Syndrome of the iliopsoas muscle (psoas-syndrome)

… the development of this syndrome is observed with pathological tension of the iliopsoas muscle .

ETIOLOGY and PATHOGENESIS

iliopsoas muscle syndrome ( psoas-syndrome) is a secondary reflex vertebrogenic syndrome(against the background of lumbar vertebral pathology) or a variety of muscular-tonic and neurodystrophic syndromes caused directly by muscle damage as a result of trauma, pelvic pathology of various etiologies (inflammatory, oncological, dystrophic), as well as pathology hip joint(fracture of the neck of the femur, arthritis of the hip joint, the initial stage of aseptic necrosis of the femoral head). Iliopsoas syndrome occurs in 30-40% of patients with diseases of the hip joint and as an independent disease in 2.5% (usually in young people).

Manifestations of clinical manifestations contribute to diseases of the intestines, gallbladder or kidneys (see the article "Reflex muscle pain syndromes with nephroptosis (clinic)" in the "vertebrology" section of the medical portal site). The implementation of exacerbation is usually due to physical overload.

ANATOMY OF THE ILIOPUM MUSCLE

Common iliopsoas muscle (m. iliopsoas) consists of two muscles: the large lumbar muscle (m. psoas major) and the iliac muscle (m. iliacus), which, starting at various places(on the lumbar vertebrae and ilium), are connected into a single muscle. The iliopsoas muscle exits (behind the inguinal ligament) through the muscle gap into the thigh region and is attached to the lesser trochanter of the femur. Before attaching to the lesser trochanter, the iliopsoas muscle is located on the anterior surface of the hip joint, covering the anterior edge of the articular cavity and the femoral head, often having a common mucous bag with the joint. Over a long distance, both parts of the muscle take part in the formation of the muscular base of the posterior wall of the abdominal cavity.

Psoas major (m. psoas major) begins with five teeth from the lateral surface of the bodies of the XII thoracic, four upper lumbar vertebrae and the corresponding intervertebral cartilages. Deeper muscle bundles originate from the transverse processes of all lumbar vertebrae. Located in front of the transverse processes, this muscle is tightly adjacent to the vertebral bodies. Somewhat narrowing, the muscle goes down and slightly outward and, connecting with the bundles of the iliac muscle, m. iliacus, forms the common iliopsoas muscle.

Iliac muscle (m. iliacus) massive, flat and fills the entire iliac fossa, fossa iliaca (ilium), adjacent to the lateral side of the psoas major muscle. It starts from the upper two-thirds of the iliac fossa, the inner lip of the iliac crest, the anterior sacroiliac and ilio-lumbar ligaments. The bundles that make up the muscle fan-shaped converge to the linea terminalis and here merge with the bundles m. psoas major, forming m. iliopsoas.

Iliopsoas muscle (m. iliopsoas) flexes the hip at the hip joint, rotating it outward. With a fixed hip, tilts (bends) the torso forward. Innervation: rr. musculares plexus lumbalis (L1-L4). Blood supply: a. iliolumbalis, circumflexa ilium profunda.

CLINICAL PICTURE and DIAGNOSIS

In recognizing the syndrome of the iliopsoas muscle (iliopsoalgia), the characteristic clinical signs of this syndrome help.

Complaints. Patients complain of excruciating pain in lumbar region, appearing then in the groin or in the lower part of the buttocks. The pains are aggravated in the position on the stomach, when walking, hip extension, turning the torso in the "healthy side".

Vertebral, cognitive and locomotor symptoms. The pelvic tilt on the side of the lesion is characteristic, which leads to functional shortening of the lower limb and hyperlordosis lumbar spine. When walking or standing, the patient is tilted forward or to the affected side. Leaning back is not possible, but forward is easily possible. Patients prefer to lie on their back or side bent leg, which is due to iliac-lumbar myopically. This also explains the fixed lumbar deformity, more often by the type of kyphosis. If the tonic activity of the muscle forms hyperlordosis, then the most unfavorable S-shaped curvature of the spine in the sagittal plane occurs. Patients can hardly walk, prefer to sit or lie only on their side. Spontaneous pain in the groin and lower back appears or increases with hip extension (Wassermann's symptom, currently considered as a test for stretching the iliopsoas muscle). Characterized by soreness of the muscle and its tendon immediately below the middle of the pupart (inguinal) ligament or the place of its attachment to the lesser trochanter. This zone of neuromyofibrosis is palpated in the lower outer gluteal quadrant. Sometimes it is possible to palpate the painful muscle through the relaxed abdominal wall (an analogy with the Shkolnikov-Osn symptom). A positive reaction of postisometric relaxation of the lumboiliac muscle is characteristic: an increase in the range of motion in the joint after a long (2-5 minutes) stretching of the lumbar muscle according to S. P. Veselovsky, a positive result after performing a therapeutic and diagnostic blockade of m. iliopsoas.

Complications of the hip joint. The pathology of the iliopsoas muscle leads to a pelvic tilt “to the affected side”, pressure on the hip joint area, causing its secondary inflammation and rotational flexion and adductor contracture (a type of hip joint hyperpressure syndrome). This symptom complex is the cause of persistent pain and contractures in at least 30% of patients, simulating and aggravating the course of various diseases and injuries of the hip joint (Ugnivenko V.I.). The diagnosis of psoas-syndrome is largely hampered by the clinical similarity of this syndrome with the clinical manifestations of arthritis of the hip joint: pain in the head of the femur radiating to the knee joint, the hip is rotated outward, flexed and adducted, active flexion in the hip joint is sharply limited.

Neural symptom complex. The neural symptom complex initially includes pain, and then paresthetic phenomena along the anterior and inner surfaces of the thigh, and sometimes the lower leg. There are complaints of a slight decrease in strength in the leg, more often noted when walking. Hypesthesia or hyperpathy is determined below the pupart ligament in the anterior-medial parts of the thigh and, rarely, the lower leg. Possible hypotension and hypotrophy of the quadriceps muscle, decreased knee jerk.

Flow usually chronically recurrent, progredient-regredient. The exacerbation stage is delayed for more than one month. The regression of the disease is protracted. Remission is incomplete.

On the radiograph of the lumbar region in a direct projection, an increase in the density of the shadow of the psoas major muscle on the diseased side, a curvature of the spine in the frontal plane associated with a skew of the pelvis, and hyperlordosis of the lumbar region are sometimes detected.

With magnetic resonance imaging (MRI) an increase in the contour of the lumbar muscle at the level of L2-L4 is determined, probably due to its hypertonicity.

With needle EMG in the zone of muscle exit from under the pupart ligament, there is an increase in spontaneous activity during hyperextension in the hip joint and a decrease in amplitude with maximum effort on the affected thoron.

A method for diagnosing unilateral or bilateral pelvic pain caused by the syndrome of the iliopsoas muscle published by Ulyatovskaya LN; Silver L.A.; Zaporozhtsev D.A. February 10, 2003 (Base of patents of the Russian Federation). The essence of this method is as follows. Post-isometric relaxation is carried out by bending one leg at the knee in the supine position, then the patient rests on the knee with the palms of both hands and alternately strains and relaxes the leg for 10 seconds for 2-3 minutes. Similar actions are carried out with the other leg. If post-isometric relaxation leads to a noticeable decrease in the level of pelvic pain on one or both sides, then unilateral or bilateral pelvic pain is diagnosed due to the iliopsoas muscle syndrome.

TREATMENT

Methods for eliminating the syndrome of the lumboiliac muscle

In the early stages of the syndrome of the lumboiliac muscle (with the exception of cases of the occurrence of this syndrome in the pathology of the abdominal cavity and pelvic organs), it is performed by the method of post-isometric relaxation, in case of ineffectiveness, drug blockade of the muscle is performed. Comprehensive treatment includes methods for stabilizing the lumbar spine (unloading mode, bandage, therapeutic exercises to strengthen the muscles of the body), general strengthening, anti-inflammatory drug therapy, hydrokinesitherapy, muscle relaxants.

Postisometric relaxation of the iliopsoas muscle

First option. Starting position the patient - lying on his back, the leg hangs freely from the couch. The starting position of the doctor - standing facing the head end, fixes the upper third of the lower leg with the same hand. On inspiration, the patient raises the straight leg, overcoming the resistance of the doctor. The position is fixed for 9-12 seconds. On the exhale - the leg freely falls down. Reception is repeated 3-4 times.

Second option. The initial position of the patient is lying on his stomach. The starting position of the doctor is standing facing the head end. The doctor's opposite hand and thigh fix the lower third of the patient's thigh, the other hand fixes the lumbar spine. On inspiration, the patient seeks to press his leg to the couch, and the doctor resists. The position is fixed for 9-12 seconds. On exhalation, the doctor passively stretches the muscle, lifting the patient's leg up and fixing the lower back. Reception is repeated 3-4 times.

Third option. The initial position of the patient is lying on his back, at the end of the couch, the pelvis at the edge of the couch. The leg, on the side of the relaxed muscle, hangs freely, the other leg is bent at the knee and hip joints. The starting position of the doctor is standing at the foot end of the couch, facing the patient. One hand of the doctor fixes the lower third of the thigh, the other - the upper third of the lower leg of the bent healthy leg. On inspiration, the patient seeks to raise the lowered leg, overcoming the resistance of the doctor. The position is fixed for 9-12 seconds. On exhalation - the doctor passively stretches the muscle with moderate pressure on the thigh of the lowering leg. Reception is repeated 3-4 times.

Medicinal blockades of m.iliopsoas according to the methods developed in CITO

First option. The drug mixture in a volume of 50-100 ml (0.5% novocaine solution, 25-50 mg hydrocortisone, 400 mg cyanocobalamid) after appropriate anesthesia through a 15-20 cm long needle is injected into the abdomen of the iliopsoas located in the pelvic area. Direction of the needle: entry point - 6 cm below the inguinal fold at the level of its middle and outer third, the direction of the needle at an angle of 30 degrees to the surface of the thigh in the direction of the posterior superior iliac spine, through the lacuna musculorum into the cavity of the small pelvis until resistance of the muscular fascia appears . The correctness of the introduction is determined as paresthesia appears in the projection of innervation femoral nerve and elimination of the muscular component of flexion contracture in the hip joint.

Second option. Blockade of the lumbar muscle by paravertebral access. Paravertebral (departing from the spinous process by 5-6 cm) at the level of L1-L2, a puncture needle 15-20 cm long is inserted until it stops into the transverse process of the vertebra and, bending around it along the upper edge, until a “dip” is felt to a depth of 5 cm. in the forward direction. With the technically correct implementation of the blockade at the time of injection, there is a feeling of warmth in the limbs, paresthesia, elimination of pain in the hip joint.

Third option. In the absence of skills or tools necessary for a full puncture, the drug mixture is injected into the area of ​​the "Skarpovsky triangle" outward from the vascular bundle.

The iliopsoas muscle belongs to the group internal muscles pelvis and takes part in the movement of the lower limbs and body, being one of the most powerful flexor muscles in the human body. The iliopsoas muscle is located in the large iliac fossa, connecting the three most important segments of the human musculoskeletal system: the pelvis, trunk and legs.

Anatomy of the iliopsoas muscle

PPM is a paired structure formed by the bundles of the iliac and psoas muscles.

The psoas major muscle originates at the lateral surface of the vertebrae of the lumbosacral region, attaching to their transverse processes. The iliac muscle starts from the fossa of the same name, attaching to the lower anterior spine. The bundles of these muscles, intertwining, exit the pelvic cavity through the muscle gap, descend down the anterior surface of the hip joint and are attached to the femur directly above its lesser trochanter with a short narrow tendon. Thus, the lateral processes of the lumbar vertebrae and the iliac spine can be called the place of attachment of the iliopsoas muscle in the upper part, and the femur in the lower part. Due to the deep location of the muscle, it is difficult to palpate, but the iliopsoas muscle can be felt at the point of its attachment to the femur above the lesser trochanter.

The main functions of the iliopsoas muscle are:

• stabilization of the body vertical position,
• adduction and rotation outwards of the lower extremities,
• hip flexion and adduction,
• fixation and supination of the hip joints,
• fixation of the kidneys in the abdominal cavity.

The innervation of the iliopsoas muscle is provided by the roots of the lumbar and femoral nerve plexuses. Blood supply is provided by the iliac-lumbar artery, deep artery and vein.

