- Can develop with manipu­lable lesions in SI joint
- Increased Tx kyphosis and AHC can increase hip flexion
- Sitting on a wallet or uneven chair
- Glut med, hamstr­ing­s,m­inimus can develop satellite TrPs with glut max
- Hamstr­ing­s,lower paraspinal muscles distorts pelvic structure when tight - anatag­onist iliopsoas and rect fem developing Trps - treating these eases pressure off glut max

Glut Med

Glut Medius and Minimus

Glut Medius

- Origin: Outer surface of the ilium between iliac crest and posterior gluteal line above and anterior gluteal lone below
- Insertion: Lateral surface of GT
- NS:* Superior gluteal nerve L4-S1
- Action: Abduct the thigh, anterior fibres rotate it medially, posterior fibres create lateral rot
Maintains upright trunk posture when walking (foot on opposite side is raised from the ground - makes pelvis sag downwards on unsupp­orted side)

Glut Med Trps

- Presents similar to SIJ dysfun­ction
- Sitting for too long/l­eaning forwar­d/lying on affected side can activate Trps
- Unequal leg length, walking on uneven ground can perpetuate TrPs
- Secondary Trps can develop in pirifo­rmis, posterior part of glut min and max when posterior fibres of glut max develop TrPs
- When anterior glut max fibres are involved, 2ndary Trps can delevop in the TFL and satellite TrPs from QL
  

Glut Minimus

Glut Minimus

- Origin: Outer surface of ilium
- Insertion: Antero­lateral ridge on GT
- NS: Superior Gluteal Nerve L4-S1
- Actions: Abduction of the thigh and anterior fibres rotate it medially, maintains upright posture of trunk when foot of the opposite side is raised from the ground

Glut Minimus and Medius - Palpation

Glut Min TrPs

- Referred to as pseudo­sci­atica - severe and persistant pain down leg
- TrPs in anterior fibres = mimics L5 Radicu­lopathy
- TrPs in posterior fibres = mimics S1 Radicu­lopathy
- Can cause SIJ Dysfun­ction
- Associated with TrPs in pirifo­rmis, gluteus medius, vatus lateralis, fibularis longus, quadratus lumborum and gluteus maximus

Piriformis

Piriformis

Origin: Anterior surface of sacrum, Gluteal surface of ilium, Sacrot­uberous ligament
Insertion: Medial side of upper border of GT
NS: Branches from L5-S2
Action: Rotates extended thigh laterally, abducts flexed thigh

Piriformis - Palpation

Piriformis TrPs

Associated trigger points include the gluteus medius, gemelli, obturator internus, levator ani and coccygeus
- Causes Pain and parest­hesia in LB, Grion, perineum, buttoc­k,hip, posterior thigh, leg and foot, defaec­ation
- Aggravated by prolonged sitting, hip flexion, adduction, internal rotation

Short Lateral Rotators

Consists of:
- Obturator Internus
- Oburator Externus
- Gemellus inferior and Gemellus superior
- Quadratus Femoris
TrPs usually presents as tenderness deep to glut max and inferior to piriformis (medial to upper third of GT - Gemelli or obturator internus)
Tender­sness deep to medial border of the GT = Quadratus femori­s/o­btu­rator externus
- Obutartor externus can present with groin pain, check pectineus and adductor brevis

Oburator Internus

- Origin: Ischio­pubic Ramus and obturator membrane
- Insertion: Medial aspect of GT
- NS: Nerve to obturator internus (L5-S2)
- Action: Abducts and lateral rotates extended hip, abducts the flexed thigh at the hip and stabilises hip during walking

Obturator externus

-Origin: Obturator foramen and Obturator membrane
- Insertion: Trochantic fossa of femur
- NS: Posterior branch of obturator nerve (3rd and 4th lx nerves)
- Actions: Adduct thigh, laterally rotates thigh

Gemellus inferior and gemellus superior

- Top: Inferior Gemellus
- Bottom: Superior Gemellus

Superior Gemellus

- Origin: Dorsal surface of ischial spine
- Insertion: Medial surface of GT
- NS: Nerve to Oburator internus L4-S1
- Action: rotates extended thigh laterally and abduct flexed thigh

Inferior Gemellus

Origin: Upper part of lateral surface of the ischial tuberosity
Insertion: Medial surface of GT
NS: Nerve to Quadratus Femoris L4-S1
Action: Rotate extended thigh laterally and abduct the flexed thigh

Quadratus Femoris

Origin: Upper part of external aspect of ischial tuberosity
Insertion: Middle of trocha­nteric crest of the femur
NS: Quadratus Femoris nerve L5 and S1
Action: Lateral rotation of the thigh

Quadratus Femoris - Palpation