Trigger Point Therapy - Treating the Hip Adductors
Treating the hip adductors - Stuart Hinds
The adductor magnus is the largest of the adductor muscle group, which also includes the adductor brevis and adductor longus.
The adductor longus is the most anterior of the three. The adductor brevis lies anterior to the adductor magnus.
The lateral border of the upper fibers of the adductor longus form the medial border of the femoral triangle (the sartorius forms the lateral boundary; the inguinal ligament forms the superior boundary).
Adductor Magnus - Common Trigger Point Sites
Adductor Brevis and Adductor Longus - Common Trigger Point Sites
ORIGIN
Anterior part of pubic bone (ramus). Adductor magnus also takes origin from ischial tuberosity.
INSERTION
Whole length of medial side of femur, from hip to knee.
ACTION
Adduct and laterally rotate hip joint. Adductors longus/brevis also flex extended femur and extend flexed femur.
NERVE
Magnus: posterior division of obturator nerve L2, 3, 4. Tibial portion of sciatic nerve, L4, 5, S1. Brevis: anterior division of obturator nerve, (L2–L4). Sometimes the posterior division also supplies a branch to it.
Longus: anterior division of obturator nerve, L2, 3, 4.
BASIC FUNCTIONAL MOVEMENT
Example: bringing second leg in or out of a car.
REFERRED PAIN PATTERNS
There are several zones of referred pain: (1) two zones localized around anterior hip 5–8 cm, and above knee 5–8 cm; (2) whole anteromedial thigh from inguinal ligament to medial knee joint; (3) medial thigh from hip to knee.
INDICATIONS
Deep pain/tenderness in medial thigh, hip/leg stiffness on abduction, pain on weight bearing/rotating hip, “clicky” hip, hot/stinging pain under thigh, groin strain, post hip- replacement/fracture rehabilitation, renal tubular acidosis, swollen legs, osteoarthritis of hip.
CAUSES
Leg splint/cast, foot/ankle problems, sudden overload due to gymnastics, football/ice skating injury, horse riding, skiing, cross-legged sitting.
DIFFERENTIAL DIAGNOSIS
Avulsion. Pubic symphysis dysfunction. Neuropathy. Lymphadenopathy. Hernia. Knee pain (mechanical). Osteoarthritic hip. Femoral herniation.
CONNECTIONS
Pectineus, vastus medialis, iliopsoas, vastus lateralis, sartorius (lower end).
Prescribed stretching exercises can be useful
GENERAL ADVICE TO CLIENTS
Modify activities until trigger points diminish. Home stretch program. Avoid overuse at gym. Explore habitual postures. Check techniques (ex. skiing/ cycling). Explore vitamin/mineral deficiency.
Treatment techniques include deep stroking massage, compression, muscle energy techniques, and positional release techniques
Post-Isometric (PIR) Technique
Indications: subacute to chronic settings
1. Identify the trigger point.
3. Using 10–25% of their power, ask the patient to contract the affected/host muscle at its maximal pain-free length, while applying isometric resistance for 3–10 seconds; stabilize the body part to prevent muscle shortening.
5. During this relaxation phase, gently lengthen the muscle by taking up the slack to the point of resistance (passive)—note any changes in length.
Links
Find a Trigger Point Professional in your area
Corrective Exercises for Hip and Shoulder
Treating Hip Pain and Dysfunction
Certify as a Trigger Point Therapist
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