The antagonist of the iliopsoas muscle is the gluteus maximus, biceps, semimembranosus, and semitendinosus muscles of the thigh.

iliopsoas syndrome

Iliopsoas syndrome, or iliopsoalgia, is a traumatic or vertebrogenic functional disorder resulting from compression of the femoral nerve. The syndrome is manifested by autonomic, sensory, motor disorders, as well as persistent pain in the pelvic area. Pain intensifies when lying on the stomach, when walking, bending the hip, turning the torso.

The neural symptom complex in SPPM includes:

• weakening of the limb on the side of the injury,
• sensitivity disorders,
• numbness,
• burning sensation, tingling on the inner and front of the thigh.

With pathology, a pelvic tilt occurs, which creates increased pressure on the hip joint. This can lead to the development of contractures. Also, a prolonged spasm of the internal muscles of the pelvis has a negative impact on the work of vital internal organs.

Treatment of iliopsoas muscle syndrome is carried out with the help of a complex of drug and non-drug measures. To relieve pain and relieve muscle spasm, drugs are injected directly into the tissues - novocaine, hydrocortisone, cyanocobalamid.

Post-isometric relaxation is considered to be the most effective drug-free treatment method, which is a set of exercises based on tension and relaxation of individual muscle groups performed by the patient in close cooperation with the doctor.

muscle weakness

Weakening of the iliopsoas muscle can lead to the development of stoop and the so-called flat back. Prolonged stretching of the ligaments of the anterior part of the hip joint with stoop is one of the possible causes of the development of osteochondrosis. Also, the weakening of the muscle leads to a decrease in the mobility and flexion function of the hip joint, creating difficulties for the patient when standing up, climbing stairs, walking uphill.

Exercises to strengthen the iliopsoas muscle

To strengthen the muscle structures responsible for the movement of the lower limbs and keeping the body in an upright position, special exercises allow:

1. Alternately lifting the legs from a prone position. Lying on your back on a flat surface, place your hands under your head or under your buttocks. Alternately raise straight legs to a height of 10-15 cm from the floor and hold them for a few seconds in weight, then slowly lower them.
2. "Corner". Lie down on a flat surface. Raise your knees bent. Then, clasping your shins with your hands, begin to pull up to a vertical position. upper part torso while straightening the legs. The angle between the trunk and lower limbs should be right. In this position, you need to linger for a few seconds, and then smoothly return to the starting position.
3. Pulling up the legs in the hang. On the horizontal bar, pull your legs bent at the knees to your chest.
4. "Bridge". Lie on the floor, stretch your arms along the body. Bend your knees so that your feet are as close to your buttocks as possible. Slowly lift your pelvis up, hold in the extreme position for a few seconds and just as smoothly lower yourself to the floor.
5. Reverse plank. Sit on the floor. Leaning on straight arms and bending your knees to a right angle, raise your pelvis so that your torso is parallel to the floor. Stay in this position. If the exercise is easy to perform, do the bar, leaning on straight arms and heels; the body must be a straight line.

Disease prevention

The iliopsoas muscle can be called one of the most important in the human body. It is responsible for the movement of the limbs and keeping the body in an upright position, fixes the vital internal organs in the correct position. Its pathologies are fraught with motor disorders, disorders of innervation and circulation of the lower extremities, functional disorders of the kidneys and pelvic organs, so it is very important to prevent their occurrence. Since the most common causes of diseases are a sedentary lifestyle or, conversely, excessive exercise, the following prevention rules should be followed:

• Do not allow inadequately high loads when playing sports and other types of physical activity. It is necessary to start performing any exercises only after a special warm-up warm-up.
• Lead an active lifestyle in accordance with your age and fitness level.
• Avoid prolonged stay in one position, especially one in which the pelvis is skewed.
• Timely treat any inflammatory and infectious diseases.
• Eat rationally, including in your daily diet foods rich in protein, calcium, phosphorus, magnesium.
• To refuse from bad habits.

Preventive measures can minimize the risk of developing pathologies of the iliac-lumbar muscular-fascial group and associated complications.

1.0 Introduction

With this compilation, I want to start a series of articles on asanas for the legs. Such articles help me, and I hope they will help you too, to better understand the anatomy and work of the muscles of the human body and understand which muscles we use in the practice of yogaasanas.

I spent most of my time searching on the Internet and in e-books for visual pictures of asanas.

Many specialized terms are used to describe muscles and functions. Some of them can be found in the list of terms.

Hope the content is helpful! I look forward to comments and additions.

The muscles of the lower limb (mm.membri inferioris), according to their topographic and anatomical features, are divided into the muscles of the girdle of the lower limb (pelvic muscles) and the muscles of the free part of the lower limb.

1.1 Muscles of the girdle of the lower extremities (muscles of the pelvis)

The muscles of the pelvis (mm.cinguli pelvici) are divided into internal and external groups.

1.1.1 Inner pelvic muscle group

Iliac muscle (lat.Musculus iliacus)

Description: It starts from the walls of the iliac fossa (fossa iliaca), filling it entirely. In shape, the muscle approaches a triangle, with its apex pointing down. The bundles that make up the muscle fan-shaped converge to the boundary line of the pelvis and merge with the bundles of the psoas major (m.psoas major) forming the iliopsoas muscle (m.iliopsoas).
Function: The muscle is essentially one of the heads of the armor. m. iliopsoas. Its function is similar to that of this muscle.
Attachment: beginning - the walls of the iliac fossa, attachment - connecting with the bundles of the psoas major muscle forms a common iliopsoas muscle.

Large lumbar muscle (lat.Musculus psoas major)

Description: Long fusiform. It starts with 5 teeth from the lateral surface of the bodies of the XII thoracic, four upper lumbar vertebrae, as well as the corresponding intervertebral discs. Deeper muscle bundles start from the transverse processes of all lumbar vertebrae. Tapering somewhat, the muscle goes down and slightly outward and, connecting with the bundles of the iliac muscle (m iliacus), forms a common iliopsoas muscle (m.iliopsoas).
Function: The muscle is essentially one of the heads (m.iliopsoas). Its function is similar to that of this muscle.
Attachment: beginning - the lateral surface of the bodies of the XII thoracic, four upper lumbar vertebrae, attachment - connecting with the bundles of the iliac muscle forms a common iliopsoas muscle.

Small psoas muscle (lat.Musculus psoas minor)

Description: Inconstant, thin, spindle-shaped. It is located on the anterior surface of the psoas major muscle (m.psoas major). It starts from the lateral surface of the bodies of the XII thoracic and I lumbar vertebrae and, heading down, passes with its tendon into the iliac fascia, attaching with it to the crest of the pubic bone and the iliopubic joint.
Function: Stretches the iliac fascia and is involved in the flexion of the spinal column.
Attachment: beginning - the lateral surface of the bodies of the XII thoracic and I lumbar vertebrae, attachment - is woven into the iliac fascia.

Iliopsoas muscle (lat.Musculus iliopsoas)

Description: consists of two parts: large lumbar (t. psoas major) and iliac (m. iliacus) muscles. The muscle from the pelvic cavity exits through the muscle gap and, heading downward, passes along the anterior surface of the hip joint, attaching with a thin short tendon to the lesser trochanter of the femur.
Function: Flexes the hip joint until the thigh touches the anterior abdominal wall; rotates the hip outward. With a fixed hip, it flexes (tilts) the lumbar spine forward.
Attachment: beginning - is formed by the fusion of two muscles, each of which has its own beginning, attachment - a small trochanter of the femur.
Function details: This muscle is directly adjacent to the anterior surface of the hip joint. Its function is to flex and supinate the hip. If the hip is fixed, then it flexes the spinal column and pelvis in relation to the hip (for example, when moving from a lying position to a sitting position). In a standing position on one leg, she not only bends the pelvis, but also rotates it around the vertical axis of the hip joint.
When the body rotates to the right and to the left in a standing position on two legs, the iliopsoas muscle of the opposite side works, stretching on the side of the same name. The iliopsoas muscle is essential for the formation of lumbar lordosis. With its relaxation, lordosis decreases (in a sitting position), with tension, it increases.
If the tension of this muscle occurs simultaneously with a strong contraction of the rectus abdominis muscle, then not only a decrease in lumbar lordosis is possible, but even the formation of a general thoracic-lumbar kyphosis (for example, in the “angle” position in support).

Piriformis muscle (lat.Musculus piriformis)

Description: It has the appearance of a flat isosceles triangle, the base of which originates from the lateral surface of the sacrum, lateral to the holes between the II and IV sacral pelvic foramina (foramina sacralia). Converging, the muscle bundles are directed outward, exit the pelvic cavity through the large sciatic foramen (foramen ischiadicum majus) and pass into a narrow and short tendon attached to the top of the greater trochanter.
Passing through the large sciatic foramen, the muscle does not completely fill it, leaving small gaps along the upper and lower edges (suprapiriform and subpiriform openings) through which the vessels and nerves pass.
Function: Rotates the hip outward
Attachment: the beginning is the lateral surface of the sacrum; insertion - apex of the greater trochanter of the femur
Function details: Abducts the hip.
Since its resultant passes behind the vertical axis of the hip joint, it participates in the external rotation (supination) of the thigh.
With a fixed leg, it can tilt the pelvis to its side.

Obturator internus muscle (lat. Musculus obturatorius internus)

Description: It is a flattened muscle, the bundles of which are somewhat fan-shaped. With its wide part, the muscle originates from the inner surface pelvic bone around the obturator membrane and from its inner surface. A small gap between the muscle bundles and the obturator groove of the pubic bone turns into the obturator canal (canalis obturatorius), through which the vessels and nerve pass. Then the muscle bundles, converging, go outward and, bending almost at a right angle through the small sciatic notch, leave the pelvic cavity through the small sciatic foramen, attaching themselves with a short powerful tendon in the region of the trochanteric fossa.
Topographically, the obturator internus muscle is divided into two parts: a large one, before exiting the pelvic cavity, intrapelvic, and a smaller tendon, lying under the gluteus maximus muscle, extrapelvic.
Functions: Rotates outward (supinates) the thigh.
Attachment: origin - the inner surface of the pelvis in the circumference of the obturator membrane, attachment - the trochanteric fossa of the femur.
Function details: To the tendon of the obturator internus muscle, upon its exit from the small pelvis, the upper and lower twin muscles are attached, lying above and below it. These two small muscles originate from the ischial spine (upper muscle) and the ischial tuberosity (lower muscle).
The function of the internal obturator and gemelli muscles is to abduct the hip if the pelvis is fixed, and in a standing position on one leg - to keep the pelvis from tilting towards the opposite leg. In addition, these muscles are also involved in the supination of the thigh.

Gluteus maximus (lat.Musculus gluteus maximus)

Description: The most big muscle of the three gluteal muscles, which is closest to the surface. The muscle is large-fibered, consisting of bundles lying parallel to each other and connected together into one large knot, but separated by connective tissue layers. Powerful, flat, reaches 2-3 cm in thickness, approaches a rhombus in shape. It covers the greater trochanter, as well as the rest of the muscles of this group. It makes up a large part of the shape and appearance of the buttocks, it depends on how much the buttocks will protrude. Its large size (diameter about 30 cm) is one of the most characteristic features muscular system in humans, as it holds the human torso in an upright position.
Function: Extends the leg (thigh) in the hip joint, and also stretches the wide fascia of the thigh.
With fixed legs, it unbends the torso (pelvis) in relation to the thigh (extension of the torso from a bent position).
Regarding the rotation of the hip, the opinions of different authors differ:
* Sinelnikov R.D. "Atlas of Anatomy" 2009 - "extends the thigh, simultaneously penetrating it."
* Ivanitsky M.F. "Human Anatomy", 7th edition, 2008 - "the function of the muscle is to extend and supinate the hip"
Attachment: beginning - from the back of the outer surface of the ilium, posterior to the posterior gluteal line, from the lateral edge of the sacrum and coccyx and from the sacrotuberous ligament; attachment - the upper bundles of muscle are attached to fascia lata, passing into the iliac-tibial tract, and the lower ones - to the gluteal tuberosity of the femur.
Antagonist: iliac, psoas major and minor muscles.

