Adductor longus : The adductor longus has the most easily palpable proximal tendon of all the hip flexors ; and is usually clearly palpable even when it is relaxed . Once located , return laterally for the pectineus ( Image 7 ). But if we did want to engage it to make it contract and pop , then we ask the client to gently adduct the thigh at the hip joint .
Image 7 . Palpation of the adductor longus .
Adductor brevis : The adductor brevis is the most challenging and variable of the hip flexors . Sometimes it is wholly deep to the adductor longus , and therefore not discernable from the more-superficial adductor longus . Sometimes there is some superficial exposure of the adductor brevis on the lateral side of the adductor longus , between it and the pectineus . But most often , there is a small amount of superficial exposure of the adductor brevis lateral ( and at this point , it could be said to be posterior ) to the adductor longus . However , because the longus and brevis share all the same joint actions , it is not possible to find a different joint action to discern between them .
Gracilis : Whether it is the adductor longus or brevis , we drop immediately medial ( posterior ) and we should be on the gracilis . To discern the gracilis , we ask the client to flex the leg at the knee joint and only the gracilis will engage , given that the adjacent muscle on each side does not cross the knee joint and , therefore , will not engage with knee flexion ( Image 8 ).
Adductor magnus : Once the gracilis has been found , we drop immediately posterior off it and we will be on the adductor magnus . To engage it , we can
A Image 8 . Palpation of the gracilis .
ask the client to extend the thigh at the hip joint and the adductor magnus will engage ( the anterior head of the adductor magnus is a hip flexor , but its posterior head does hip extension ), but the gracilis will not ( Image 9 ).
A
B
Medial hamstrings
Gracilis
Image 9 . Palpation of the adductor magnus .
Medial hamstrings : We can locate the medial hamstrings ( semitendinosus and semimembranosus ) by asking the client to flex the leg at the knee joint . This will engage the hamstrings but not the adductor magnus . Given that the exercise that we are engaging in with this article is to palpate and discern the hip flexors , we are only locating the medial hamstrings as a means of locating the posterior border of the adductor magnus .
As I hope this rubric shows , we can use joint actions as a means of palpation to locate and discern our target muscle . Indeed , this is how muscle palpation is classically taught and I wholly approve of this approach and use it as my default guideline with palpation assessment . However , this approach can be costly
B timewise , so I would like to offer the possibility of a different approach to muscle palpation . When possible , if a target muscle can be palpated and discerned simply by knowing its location , and then using its contour to be confident that we are on it , this saves time and energy and facilitates the job of muscle palpation . This contour approach to muscle palpation can be used when palpating the hip flexor musculature , and when used here , I like to call it the hill and valley approach . Instead of spending time asking the client to engage the target muscles , we can simply discern each hip flexor muscle by its contour : if the contour is rounded and prominent , it is a hill ; if it is flat and sits recessed between two hills , it is a valley .
Hill and Valley Approach
The beauty of applying the hill and valley approach to palpation of the hip flexor musculature is that the hip flexor muscles form an alternating contour of hill , valley , hill , valley , etc .
We begin with the TFL which has a rounded contour and is clearly a hill . We drop immediately medial off it and the rectus femoris sits in a valley between the rounded hills of the TFL on the lateral side and the sartorius on the medial side . From the hill of the sartorius , we drop medially off it , and we have the valley of the iliacus , which sits between the hills of the sartorius on the lateral side and the psoas major on the medial side . The psoas major is another hill , and immediately medial to it is the valley of the pectineus that sits between the hills of the psoas major on its lateral side and the adductor longus on its medial side . The adductor brevis is variable , but often sits as a valley between the hills of the adductor longus on its lateral side and the gracilis on its medial ( posterior ) side . The gracilis is a hill and immediately posterior to it is the adductor magnus that is a valley that sits between the hills of the gracilis on its anterior side and the medial hamstrings that sit on its posterior side .
142 | vol30 | no3 | JATMS