Gluteus medius (lat.Musculus gluteus medius)

Description: Partially covered by the gluteus maximus muscle. Approaches a triangle in shape. The muscle is thick, two layers of bundles are distinguished in it - superficial and deep. The physiological diameter is 21 cm, in strength it is somewhat inferior to the gluteus maximus muscle. The muscle bundles are fan-shaped, starting with a wide part from the outer surface of the iliac wing, bounded in front by the anterior gluteal line, from above by the iliac crest, from below by the posterior gluteal line. Then all muscle bundles converge into a common powerful tendon, which is attached to the apex and outer surface of the greater trochanter.
Function: The main function is to abduct the hip in the hip joint.
Due to the fact that the anterior fibers of the muscle go from top to bottom and back, and the posterior ones - from top to bottom and forward, it takes part in both pronation (anterior bundles) and supination (posterior bundles) of the thigh.
With a fixed leg, it abducts (tilts in its direction) the pelvis. Takes part in straightening the torso bent forward.
Attachment: beginning - the outer surface of the iliac wing; attachment - the top and outer surface of the greater trochanter of the femur.

Gluteus maximus muscle (lat.Musculus gluteus minimus)

Description: It resembles the gluteus medius in shape, but is much thinner in diameter. Covered throughout by the gluteus medius (m.gluteus medius). It starts from the outer surface of the iliac wing, between the anterior and inferior gluteal lines. Then the muscle bundles converge and pass into the tendon, which is attached to the anterior edge of the greater trochanter of the femur.
Function: like the gluteus medius muscle, it abducts the leg and, with a fixed leg, abducts (tilts to its side) the pelvis.
Attachment: beginning - the outer surface of the iliac wing; attachment - the anterior edge of the greater trochanter of the femur.

Description:
Function: Rotates the hip outward.
Attachment:

Upper twin muscle (lat.Musculus gemellus superior)

Description: It has the appearance of a small muscle cord, originating from the ischial spine and attached to the trochanteric fossa. The muscle is adjacent to the upper edge of the tendon of the obturator internus muscle (m.obturatorius internus) after it leaves the small pelvis.
Attachment: beginning - ischial spine; attachment - trochanteric fossa of the femur.
Function: Rotates the hip outward.

Lower gemellus muscle (lat.Musculus gemellus inferior)

Description: The shape resembles the upper twin muscle. Unlike the latter, it is located below the tendon of the internal obturator muscle (m.obturatorius internus). It starts from the ischial tuberosity and attaches to the trochanteric fossa of the femur.
Function: Rotates the hip outward.
Attachment: beginning - ischial tubercle; attachment - trochanteric fossa of the femur

External obturator muscle (Latin Musculus obturatorius externus)

Description: It has the shape of an irregular triangle. It starts from the obturator membrane and the bone edge of the obturator foramen with its wider part. Then the muscle bundles, converging fan-shaped, pass into the tendon adjacent to the posterior surface of the hip joint capsule. The muscle attaches to the trochanteric fossa, adjacent to the obturator internus muscle.
Function: Rotates the hip outward.
Attachment: beginning - the outer surface of the obturator membrane and adjacent areas of the pubic and ischial bones; attachment - trochanteric fossa of the femur and the posterior surface of the articular capsule of the hip joint.

Tensioner of the broad fascia of the thigh (lat. Musculus tensor fasciae latae)

Description: A flat, slightly elongated muscle that lies on the anterolateral surface of the pelvis. With its distal end, it is woven into the wide fascia of the thigh. It begins on the outer lip of the iliac crest, closer to the superior anterior iliac spine. It goes down and a little back, between two sheets of the wide fascia, to which it is fixed. The continuation of the tendon of this muscle is called the ilio-tibial tract of the wide fascia of the thigh. The iliotibial tract inserts on the lateral condyle of the tibia.
Function: Stretches the wide fascia of the thigh and the iliac-tibial tract, through which it acts on the knee joint. Flexes and rotates inward (pronates) the thigh. In addition, she abducts the hip. With a fixed hip, it participates in the rotation of the pelvis.
Attachment: origin - the outer lip of the iliac crest, attachment - a wide fascia of the thigh.

1.2 Muscles of the free part of the lower limb

The muscles of the free part of the lower limb (mm.partis liberae membri inferioris) are divided into thigh muscles, leg muscles and foot muscles.

1.2.1 Muscles of the thigh

The thigh muscles (mm.femoris) are divided into anterior, medial and posterior groups. The first includes mainly extensor muscles, the second - adductor muscles, and the third - flexor muscles.

1.2.1.1 Front group

Square muscle of the thigh (lat.Musculus quadratis femoris)

Description: It has the appearance of a relatively thick rectangle, covered behind the gluteus maximus muscle (m.gluteus maximus). It starts from the lateral surface of the ischial tuberosity and is attached to the intertrochanteric crest, reaching the greater trochanter of the femur.
Function: Rotates the hip outward.
Attachment: beginning - the lateral surface of the ischial tuberosity; attachment - a large trochanter of the femur.

Tailor muscle (lat.Musculus sartorius)

Description: It looks like a narrow ribbon and is the longest muscle in the human body. It starts from the superior anterior iliac spine, and spirals obliquely down through the anterior surface of the thigh, passing to its inner surface, and then, rounding the medial epicondyle from behind, passes to the anteromedial surface of the lower leg. The muscle passes into a flat tendon, which is attached to the tuberosity of the tibia, and a number of bundles are woven into the fascia of the upper leg. At the point of attachment of the muscle, 2-3 dry bags of the sartorius muscle (bursae subtendineae m. Sartorii) are formed, which separate the tendon of the latter from the tendons of the fine and semitendinous muscles.
Its upper part is the lateral border of the femoral triangle.
Function: Being biarticular, the muscle produces the movement of the thigh and lower leg. Flexes the leg at the hip and knee joints; rotating the thigh outward, and the lower leg inward, thereby taking part in throwing the leg over the leg.
With a fixed hip, the sartorius muscle is involved in the tilt of the pelvis and its rotation around the vertical axis.
Attachment: beginning - anterior superior iliac spine (spina iliaca anterior superior); attachment - anteromedial surface of the tibia (tibial tuberosity).

Quadriceps femoris muscle (lat.Musculus quadriceps femoris)

Description: occupies the entire front and partly the lateral surface of the thigh. Consists of four heads. Each of the heads has its own origin, but, approaching the knee area, they all pass into a common tendon that covers the patella and is attached to the tibial tuberosity.
The quadriceps femoris muscle has a pinnate structure, which increases its lifting power. The physiological diameter of the muscle is 56 cm2. The patella, being a sesamoid bone, contributes to an increase in the shoulder strength of the quadriceps muscle (the moment of its rotation).
Rectus femoris muscle (lat.Musculus rectus femoris)
The rectus femoris is the longest of all heads. It occupies the anterior surface of the thigh. It begins with a thin tendon from the lower anterior spine, supraacetabular groove. At the very beginning, it is covered with m tensor fasciae latae and tailor muscle (m.sartorius). It goes down and passes into a narrow tendon, which is part of the common tendon of the quadriceps femoris muscle. Having reached the tibia, the tendon of the muscle is attached to the tibial tuberosity. Below the patella, it is called the patellar ligament (ligamentum patellae).
Medial broad muscle of the thigh (lat.Musculus vastus medialis)
The vastus medialis muscle of the thigh occupies the anteromedial surface of the lower half of the thigh. The front is somewhat covered by the rectus femoris. The muscle originates from medial lip rough line thigh and, heading down, passes into the wide tendon, which is partly woven into the wide tendon along with the rectus femoris, and partly attached to the medial edge of the patella, forming the medial supporting patellar ligament. Thus, the bundles forming the muscle are directed obliquely from top to bottom and from the inside to the front.
Lateral broad muscle of the thigh (lat.Musculus vastus lateralis)
The lateral broad muscle of the thigh occupies almost the entire anterolateral surface of the thigh. From above, it is somewhat covered by a muscle that strains the wide fascia, and in front - by the rectus femoris muscle. Muscle bundles are directed from top to bottom and outside anteriorly. The muscle starts from the greater trochanter, the intertrochanteric line and the lateral lip of the broad line of the thigh. Heading down, the muscle passes into the wide tendon, which is part of the common tendon of the quadriceps muscle and participates in the formation of the lateral supporting ligament of the patella.
Intermediate wide muscle of the thigh (lat.Musculus vastus intermedius)
The vastus intermedius is located on the anterior surface of the thigh between the medial and lateral vastus muscles, directly below the rectus femoris. It is the weakest among the other heads. It starts on the anterior surface of the femur - from the intertrochanteric line and, heading down, passes (almost half its length) into a wide tendon, which in the distal section joins the tendon of the rectus femoris muscle, passing into the common tendon of the quadriceps muscle.

General for quadriceps:
Attachment: The rectus femoris muscle starts from the lower anterior iliac spine, goes down and connects in the lower third of the thigh with the rest of the heads.
The place of origin of the three broad thigh muscles are the anterior, lateral and medial surfaces of the femur. All four heads of the quadriceps femoris are attached to the patella. From it to the tuberosity of the tibia there is a ligament of the patella, which is a continuation of the quadriceps muscle of the thigh.
Attachment in short: beginning - each of the four heads has its own beginning; attachment - tuberosity of the tibia.
Function: The rectus femoris muscle, being a biarticular (throws through the hip and knee joints), takes part in flexion of the thigh and extension of the lower leg in the knee joint.
The remaining heads of the quadriceps femoris muscle are single-joint (throws over the knee joint) and produce extension of the lower leg in the knee joint.

The articular muscle of the knee (lat. M. articularis genus)

Description: flat plate, consisting of several well-defined muscle bundles; lies on the front surface of the thigh under the intermediate broad muscle of the thigh (m.vastus intermedius). The muscle originates from the anterior surface of the lower third of the femur and, heading down, is attached to the anterior and lateral surfaces of the knee joint capsule.
Attachment: beginning - the anterior surface of the lower third of the femur; attachment - the anterior and lateral surface of the capsule of the knee joint.
Function: stretches the capsule of the knee joint.

1.2.1.2 Medial group

Thin muscle (lat. Musculus gracilis)

Description: long, slightly flattened, lies subcutaneously, is located most medially. It starts from the anterior surface of the pubic bone and, heading down, passes into a long thin tendon, which, having rounded the medial epicondyle of the femur, is attached to the tuberosity of the tibia.
Even before the point of attachment, the tendon of the fine muscle (m.gracilis) fuses with the tendons of the tailor (m.sartorius) and semitendinosus muscles (m.semitendinosus), as well as with the fascia of the lower leg, forming the so-called superficial crow's foot.
Function: Of all the adductor muscles, this is the only biarticular muscle. Passing near the knee joint, somewhat behind and medially from its transverse axis, it leads the thigh, promotes flexion of the lower leg at the knee joint and turning the leg outward
Attachment: origin - anterior surface of the pubic bone, attachment - tuberosity of the tibia

Long adductor muscle (Latin Musculus adductor longus)

Description: flat, somewhat reminiscent of a triangle in shape, located on the anteromedial surface of the thigh. It begins with a short powerful tendon from the pubic bone below the pubic tubercle, lateral to the fine muscle. Then, gradually expanding, it goes downward and attaches to the middle third of the medial lip of the rough line of the femur.
Function: Leads the thigh, taking part in its flexion and rotation outwards.
Attachment: beginning - the pubic bone below the pubic tubercle; attachment - the middle third of the medial lip of the rough line of the femur.

Short adductor muscle (lat.Musculus adductor brevis)

Description: triangular, located deeper than the long adductor muscle (m.adductor longus). It starts on the anterior surface of the lower branch of the pubic bone, lateral to the thin muscle (m. gracilis). It goes down and outward, slightly expanding, attaching to the upper third of the medial lip of the rough line of the femur.
Function: Leads the thigh, participating in its outward rotation.
Together with the long adductor, pectineus (on one side), sartorius, and tensor fascia lata (on the other), it forms a pair of forces involved in hip flexion.
Attachment: beginning - the anterior surface of the lower branch of the pubic bone; attachment - the upper third of the medial lip of the rough line of the femur

Large adductor muscle (lat.Musculus adductor magnus)

Description: wide, thick, largest in size among the muscles of the medial group. The physiological diameter of the large adductor muscle is 20 cm2. It lies somewhat deeper than the long and short adductor muscles (mm.adductor longus & brevis), outside the thin muscle (m.gracilis). It begins with a powerful short tendon from the lower branch of the pubic and branches of the ischium to the ischial tuberosity. Muscle bundles diverging fan-shaped from top to bottom and outwards, are attached by a wide tendon throughout the medial lip of the rough line of the femur. Part of the distal muscle bundles passes into a thin tendon attached to the medial epicondyle of the femur.
Function: Brings the thigh and rotates it outward; flexes the hip.
Attachment: beginning - from the lower branch of the pubic and branches of the ischium to the ischial tuberosity; attachment - the entire length of the medial lip of the rough line of the femur, reaching the medial epicondyle of the femur.
Function optional: This muscle also plays a large role in hip extension if the pelvis is fixed, or in pelvic extension if the hip is fixed. This action of the muscle increases as the hip flexes, as the arm of the force and the moment of its rotation become larger. When the hip is extended, the direction of the resultant muscle almost coincides with the transverse axis of the hip joint, as a result of which its moment of rotation with respect to this axis approaches zero. As a hip adductor, it acts with particular force when the hip is abducted.

Comb muscle (lat.Musculus pectineus)

Description: flat, shaped like a quadrilateral. On the lateral side, it borders on the iliopsoas muscle (m.iliopsoas), on the medial side, on the long adductor muscle (m.adductor longus). Between m.iliopsoas and the comb muscle (m.pectineus) a small depression is formed. It starts on the superior branch and crest of the pubic bone and, heading down and slightly outward, is attached to the crest line of the femur.
Attachment: beginning - the upper branch and crest of the pubic bone; attachment - comb line of the femur.
Function: Flexes the leg at the hip joint, simultaneously adducting it and rotating it outward.
Together with other muscles, it is involved in the forward tilt of the pelvis.

1.2.1.3 Rear group

Semitendinosus muscle (lat.Musculus semitendinosus)

Description: long, thin, located closer to the medial edge of the back of the thigh. Its outer side is bordered by the biceps femoris muscle (m.biceps femoris), the inner side is semi-membranous (m.semimembranosus). The proximal muscle is covered by the gluteus maximus muscle (m.gluteus maximus).
In the middle, the muscle is often interrupted by an oblique tendon bridge (intersectio tendinea). Starting from the ischial tuberosity, it follows down, passes into a long tendon, which, having rounded the medial epicondyle of the thigh, follows to the anteromedial surface of the tibia and is attached to its tuberosity. Part of the end bundles of the tendon is woven into the fascia of the lower leg.
The tendon of the muscle at its point of attachment, together with the tendon of the gracilis and sartorius muscles, forms a triangular tendon stretch that connects to the fascia cruris, the so-called superficial crow's foot (pes anserinus superficialis).
Attachment: the beginning is the tubercle of the ischium, the attachment is the tuberosity of the tibia. Part of the end bundles of the tendon is woven into the fascia of the lower leg
Functions: Biarticular muscle. Hip extension, flexion and pronation of the leg. Pronation (inward rotation) of the lower leg is most possible when the lower leg is bent.
With a fixed limb, together with the gluteus maximus muscle, it unbends the torso at the hip joint.

Semimembranous muscle (Latin Musculus semimembranosus)

Description: located along the medial edge of the posterior thigh. The outer edge of the muscle is covered by the semitendinosus muscle (m.semitendinisus), which leaves an imprint in the form of a longitudinal wide groove. The inner edge of the muscle is free. It begins with a flattened powerful tendon from the ischial tuberosity. Heading down, it passes into a flat tendon, which then gradually narrows and rounds and, having rounded the medial epicondyle, goes to the anteromedial surface of the tibia. At this point, the tendon becomes wider and is divided into three bundles. The inner bundle, located horizontally, ends on the medial condyle of the tibia, the middle bundle also reaches the medial condyle, passing into the fascia covering the popliteal muscle; the outer bundle, approaching the capsule of the knee joint, passes into the oblique popliteal ligament.
Attachment: origin - tubercle of the ischium, attachment - medial condyle of the tibia
Function short: Biarticular muscle. Extends the leg at the hip joint and flexes at the knee. At bent knee rotates the lower leg inward
With a fixed limb, together with the gluteus maximus muscle, it unbends the torso at the hip joint. It also fixes it to the thigh, preventing it from leaning forward.

Biceps femoris (lat. Musculus biceps femoris)

Description: located along the lateral edge of the posterior thigh. There are two heads in the muscle - long and short. The long head (caput longum) starts from the ischial tuberosity with a small flat tendon; short head (caput breve) - from the lateral lip of the rough line along the lower half of the thigh.
Both heads, connecting, form a powerful abdomen, which, heading down, passes into a long narrow tendon. The latter, having rounded behind the lateral epicondyle, is attached to the head of the fibula. Part of the beams, going horizontally, is attached to the edge of the upper articular surface of the fibula, and part, going slightly down, is woven into the fascia of the leg.
Function: The long head is a biarticular muscle. Extends the leg at the hip joint and flexes at the knee.
With a fixed limb, together with the gluteus maximus muscle, it unbends the torso at the hip joint.
When the knee is bent, rotates the lower leg outward. As the lower leg flexes, the tendon of this muscle moves backward, due to which its moment of rotation increases.
Attachment: beginning - each of the two heads has its own beginning: a long head from the ischial tuberosity, and a short one from the lower part of the rough line of the femur and the lateral intermuscular septum; attachment - the head of the fibula, the edge of the upper articular surface of the fibula, is woven into the fascia of the lower leg.

1.2.2 Leg muscles

The muscles of the lower leg (mm.cruris) are divided into three groups: anterior, posterior and lateral. In the posterior group, two layers are distinguished - superficial and deep. The muscles of the lateral group are mainly the flexor and pronator muscles of the foot, the anterior group are the extensor muscles of the foot, and the posterior group are mainly the flexor muscles and the arch support muscles of the foot.

1.2.2.1 Front group

Anterior tibialis muscle (lat.Musculus tibialis anterior)

Description: long, narrow, lies superficially, occupying the most medial position of all the muscles of this group. With the inner edge, it borders on the anterior edge of the tibia, and the outer in the proximal part - with the long extensor of the fingers (m.extensor digitorum longus), in the distal - with the long extensor of the thumb (m.extensor hallucis longus). The muscle originates with its wider part from the lateral condyle and the lateral surface of the tibia and the interosseous membrane of the leg. In the lower third of the lower leg, it passes into a long flat tendon, which lies in the tendon pocket under the extensor muscle retinaculum (retinaculum mm. extensorum inferius) and goes first to the medial edge of the foot, and then to the plantar surface. Here the tendon is attached to the medial sphenoid bone and the base of the first metatarsal bone.
Function: Extends the foot and raises its medial edge (supination). Together with the posterior tibial muscle leads the foot. When the foot is fixed, the muscle tilts the lower leg forward, bringing it closer to the rear of the foot.
Attachment: beginning - lateral condyle and lateral surface of the tibia and interosseous membrane of the leg; attachment - bones of the foot (medial sphenoid bone and base of the 1st metatarsal bone)

Long finger extensor (lat. Musculus extensor digitorum longus)

Description: lies outward from the anterior tibial muscle (m.tibialis anterior). In the lower third of the lower leg, a tendon passes between them extensor longus thumb (m.extensor hallucis longus). The muscle starts from the upper third of the tibia, the head and anterior edge of the fibula, the interosseous membrane of the leg, the anterior intermuscular septum of the leg, and the fascia of the leg. Then the muscle goes down, gradually narrows and passes into a narrow long tendon, which passes under the extensor muscle retinaculum (retinaculum mm. extensorum inferius) in the lateral canal. Even before entering the canal, the tendon is divided into four thin individual tendons, which, moving to the back of the foot, are attached to the base of the proximal phalanges of the four toes - from II to V. At the point of attachment, each of the tendons is divided into three bundles. The middle bundle ends at the base of the middle phalanx, and both extreme ones - at the base of the distal phalanx.
Function: unbends the four toes of the foot (II-V), the foot, and together with the third peroneal muscle (m. peroneus tertius) raises (pronates) the outer edge of the foot.
With a strengthened foot, the muscle tilts the lower leg forward, bringing it closer to the rear of the foot.
Attachment: beginning - the upper third of the tibia, the head and anterior edge of the fibula, the interosseous membrane of the leg, the anterior intermuscular septum of the leg, the fascia of the leg; attachment - the bases of the proximal, middle and distal phalanges of the four toes (II-V).

Long extensor of the thumb (lat.Musculus extensor hallucis longus)

Description: Lies between the anterior tibial muscle (m. tibialis anterior) and the long extensor of the fingers (m.extensor digitorum). The upper two-thirds of this muscle is covered by these muscles. The muscle originates from the medial surface of the middle and lower thirds of the fibula and the interspinous membrane of the lower leg and, heading down, passes into a narrow long tendon, which passes through the middle channel under the extensor muscle retinaculum (retinaculum mm. extensorum inferius) to thumb feet. Here the tendon is attached to the distal phalanx. Part of its bundles fuses with the base of the proximal phalanx.
Function: Unbends the thumb, takes part in the extension of the foot, raising (supinating) its medial edge.
With a fixed foot, along with other front muscles, the lower leg tilts forward.
Attachment: beginning - the medial surface of the middle and lower thirds of the fibula and the interspinous membrane of the leg; attachment - the distal phalanx and the base of the proximal phalanx of the big toe.

1.2.2.2 Back group surface layer

Triceps muscle of the lower leg (lat.Musculus triceps surae)

Description: consists of two muscles - gastrocnemius (lying superficially) and soleus (located closer to the bones of the lower leg). Each of the three muscle heads (2 from the gastrocnemius and one from the soleus) has its own origin. Both muscles are connected into one calcaneal (Achilles) tendon and are attached to the tuber of the calcaneus. The calcaneal tendon is very strong: it can withstand a load of up to 549 kg in an adult.
Function of the triceps muscle: The entire musculature of the triceps muscle of the lower leg produces flexion in the ankle joint both with the free leg and with support on the end of the foot. The line of traction of the muscle passes medially from the axis of the subtalar joint, then it still adducts and supinates the foot.
When standing, the triceps muscle of the lower leg (mainly its part is the soleus muscle) prevents the body from tipping forward in the ankle joint. The muscle has to work mainly when burdened with the weight of the whole body. In this regard, it is distinguished by strength and has a large diameter. The gastrocnemius muscle can also flex the knee with a fixed lower leg and foot.

Calf muscle (lat.Musculus gastrocnemius) is a biceps muscle, formed by two powerful fleshy heads - medial (caput mediate) and lateral (caput laterale). A more powerful medial head originates from the popliteal surface above the medial condyle of the femur, and the lateral head is symmetrical to it, but slightly lower, above the lateral condyle of the femur. Under each of the tendons of these heads on the condyles, there are, respectively, medial and lateral dry bursae of the gastrocnemius muscle (bursa subtendinea musculi gastrocnemii medialis & lateralis). Heading down, both heads are connected together approximately in the middle of the lower leg, and then pass into a common tendon, which forms a powerful calcaneal (Achilles) tendon in the lower third of the lower leg, which is attached to the calcaneal tubercle.
Attachment: beginning - medial and lateral condyles of the thigh; attachment - calcaneal tendon (Achilles), which is attached to the calcaneus.
Function: being two-component muscles, the two heads of the gastrocnemius muscle flex not only the foot in the ankle joint, but also the lower leg in the knee joint.
Function details: The effect of the gastrocnemius muscle on the knee joint is small, since its origin is located very close to the axis of rotation of the knee joint. As the knee flexes, the muscle's arm strength increases, increasing its action as a calf flexor.

Soleus muscle (lat.Musculus soleus) flat, covered with gastrocnemius muscle. It starts from the head and upper third of the body of the fibula, as well as from the line of the soleus muscle of the tibia and the middle third of the body of this bone. Part of the muscle bundles starts from the tendon arch of the soleus muscle (stretched between the bones of the lower leg). Heading down, the muscle passes into the tendon, which, having joined the tendon of the gastrocnemius muscle, forms a powerful calcaneal (Achilles) tendon (tendo calcaneus (Achillis)) in the lower third of the lower leg, which is attached to the tuber of the calcaneus.
Function: the muscle is single-joint and acts only on the ankle joint, bending the foot at the ankle joint. It plays an important role when standing, fixing the lower leg and preventing the body from falling forward.
Attachment: beginning - from the posterior surface of the upper third of the body of the tibia and from the tendon arch located between the bones of the lower leg; attachment - calcaneal tendon (Achilles), which is attached to the calcaneus.

Plantar muscle (lat. Musculus plantaris)

Description: calf muscle of the posterior group. The muscle is rudimentary and highly unstable. Her abdomen is spindle-shaped, short. It starts from the lateral condyle of the femur and the posterior wall of the capsule of the knee joint. It goes down and somewhat medially, the muscle passes into a narrow tendon, located between the gastrocnemius (m.gastrocnemius) and soleus (m.soleus) muscles. In the lower third of the lower leg, the tendon most often grows together with the Achilles tendon, and sometimes it attaches itself to the calcaneus, weaving fibers into the calcaneal aponeurosis.
Function: This muscle is rudimentary in nature (it is absent in 12% of cases) and cannot significantly affect movements in both the ankle and knee joints. Performs functions identical to the triceps muscle and stretches the capsule of the knee joint.
Attachment: the beginning is the lateral condyle of the femur and the posterior wall of the capsule of the knee joint; attachment - grows into the Achilles tendon

1.2.2.3 Rear group deep layer

Popliteal muscle (lat.Musculus popliteus)

Description: It is a flat, short muscle cord that lies directly on the posterior surface of the knee joint capsule. It originates from the lateral condyle of the femur and the arcuate popliteal ligament. Heading down and slightly expanding, the muscle is attached to the posterior surface of the tibia above the soleus muscle line (linea musculi solei).
Function: Flexes the lower leg, rotating it inward (prone), and also pulls the capsule of the knee joint (due to the fact that it is partially attached to the capsule of the knee joint).
Attachment: origin - lateral condyle of the femur and arcuate popliteal ligament, attachment - posterior surface of the tibia above the soleus muscle line.

Long finger flexor (lat. Musculus flexor digitorum longus)

Description: occupies the most medial position of all the muscles of the deep layer of the posterior group, located on the posterior surface of the tibia. It starts from the middle third of the posterior surface of the tibia and from the deep sheet of the fascia of the leg. Heading down, it passes into a long tendon, which goes around the back of the medial ankle, located under the flexor muscle retinaculum (retinaculum mm.flexorum). Then the tendon passes to the sole, going obliquely outward, and is divided into four separate tendons, which are directed along the II-V toes, attaching to the bases of the distal phalanges. Before attachment, each tendon perforates the tendon of the short flexor of the fingers (m. flexor digitorum brevis).
Function: The function of the muscle with respect to flexion of the fingers is small - it slightly flexes the distal phalanges of the II-V toes.
It mainly affects the foot as a whole. With a free foot, it flexes and raises its medial edge (supination).
She also, together with the triceps muscle of the lower leg, takes part in putting the foot on the toe (walking on tiptoe).
In a standing position, together with a long plantar ligament (lig. Plantare longum) actively contributes to the strengthening of the longitudinal arch of the foot.
When walking, he presses his fingers to the support.
Attachment: beginning - from the middle third of the posterior surface of the tibia and from the deep sheet of the fascia of the leg; attachment - the base of the distal phalanges II-V of the toes.

Long flexor of the thumb (lat. Musculus flexor hallucis longus)

Description: It occupies the most lateral position, located on the posterior surface and somewhat covering the posterior tibial muscle (m.tibialis posterior). It is the most strong muscle among all the deep muscles of the back of the leg. It starts from the lower two-thirds of the fibula, the interosseous membrane and the posterior intermuscular septum of the leg. It goes down and goes into a long tendon, which passes under the flexor muscle retinaculum (retinaculum mm.flexorum) and goes to the sole, lying in the groove between the talus and calcaneus. In this place, the tendon passes under the tendon of the long flexor of the fingers, giving it part of the fibrous bundles. Then it goes forward and attaches to the base of the distal phalanx of the big toe.
Function: It flexes the thumb, and also, due to its connection with the tendon of the long flexor of the fingers, participates in the flexion of the II-IV toes.
Like the rest of the posterior muscles of the lower leg, it produces flexion, adduction and supination of the foot.
Strengthens the longitudinal arch of the foot.
Attachment: beginning - from the lower two-thirds of the fibula, interosseous membrane and posterior intermuscular septum of the leg; attachment - the base of the distal phalanx of the big toe, giving part of the fibrous bundles to the tendon of the long flexor of the fingers.
Function optional: The action of this muscle on the big toe is quite large and amounts to 18.1 kg in men and 14 kg in women. In ballerinas, this muscle, together with the long extensor, fixes the big toe when walking on the fingers.

Tibialis posterior muscle (lat.Musculus tibialis posterior)

Description: It is located between the long flexor of the fingers (m.flexor digitorum longus) and the long flexor of the big toe (m.flexor hallucis longus). It starts from the interosseous membrane, as well as from the adjacent edges of the tibia and fibula. It goes down and passes into a long tendon, which, having passed in a separate channel under the flexor muscle retinaculum (retinaculum mm.flexorum), bends around the medial malleolus behind and, passing to the sole, is attached to the tuberosity of the scaphoid and to the three sphenoid bones.
Function: It flexes the foot, rotates it outward (supinates) and adducts it along with the tibialis anterior.
Together with other muscles attached to the medial edge of the foot, it also participates in the formation of the "stapes", which strengthens the transverse arch of the foot.
In a standing position, he presses his fingers to the ground.
Attachment: beginning - from the interosseous membrane of the lower leg and from the adjacent edges of the tibia and fibula; attachment - bones of the foot (tuberosity of the scaphoid and three cuneiform bones).

1.2.2.4 Lateral group

Long peroneal muscle (lat.Musculus fibularis (peroneus) longus)

Description: It is located on the lateral surface of the leg. In the upper half, it lies directly on the fibula, and in the lower half it covers the short peroneal muscle (m.peroneus brevis). The muscle begins with two heads: the anterior one - from the head of the fibula, the lateral condyle of the tibia and the fascia of the lower leg, and the posterior one - from the upper parts of the lateral surface of the fibula. Heading down, the muscle passes into a long tendon, which goes around the lateral malleolus behind, passes under the upper and lower peroneal muscle retinaculum (retinaculum musculorum peroneorum superius & retinaculum musculorum peroneorum inferius) and follows the outer surface of the calcaneus under the fibula block (trochlea fibularis (peronealis) ), passing to the sole. Here it lies in the groove of the tendons of the peroneal muscles and, crossing the foot obliquely, is attached to tuberosity I and the base of the II metatarsal bones.
Function: Together with the short peroneal muscle, it flexes and pronates the foot, lowering its medial and raising the lateral edge (pronates). Also abducts the foot.
Attachment: The two heads have different beginnings. The short one - from the head of the fibula, the lateral condyle of the tibia and the fascia of the lower leg, and the long one - from the upper sections of the lateral surface of the fibula; attachment - foot bones (tuberosity I and base II of the metatarsal bones).
Function optional: Of the muscles that penetrate the foot, the long peroneal muscle is the strongest.
Together with the anterior tibial muscle, it forms a tendon-muscle loop that strengthens the transverse arch of the foot.

Short peroneal muscle (lat.Musculus fibularis (peroneus) brevis)

Description: Long, thin, located directly on the outer surface of the fibula under the long peroneal muscle (m.fibularis longus). The muscle starts from the lower half of the lateral surface of the fibula and from the intermuscular septum of the leg, goes down and then goes near the tendon of the long peroneal muscle. Having rounded the lateral malleolus from behind, the tendon goes forward along the outer side of the calcaneus and is attached to the tuberosity of the fifth metatarsal bone.
Function: Together with the long peroneal muscle, it flexes and pronates the foot, lowering its medial and raising its lateral edge. Also abducts the foot.
Attachment: beginning - the lower half of the lateral surface of the fibula and the intermuscular septum of the leg; attachment - foot bones (tuberosity of the V metatarsal bone).

The third peroneal muscle (Latin Musculus fibularis (peroneus) tertius)

Description: The muscle starts from the lower half of the lateral surface of the fibula and the interosseous membrane of the leg and is attached near the base of the fifth metatarsal bone.
Function: Raises the lateral edge of the foot.
Attachment: beginning - the lower half of the lateral surface of the fibula and the interosseous membrane of the leg; attachment - foot bones (base of the fifth metatarsal bone).

1.2.3 Muscles of the foot

The muscles that pass from the lower leg to the foot and the muscles of the foot itself participate in the movements of the toes. The muscles of the foot itself (mm.pedis) include those that both begin and attach to the foot. They are quite numerous and can be divided into two groups: the muscles of the plantar surface of the foot and the muscles of the dorsum of the foot. The muscles located on the plantar surface of the foot flex the toes, and the muscles located on the back of the foot extend them.

When comparing the muscles of the plantar dorsum of the foot, it is clearly seen that the former are much stronger than the latter. This is due to the difference in their functions. The muscles of the plantar surface of the foot are involved in holding the arches of the foot and largely provide its spring properties. The muscles of the back surface are involved in the extension of the fingers when moving the foot forward (for example, while walking and running). These muscles are so weak that they cannot keep the body from falling back if the fingers are fixed, and the vertical of the body's common center of gravity is placed on the back border of the support area.

Muscles of the back of the foot: short extensor of fingers (m.extensor digitorum brevis); short extensor of the big toe (m.extensor hallucis brevis); rear interosseous muscles(m. interossei dorsales).

The muscles of the sole of the foot are numerous and for convenience of consideration we will divide them into several layers according to the depth of occurrence: first level: Abductor hallucis muscle (m.abductor hallucis); Short finger flexor (m.flexor digitorum brevis); Muscle abducting the little toe of the foot (m.abductor digiti minimi); second level: Vermiform muscles of the foot (m.lumbricales); Square muscle of the sole (m.quadratus plantae); third level: The muscle that leads the big toe (m.adductor hallucis); Short flexor of the big toe (m.flexor hallucis brevis); Short flexor of the little toe of the foot (m.flexor digiti minimi brevis); fourth level: Muscle opposing the little toe of the foot (m.opponens digiti minimi); Plantar interosseous muscles (m.interossei plantares).

1.2.3.1 Back side

Short extensor of the fingers (lat. Musculus extensor digitorum brevis)

Description: A flat muscle that lies directly on the dorsum of the foot. It starts from the upper and lateral surfaces of the anterior part of the calcaneus and, heading anteriorly, passes into four narrow tendons. They fuse in the distal section with the tendons of the long extensor of the fingers (m.extensor digitorum longus) and are attached to the base of the proximal, middle and distal phalanges of the II-V fingers, weaving into the dorsal fascia of the foot. In some cases, the tendon to the little finger is missing.
Function: Performs extension II-IV (V) of the toes along with their slight abduction to the lateral side.
Attachment: origin - the upper and lateral surfaces of the anterior part of the calcaneus; attachment - the base of the proximal, middle and distal phalanges II-IV (V) of the toes

Short extensor of the big toe (lat.Musculus extensor hallucis brevis)

Description: Lies inside of short extensor fingers (m. extensor digitorum brevis). It starts from the upper surface of the anterior part of the calcaneus and, heading forward and medially, passes into the tendon, which is attached to the base of the proximal phalanx of the thumb. In the distal section, the tendon fuses with the tendon of the long extensor hallucis longus (m.extensor hallucis longus), taking part in the formation of the dorsal fascia of the foot.
Function: Extends the big toe.
Attachment: origin - the upper surface of the anterior part of the calcaneus; insertion - base of the proximal phalanx of the big toe

Dorsal interosseous muscles (lat.Musculi interossei dorsales)

Description: Four muscles on the back side fill all the interosseous spaces. Each muscle starts from the sides of the adjacent metatarsal bones facing one another and, heading forward, is attached to the bases of the proximal phalanges of the II-IV fingers, weaving into the dorsal fascia.
Function: The first dorsal interosseous muscle pulls the second toe in the medial direction.
The second, third and fourth muscles pull II-IV fingers in the lateral direction.
In addition, all the dorsal interosseous muscles flex the proximal and extend the middle and detailed phalanges of the II-IV fingers.
Attachment: beginning - metatarsal bones (surfaces of two adjacent metatarsal bones facing each other); attachment - the base of the proximal phalanges of the II-IV fingers.

1.2.3.2 Plantar side 1 and 2 layer

Abductor hallucis muscle (lat.Musculus abductor hallucis)

Description: It is located superficially, occupies the most medial position of the muscles of the plantar part of the foot. It starts with two heads from the flexor muscle retinaculum (retinaculum mm.flexorum), the medial process of the calcaneal tuber and the plantar surface of the navicular bone. Heading forward, the muscle passes into the tendon, which fuses with the tendon of the short flexor of the big toe (m.flexor hallucis brevis) and is attached to the medial sesamoid bone of the thumb at the base of its proximal phalanx
Function: flexes and abducts the big toe. Participate in strengthening the medial part of the arch of the foot.
Attachment: the beginning - the bones of the foot (the medial process of the tuber of the calcaneus and the plantar surface of the navicular bone); attachment - to the base of the proximal phalanx of the big toe.

Short finger flexor (lat. Musculus flexor digitorum brevis)

Description: muscle of the plantar part of the foot. It occupies a median position on the foot, located under the plantar aponeurosis. It begins with a short powerful tendon from the medial process of the calcaneal tuber and the plantar aponeurosis. Heading forward, the muscle belly passes into four tendons that lie in the synovial sheaths along with the tendons of the long flexor of the fingers (m.flexor digitorum longus). In the region of the proximal phalanges of the II-V toes, each of the four tendons of the short flexor is divided into two legs, which are attached to the base of the middle phalanges of these fingers. Between the legs are the tendons of the long flexor of the fingers.
Function: The muscle strengthens the arch of the foot and flexes the middle phalanges of the II-V toes.
Attachment: beginning - medial process of the calcaneal tuber and plantar aponeurosis; attachment - bones of the toes (bases of the middle phalanges of II - V fingers)

Muscle abductor of the little toe of the foot (lat.Musculus abductor digiti minimi)

Description: It is located directly under the plantar aponeurosis. It starts from the lateral and medial processes of the calcaneal tuber and from the plantar aponeurosis. It goes forward and passes into a short tendon, which is attached to the lateral side of the base of the proximal phalanx of the little finger.
Function: Flexes the main phalanx of the little toe of the foot and pulls it laterally (retracts). But the effect on the little finger is negligible.
Attachment: beginning - foot bones (lateral and medial processes of the calcaneal tuber and plantar aponeurosis); attachment - the lateral side of the base of the proximal phalanx of the little toe of the foot.

Vermiform muscles of the foot (lat. Musculi lumbricales)

Description: Four thin and short muscles that are located between the tendons of the long flexor of the fingers (m.flexor digitorum longus) and are covered by the short flexor of the fingers (m.flexor digitorum brevis), and in depth are in contact with the interosseous muscles (mm.interossei plantares). Each worm-like muscle starts from the corresponding tendon of the long flexor of the fingers, with three lateral (II-IV) - two heads, and medial (I) - one head. Heading forward, the muscles in the area of ​​the metatarsophalangeal joints go around the toes from the side of the medial surface of the II-V toes and, moving to their back surface, are woven into their dorsal fascia. Sometimes the worm-like muscles attach to the articular capsules and even reach the proximal phalanges.
Function: Bend the proximal phalanges II-V of the toes.
They have a weak or completely absent extensor effect on other phalanges of the same fingers.
Can pull four fingers towards the thumb.
Attachment: beginning - the corresponding tendons of the long flexor of the fingers (m.flexor digitorum longus); attachment - bones of the toes (dorsal surface of II-V toes).

Square muscle of the sole (lat. Musculus quadratus plantae)

Description: It resembles a quadrangle in shape and lies under the short flexor of the fingers (m.flexor digitorum brevis). It starts from the lower and medial surfaces of the back of the calcaneus with two separate heads, connected to a common abdomen. Heading forward, the muscle narrows slightly and attaches to the outer edge of the tendon of the long flexor of the fingers (m.flexor digitorum longus) at the place of its division into separate tendons.
Function: This muscle is, as it were, an additional head of the long flexor of the fingers (m.flexor digitorum longus). This muscle bundle establishes the longitudinal (direct) direction of traction of the long flexor of the fingers, the tendon bundles of which approach the fingers obliquely. Besides, square muscle soles increases the traction force of the long flexor of the fingers.
Attachment: beginning - the lower and medial surfaces of the posterior part of the calcaneus; attachment - the outer edge of the tendon of the long flexor of the fingers.

1.2.3.3 Plantar side 3 and 4 layer

Adductor hallucis muscle (lat.Musculus adductor hallucis)

Description: It is located deep, directly on the metatarsal bones. Covered by long and short finger flexors. It begins with two heads - transverse and oblique.
Transverse head (caput transversum) begins on the plantar surface of the capsules of the III-V metatarsophalangeal joints, from the distal ends of the II-V metatarsal bones, from the plantar aponeurosis (septum laterale), from the deep transverse metatarsal ligaments.
Oblique head (caput obliquum) more powerful, starts from the plantar surface of the cuboid bone, the lateral sphenoid bone, the base of the II-IV metatarsal bones, the long plantar ligament and the plantar sheath of the long peroneal muscle (m. flbularis (peroneus) longus).
Both heads pass into a common tendon attached to the lateral sesamoid bone and the base of the proximal phalanx of the big toe.
Function: Adducts the big toe and flexes it.
Participate in strengthening the arch of the foot on its medial side.
Attachment: beginning - each head has its origin on the bones of the foot; attachment - bones of the big toe (lateral sesamoid bone and base of the proximal phalanx of the big toe).

Short flexor of the big toe (lat.Musculus flexor hallucis brevis)

Description: It is located directly on the I metatarsal bone and is partially covered by the muscle that abducts the big toe (m.abductor hallucis). It starts from the medial sphenoid bone, the plantar surface of the navicular bone, the tendon of the posterior tibial muscle (m.tibialis posterior), the long plantar ligament. The tendon of the short flexor of the big toe (m.flexor hallucis brevis), together with the tendon of the muscle that adducts the big toe (m.adductor halluces), is attached to the lateral and medial sesamoid bones and to the base of the proximal phalanx of the big toe, thus dividing into two distal tendons, each of which belongs to the lateral and medial parts, respectively.
Function: Flexes the big toe. Participate in strengthening the medial part of the arch of the foot.
Attachment: beginning - bones of the foot (medial sphenoid bone, plantar surface of the navicular bone, tendons of the posterior tibial muscle, long plantar ligament); attachment - bones of the big toe (to the lateral and medial sesamoid bones and to the base of the proximal phalanx of the big toe).

Short flexor of the little toe of the foot (lat. Musculus flexor digiti minimi brevis)

Description: lies medial to muscle abducting the little toe of the foot (m.abductor digiti minimi) and partially covered by it. It starts from the V metatarsal bone, the long plantar ligament and the plantar sheath of the long peroneal muscle (m.fibularis (peroneus) longus). It goes forward and passes into the tendon, which, fused with the tendon (m.abductor digiti minimi), is attached to the base of the proximal phalanx of the little toe of the foot.
Function: The main role of the muscle is to strengthen the lateral edge of the arch of the foot.
Flexes the proximal (main) phalanx of the little toe of the foot, but the effect of the muscle on the little toe is negligible.
Attachment: the beginning - the bones of the foot (V metatarsal bone, long plantar ligament and plantar sheath of the long peroneal muscle); attachment - the base of the proximal phalanx of the little toe of the foot.

Muscle opposing the little toe of the foot (Latin Musculus opponens digiti minimi)

Description: The muscle is unstable, it is a detached part of the short flexor of the little toe of the foot (m.flexor digiti minimi brevis) and is somewhat covered by it along the outer edge. It starts from the long plantar ligament and the tendon sheath of the long peroneal muscle (m.fibularis (peroneus) longus), is attached to the lateral edge of the fifth metatarsal bone.
Function: The main role of the muscle is to strengthen the lateral edge of the arch of the foot.
Opposes the little toe to the big toe, but the effect of the muscle on the little toe is negligible.
Attachment: beginning - long plantar ligament and sheath of the tendon of the long peroneal muscle; attachment - the lateral edge of the fifth metatarsal bone.

Plantar interosseous muscles (lat. Musculi interossei plantares)

Description: Three are narrow, short, shaped like dorsal interosseous muscles. They are located in the interosseous spaces between the II-III, III-IV and IV-V metatarsal bones. Each of these muscles originates on the medial side of the III, IV and V metatarsal bones, respectively, and is attached to the base of the proximal phalanges.
Function: bend the proximal and unbend the middle and distal phalanges of the III - V toes, and also bring the III - V fingers to the II finger (pull to the medial side).
Attachment: beginning - the medial side, respectively, III, IV and V metatarsal bones; attachment - the base of the proximal phalanges of the toes.

The misunderstanding of the role of the psoas is not surprising. The very process of naming these muscles, which connect the upper body to the lower body, contains a series of errors spanning four centuries.

Long before Hippocrates began to use the modern Latin term "psoa" - lumbar (muscle), anatomists Ancient Greece They called these muscles "the womb for the kidneys" because of the physical relationship with these organs.

In the 17th century, the French anatomist Riolanus made a grammatical error that persists to this day when he named the two psoas as one "psoas" instead of the proper Latin "psoai" (Diab, 1999).

​This may have influenced our perception of muscles as team players rather than individual muscles adapting to our asymmetrical habits.

Dr. John Basmajian, the father of electromyography (EMG) science, contributed to the misunderstanding by claiming that the psoas and iliac muscles function inseparably because they share a common inferior attachment.His opinion led to the widespread use of the term "iliopsoas" (ilio-lumbar), depriving each of the muscles of individual characteristics, and provoked the precedent to measure EMG of the iliac muscle, rather than the deep and more inaccessible psoas muscle.

This whole story helps to understand the reasons for the widespread misconceptions about the actual role of the psoas.

Psoas mechanics

In light of information about the points of insertion, questions arise: does the psoas flex the hip? Or does it move the spine? Or maybe she does both?

Biomechanics are always trying to build a picture based on a "presumed" action, taking into account the health of the joints, the leverage and the force produced.

Numerous connections to the spine imply that the main role of the psoas muscle is to provide some kind of movement of the spine. But a test of this hypothesis shows that the attachment angles do not provide sufficient force for tilting to the side.

Remember the (old school) lying down sit-ups from the National Fitness Testing program (now known as the President's Challenge Program)? In a movement similar to lifting the trunk (which, oddly enough, is still on the protocol), the psoas simultaneously extends the upper vertebrae and flexes the lower vertebrae, creating a shearing force in the lumbar vertebrae (one vertebrae slides relative to the other), and also creates a significant compressive load (Bogduk, Pearcy & Hadfield, 1992) is an undesirable movement for long-term back health.

Studies show that the psoas muscle plays an active role in hip flexion, but compared to the iliacus muscle, the psoas muscle stabilizes the spine (preventing the vertebrae from rotating in the frontal plane) more than it produces leg movement (Hu et al. 2011). Finally, multiple attachments create the need for sufficient elongation in the psoas to allow the spine, pelvis, and hips to move freely, naturally, without pain or injury.

With sedentary lifestyle and psoas

If you've ever seen a triathlete go from cycling to running, you can imagine how long the psoas shortening affects your ability to walk upright.

In a less extreme situation, hours (and many more hours) spent sitting affects the ability of the psoas to stretch to its maximum length - the length that allows you to stand straight and, perhaps more importantly, lengthen when walking.

If you count the number of patients who go from eight hours of sitting at the workplace to a "fitness" activity that additionally predisposes the psoas to shortening (exercise bike, stair climber, seated machine exercise), then don't be surprised that people who exercise , so many problems with the lower back, pelvis and hips.

What does a shortened psoas look like?

Specialists, noticing excessive curvature of the lumbar spine, often conclude that the client's pelvis is tilted forward.

This form of postural assessment is erroneous, since it is not supported by objective data on the position of the skeleton, in particular, the origin of the curve.

Excessive extension of the spine or forward tilt of the pelvis is not necessarily evidence of a shortened psoas. Instead, there is a peculiar curve created by the displacement of the upper lumbar vertebrae combined with extension and displacement and flexion of the lower vertebrae. It looks like excessive bending, with one exception - a bony sign: the ribcage.

Psoas assessment

Due to the fact that the psoas muscle can move the spine forward, it is very common to see "protruding ribs" when the muscle is shortened.

It is difficult to assess this in a standing position, as many people compensate for the shortening of the psoas by slightly flexing the hips and knees, "weakening the lumbar line." For an objective assessment, use the supine position.

Start with the patient in a sitting position with straight legs. The quads should be completely relaxed and the hamstrings should touch the floor. Stop the patient when bending back when the lower thigh is lifted off the floor.

At this point, support your patient under the head and shoulder blades, leaving room for the ribs to fall to the floor. The height of the support depends on the tension of the lumbar muscle.

Ideally, the patient should be able to lie on the floor in a "neutral" skeletal position. A shortened psoas will lift the hip or lower ribs off the floor. This estimate is a corrective position. If ribs are found elevated by the psoas, ask the patient to relax until the lower ribs are on the floor. In the future, it is necessary to gradually reduce the height or position at which support is needed.

To test the iliopsoas muscle (IPM), ask the patient to sit on the edge of the couch. Stand next to the patient and place one hand on the patient's thigh just above the knee.

​Place your other hand on the patient's shoulder. Ask the patient to raise the knee against the resistance of your hand. The working effort of the PPM is then compared with the effort of the same muscle on the other leg.

Postisometric muscle relaxation

All joints of the human body are surrounded by muscle complexes and are controlled by their contractions. The contraction of some muscle groups and the timely relaxation of others is the key to the smoothness and efficiency of body movements. When pathological displacements occur in the joints, the effect of pronounced irritation of tendon receptors is manifested, muscle fibers. This leads to a contraction of both small groups of periarticular muscles, fixing the pathological position of the joint, and large muscle-fascial complexes, leading to a change in the biomechanics of the whole body.

Treatment of such a complex of disorders should consist in returning the normal position and range of motion to the causative joint. Unfortunately, severe periarticular muscle tension makes it difficult for the body to self-correct.

To help the body get on the path to healing, it is necessary to relax the muscles.

It is known that in the normal phase muscle contraction there is a depletion of the internal energy resources of the muscle, after which the phase of relaxation begins. In the case of pathologically tense muscles, different groups of fibers are alternately activated, which allows the muscle to be in a tense state for a long time. If we consciously increase the force of muscle contraction in response to resistance applied from outside, all groups of muscle fibers will be involved, which will lead to their subsequent relaxation and will make it possible to stretch the tense muscle, release the pathologically displaced joint.

Basic rules for post-isometric muscle relaxation:

1. Before starting the exercise, it is necessary to bring the joint to the side of limitation, to achieve maximum tension and tension of the pathologically contracted muscle. The preparatory movement is carried out to the level of intensification of pain manifestations. This is a traffic restriction barrier.

2. The movement to increase muscle contraction should be in the direction of maximum painlessness and correspond to the direction of the previous muscle contraction (opposite to the restriction barrier).

3. The strength of additional muscle contraction is 30% of the maximum and should not increase pain.

4. The resistance to muscle contraction must be sufficient to keep the limb or body from moving in space. The muscle should tense, but not produce movement, held by resistance.

5. The time of additional muscle tension is 5-7 seconds.

6. After tension, a 3-second pause is maintained - the muscle relaxes.

7. After a pause, the muscle is stretched towards the restriction barrier until the pain syndrome appears. This is a new limitation barrier.

8. 3-4 approaches are performed with a gradual increase in the freedom of movement of the joint and relaxation of the muscle.

Exercise 1.

​I.p.- lying on the edge of the bed on a healthy side, you can put a small pillow under the pelvis and lower back. Both legs are bent at the knee and hip joints, legs and feet hang over the edge of the bed. Due to the mass of the legs, when relaxing, the pelvis will tilt and a feeling of stretching will appear in the overlying side.

Raise the feet and shins to a horizontal position, hold the tension for 5-10 seconds (a). Movements are best performed on the exhale.

Then take a deep breath, relax and stretch. The legs will lower and, with their weight, will stretch the square muscle of the lower back and the own muscles of the spine (b). The movement is repeated 3-4 times with an increase in amplitude during stretching.

If conditions allow, you can grab the headboard with your “upper” hand. In this case, the stretch will be more noticeable and capture latissimus dorsi back.

Exercise 2.

​Allows you to stretch the same muscles and relieve stress on the joints and discs of the spine. It is more suitable for those who have pain in the evening. To perform it, place a stack of books 15-20 centimeters high next to the cabinet. If you have a crossbar in your house, then it is better to use it, although a door will do, or in extreme cases, just a wall that you can lean on.

I.p.- standing with one foot on a stack of books, the other hangs freely, without touching the support, the arms are maximally extended upwards, fixing the position, holding on to the support. As you exhale, pull the hanging leg up (“pull” the leg into the body), as shown in Fig. a.

After holding this position for 10 seconds, inhale, relax and shake the dangling leg, trying to touch the floor with the foot (Fig. b). Normally, a stretch of the muscles in the lumbar region on the side of the hanging leg should be felt. Repeat the movement 3-4 times with each leg.

After doing this exercise, you need to lie down and lie down for an hour, so it's best to do it before going to bed.

The PIRM technique will be more effective if it is carried out from the hanging position on the bar on one hand. And if on the right, then the left leg should be pulled up, and vice versa. This option is suitable for athletes and anyone who can perform it, hanging on the crossbar for 2-3 minutes, holding with one hand.

Exercise 3

​I. p.- lying on your back, legs straightened. On the foot (near the fingers), throw a long towel, like a stirrup. Hold the ends in your hands and pull on yourself like reins. The leg will begin to rise, as we have already said, normally by 80-90 °, that is, it will go into a vertical position. If the angle of elevation is smaller and, for example, after 30 ° there are pulling pains along the back of the thigh, under the knee or in the lower leg, then this is the very (hidden) muscle spasm that must be eliminated, otherwise it will sooner or late manifest itself clearly - in the form of exacerbation. To eliminate this spasm, PIRM is used.

First, slightly loosen the tension of the towel and set the initial painless position of the leg. Then take a calm breath and press your toes on the towel, as if on a pedal, you will feel how the muscles of the back of the leg have tightened. Your effort should be of medium intensity. Hold the muscle tension for 7-15 seconds (it is advisable to hold the breath as well). Exhale, slowly relax your leg muscles, and pull the towel towards you with your hands.

If everything is done correctly, without haste and jerks, then the leg will rise above the initial level and overcome the initial pain barrier.

Next, stretch the muscles to a new "threshold" - in our case, for example, from 30 to 50-70 °. And as soon as the already familiar pulling sensation appears, again press your fingers on the towel, hold the tension while inhaling and stretch. Now the angle of elevation can reach 80-90 °.

So, in 2-3 cycles, the vast majority of spasm is eliminated.

Often there is an opinion that such pains are associated with inflammation of the sciatic nerve, but the above exercise once again proves the muscular origin of the pain syndrome, which most often can be stopped with a simple stretch.

Possible difficulties with this exercise:

1. Muscles are tight to stretch, or it provokes pain. In this case, try to increase the tension delay to 20 seconds, and perform the stretching movement itself in small amplitudes - 5-10 ° each.

2. Perhaps, in one such cycle, the muscles will not stretch to the norm. Therefore, classes should be repeated for several days, sometimes 2 times a day. It is important to note that if after this exercise the range of motion increased by at least 5-10 °, then you are on the right way and things will work out.

3. If the movement "stalled" before reaching the norm, then you should look for persistent changes in the muscles or in the hip joint. This situation is often observed in patients with osteochondrosis for a long time, who have suffered injuries, and patients with coxarthrosis. In this case, do not try to bring the flexion to 90 °. Perhaps your individual norm is less and is, for example, 45 °. But even in this case, after taking PIRM, you will definitely feel relief.

The given PIRM exercises are key for the correct position of all the higher parts of the spine. In addition, they increase the reserve of the musculoskeletal system due to the increase and normalization of the volume of movement in two large joints - the knee and hip. Now they will perform the prescribed range of motion and unload the spine, and therefore, the risk of repeated exacerbations of lumbar pain will decrease.

If you perform these exercises regularly, then after a week or two you will notice that the legs bend and unbend in full and without PIRM. In this case, you can limit yourself to testing once a week using the same techniques, and in case of deviation from the norm, stretching exercises can be carried out.

Recall that the main criterion for the correct implementation of PIRM techniques is not degrees, but your feelings.

I would like to once again draw your attention to the frequently encountered abscesses of the iliopsoas muscle. In fact, in addition to septic diseases of the spine, this disease is the only one that can be accompanied by an increase in temperature (or maybe without an increase in temperature) in a patient against the background of pain. It is very difficult to make a clinical differential diagnosis.
Attention should be paid to the description of paresthetic meralgia and Roth's syndrome. Nobody ever thinks about these diagnoses - but in vain - they are very common.

ILIOPSOAS MUSCLE (m.iliopsoas). One of the most important muscles for musculoskeletal pathology, the lesion of which causes a wide variety of symptoms, the lesion of which often recurs, is associated and causes a combined pathology of many associated muscles (synergists, antagonists and those supporting posture in statics and dynamics), sometimes with difficulty is isolated from general picture of the disease and is often not taken into account in the presence of compression-irritative lesions in the groin and genitals. Since the direction of muscle contraction has a general tendency to bring the lower extremity and trunk together, which causes compression of the lumbar discs, chronic or acute muscle pathology can be the cause of discogenic disorders of the lumbar region. The importance of muscle damage is emphasized in most manual therapy manuals. In this regard, the sign (symptom) of Mennel (appearance of pain and limitation of movement during hip extension) is indicated as mandatory in the diagnosis of lesions of the lumbar region. At the same time, it should be pointed out that for the defeat of the lumbar region, the symptom is not specific and its significance is relative. The muscle is the main one that tilts (flexes) the torso forward.

Clinic. Syndrome of the iliopsoas muscle.
When the lumbar muscle is affected, pain appears on the side of the lesion mainly in the lower back in a vertical direction along the lumbar region from the thoracic (sometimes from the interscapular region) to the sacroiliac, and sometimes to the upper inner gluteal region. Lower back pain can also occur with damage to the quadratus lumborum, gluteus maximus and medius, lower rectus abdominis, longissimus dorsi, and rotator muscles. Pain with a horizontal distribution across the lumbar is more common with bilateral lesions of the square muscle of the lower back or the lower part of the rectus abdominis. The defeat of the iliopsoas muscle is often combined with the defeat of the rectus abdominis muscle and does not cause pain when coughing or deep breathing, in contrast to the defeat of the quadratus lumborum. Soreness of the muscle is often noted on the side of the functional block of the sacroiliac joint and with damage to the hip joint. Pain in the lower quadrant of the abdomen with lesions of the psoas major and minor muscles is often confused with manifestations of appendicitis, especially when a painful hardening of the muscle is detected.
When the iliac muscle is affected, pain appears on the side of the lesion in the lower back, along the anterior and anterointernal surface of the thigh, in the hip joint (damage to both muscles) and in the groin area (including the scrotum). Pain in the femoral and inguinal region may be the result of damage to the tensor fascia lata, pectineus, wide intermediate and adductor muscles. For a differentiated diagnosis, it should be borne in mind that the limitation of extension in the hip joint, characteristic of the lesion of the iliopsoas muscle, occurs only with damage to the pectineus muscle and tensor fascia lata. Subsequent palpation easily distinguishes more superficial tenderness in the two muscles above from deeper tenderness in the iliopsoas muscle.
With hypertonicity of the iliopsoas muscle, pain usually appears in the sacroiliac joint, while “pelvic squeeze syndrome” and a functional block of the sacroiliac joint on the side of the affected muscle are usually noted. On the other hand, the muscle is painful on the side of the functional blocking of the sacroiliac and hip joints, as well as in pathological processes in the abdominal cavity and small pelvis. Often the pain is found below the groin, which corresponds to the place of attachment of the muscle to the lesser trochanter. Sometimes muscle pathology is manifested only by pain in the abdominal cavity on the side of the lesion. Typical is the limitation of hip extension due to severe pain in the groin and back.
According to Ivanichev G.A., especially often the tension of this muscle is found in osteochondrosis L4-L5 with fixed hyperlordosis syndrome. In such cases, the hyperlordotic configuration of the spine is formed by a sharp tension in the lumbar muscle, especially in that part of it that is attached to the upper lumbar vertebrae.
Such pains (when both muscles are affected) are aggravated by static load and during activity to overcome the force of gravity, decrease with flexion of the leg at the hip joint, and almost disappear in the supine position with the legs bent at the hip and knee joints or lying on the side in "fetal position". Pain is significantly reduced in the standing position on all fours (knee-elbow arrangement), since in this position the attachment points of the muscles approach as close as possible. The patient has difficulty getting up from a deep chair and cannot sit up from a lying position. In the most severe cases mobility is so limited that patients can only move on all fours. With unilateral shortening of the muscle, scoliosis of the lumbar region may be observed towards the affected muscle at rest and when walking. Pain corresponding to the symptoms of a lesion of the psoas muscle on the left side can occur with pressure on the muscle with dense fecal masses during constipation, at the same time, a hypertrophied psoas muscle can compress the colon.
When a muscle is damaged, one should be alert to possible hemorrhages into the thickness of the muscle, abscesses, metastases, primary tumor processes, lymphoma, and various kinds of bursitis.
With shortening of the muscle, compression-irritative syndromes of damage to some nerves are possible. So, if a patient has undiagnosed pain and sensitivity disorders in the area of ​​​​innervation of one or more nerves (signs of pathology of the lumbosacral plexus), possible damage to the lumbar muscle should be taken into account. When the psoas major muscle is affected, pathology of the iliac, ilioceliac, and ilioinguinal nerves, as well as the femoral-genital nerve, can occur with pain and paresthesia in the groin, scrotum or labia and proximal parts of the anterior thigh. The femoral branch of the genitofemoral nerve may also be compressed by the muscle at its exit from the pelvic cavity.
With damage to the sartorius and iliopsoas muscles, compression or traumatic neuralgia of the lateral femoral cutaneous nerve (paresthetic meralgia (pain in the thigh with paresthesia), meralgia paresthetica, Berhardt-Roth neuralgia) is often associated with a compressive or traumatic neuralgia at the site of its exit from the pelvic cavity at the inguinal ligament (above or below the ligament, at a distance of five centimeters from the anterior superior iliac spine). However, the nerve (starts from L2 and L3) can be infringed in several places: at the spine; in the abdominal cavity when squeezing it near the pelvic bones; and also in the place of its exit from the pelvic cavity. According to Travell J. G. et Simons D. G., if the doctor does not have a mindset for this diagnosis, he may mistakenly diagnose radiculopathy. Subclinical femoral cutaneous neuralgia is much more common than expected and in many cases remains undiagnosed. In the clinic of the lesion, burning pains and paresthesias are noted along the nerve, spreading down the anterolateral surface of the thigh. Such pains are aggravated in an upright position, when walking and when the hip is extended (nerve tension from the place of compression), and disappear in a sitting position or when the hip is flexed. Disturbances of sensitivity are found along the nerve and pain at the exit of the nerve in the inguinal ligament (such palpation can cause pain and paresthesia along the nerve). According to Travell J. G. et Simons D. G., neuralgia is often observed with obesity and lethargy of the muscles of the abdominal wall; bringing tight clothing or a tight belt; when shortening the opposite leg. According to Lewit K., some cases of this neuralgia disappear when the spasm of the iliopsoas muscle is eliminated, with manipulations in the region of the lumbo-thoracic joint, hip joint and coccyx. For treatment, drug treatment, relaxation and stretching of the affected muscle, nerve blockade in the area of ​​the inguinal ligament, blockade in the spine, a sharp decrease in body weight, correction of excessive hip extension, as well as refusal to wear tight clothing, correction of violations of the length of the lower extremities.
Muscle pathology, as a rule, is combined with pathology in other muscles, both synergists and antagonists: antagonists (if they are weak or shortened, hypertonicity of the iliopsoas muscle may develop, exactly the same reverse effect of the muscle on its synergists is noted) - rectus abdominis , quadratus lumborum, rectus femoris, tensor fascia lata, pectineus, psoas paravertebral muscles, and contralateral iliopsoas; antagonists - big gluteal muscles, hip extensors. Poor posture caused by damage to the iliopsoas muscle causes excessive stress on other muscles, most often these are the hip flexor extensors, gluteal, lumbo-thoracic paravertebral and posterior cervical muscles.
Damage to the muscle causes pain and impaired movement of the thoracolumbar junction. If the iliac muscle is affected, there may be a violation of the movements of the L5-S1 iliac motion segment.

Anatomy. The psoas major muscle is innervated by L2-L4 roots, starts along the lateral surface of the bodies and the lower edges of the transverse processes of the T12 and L1-L5 vertebrae, the corresponding intervertebral discs, passes next to, anteriorly and inward from the square muscle, in front of the sacroiliac joint, then along the edge of the iliac bones, when leaving the pelvic cavity, it participates in the formation of the outer border of the femoral triangle, and is attached by a tendon along the posterior inner surface of the femur to the lesser trochanter. Sometimes there is a non-permanent small psoas muscle, which is innervated by the L1 root. The muscle is present in 60% of cases and runs from the T1-L1 intervertebral disc of the spinal motion segment and is attached by a tendon to the arcuate line of the ilium and to the iliopubic eminence (the muscle pulls on the iliac fascia, increasing support for the iliopsoas muscle). The iliac muscle is innervated by L2 and L3 roots, starts from the upper 2/3 of the inner surface of the iliac fossa, then it combines with the tendon of the psoas major muscle and, in addition, some of its fibers are attached directly from the femur near the lesser trochanter.
Function. Flexion of the leg at the hip joint (the main function of both muscles). The muscle is the main leg flexor at the hip joint. The psoas initially engages, followed by the iliacus (after reaching the first 30 degrees of hip flexion). Flexion of the hip is carried out in conjunction with the rectus femoris and pectus muscles with the help of the tailor, thin, adductor muscles and tensor fascia lata. Participation in external rotation. Function of both muscles (contraction of the iliac muscle causes slight external rotation). Participation in hip abduction (both muscles). Participation in the extension of the lumbar spine (increased lumbar lordosis) while standing and while walking (the psoas major), but not in the straightening of the spine. Deep bundles of the psoas muscle are attached to the posterior surface of T12 and the upper lumbar vertebrae, providing, with their contraction, no longer a tilt back, but extension-abduction of the upper lumbar posteriorly and downwards. According to Travell J.G. et Simons D.G. The main extensor muscles at the lumbar level are, in order of importance, the erector spinae, the rotators and the quadratus lumborum. The contribution of the psoas muscle is about 4% of the total effort required for extension. Flexion of the lumbar when leaning forward. The psoas major flexes (tilts) the trunk with a fixed hip, with a fixed hip, the muscle is the main muscle that bends the trunk forward. An important role in maintaining an upright position. Muscle damage is one of the main causes of scoliosis. Participation in the transition from a lying position to a sitting position, especially in the last 60 degrees (together with the rectus and oblique muscles of the abdomen). Contraction of the muscle causes stress on the intervertebral muscles (lumbar muscle). Flexion between the ilium and the sacrum (lumbar muscle), while lifting the front of the pelvis on the same side. Contraction (shortening) of the iliac muscle displaces the iliac bone of the same name into flexion, contraction (shortening) of the psoas major muscle displaces the opposite ilium into flexion.

Diagnostics.
Iliopsoas muscle - General and external examination. When the muscle is shortened, patients usually stand, transferring body weight to the unaffected leg (slightly deviate towards the opposite side of the affected muscle), the leg on the side of the lesion is bent at the knee joint to reduce muscle tension. According to Travell J.G. et Simons D.G., when attempting to lean forward in a standing position, patients lean further to the unaffected side in the first 20 degrees of flexion, and then, as flexion continues, they level the position somewhat. Patients stoop when walking. They have lumbar hyperlordosis, relaxation of the rectus abdominis muscles, and excessive forward tilt of the pelvis (pelvic flexion). All these factors taken together can lead to a shortening of the trunk in an upright position by several centimeters (2.5 or more). Patients have to arch their head and neck to see where they are going and may need support (stick or cane) due to their hunched posture and severe pain. A specific gait is noted, leading to unloading of the tense iliopsoas muscle, in which the leg is constantly bent and abducted at the hip joint, and the foot and thigh are turned outward (directions that bring together the ends of muscle attachment). On the side of the concave part of scoliosis, in most cases, muscle hypertonicity is noted (however, although much less often, muscle hypertonicity can also be observed on the side of the convexity of scoliosis). When the muscle is shortened in the position of the patient lying on his back, the leg on the side of the lesion is slightly bent at the knee joint and an increase in lumbar lordosis is observed.
Iliopsoas muscle - Palpation - supine position. Patient: lying on his back. Fulfillment: A search is made for focal tenderness (or a painful muscle roller) in three areas using point or sliding palpation: 1. The outer (lateral) border of the femoral triangle above the lesser trochanter with the hip retracted and slightly bent (to avoid compression of the femoral nerve) - distal fibers iliac muscle and the musculotendinous part of the lumbar muscle. When a muscle is damaged during palpation, pain appears in the lower back and along the anterior inner surface of the thigh and groin. 2. The inner edge of the ilium behind the anterior superior iliac spine (on the surface of the pelvis parallel to the inguinal ligament) - the uppermost fibers of the iliac muscle. When a muscle is damaged during palpation, pain appears in the lower back and sacroiliac region, sometimes in the anterior thigh region. The patient bends the legs slightly to relax the abdominal muscles. The doctor places his fingers on the inner surface of the iliac crest behind the anterior superior iliac spine, presses the muscle to the bone and moves in the anteroposterior direction parallel to the iliac crest, pressing the palpable mass against the bone. The muscle is palpated through the aponeurosis of the external oblique abdominal muscle. 3. Front abdominal wall(direct palpation of the muscle) - psoas major muscle. The patient bends the legs slightly to relax the abdominal muscles. The doctor places the tips of the second-fourth fingers of both hands slightly lateral to the outer edge of the rectus abdominis muscle (between the rectus abdominis and the aponeurosis of the oblique abdominal muscles), smoothly immerses the fingers below the level of the rectus abdominis muscle somewhat medially towards the spine, pressing the muscle to the spine (the tense muscle is palpable only in lean patients) and palpates along the lumbar spine. Such palpation of the anterior outer surface of the muscle is performed several times. When a muscle is damaged during moderate palpation, pain appears approximately at the level of the navel or slightly lower with pain mainly in the lumbar region. Note: Sometimes a tense muscle is defined as a painful hardening. With insufficient experience of the researcher, the detected seal can be mistaken for a pathological formation in the abdominal organs. Post-isometric muscle relaxation is useful for differential diagnosis. Palpation of the muscle allows you to clarify the state of the thoraco-lumbar junction, as well as the sacroiliac joint - when they are damaged, the muscle often becomes painful and tense.

Iliopsoas - Differentiation between muscle lesion and rectus femoris - Examination of muscle shortening - supine position. Patient: lies on his back, the pelvis is located on the edge of the couch. With hands clasped in a lock, he presses with both hands a healthy leg, bent at the knee and hip joints, to straighten the back and stabilize the pelvis and prevent lumbar lordosis. The leg on the side of the lesion is extended at the hip joint and hangs freely from the couch. Evaluation of test results: the extension of the hip in the hip joint is assessed. With limited extension of the hip associated with shortening of the iliopsoas muscle, it remains bent at the hip joint (the thigh remains elevated), the leg hangs down without extension at the knee joint. When hip extension is limited, associated with shortening of the rectus femoris muscle or with simultaneous shortening of the iliopsoas muscle and rectus femoris muscle, excessive extension of the leg in the knee joint is observed. With shortening of the muscle, the tensor of the fascia lata of the thigh, the hanging leg rises above the horizontal with the patella outwardly displaced.

Iliopsoas - Differentiation between muscle lesion and rectus femoris - Kendall et McCreary differential test - supine position. Patient: Lies on his back with straight legs. Doctor: supports the straightened leg of the patient slightly above the level of the couch. Execution: the doctor performs leg extension in the hip joint, lowering the leg down towards the floor. When hip extension is limited, the doctor straightens the leg at the knee joint and re-extends the leg. Evaluation of the results of the study: if straightening the leg at the knee joint increases the amount of hip extension, then this indicates that hip extension is also limited by the rectus femoris. If there is no increase in hip extension when knee extension is performed, then the rectus muscle is not involved in limiting extension. Note: The test does not distinguish shortening of the muscle from shortening of the tensor fascia lata.

Iliopsoas muscle - Differentiated test distinguishing shortening of the muscle from shortening of the tensor fascia lata according to Travell J. G. et Simons D.G. - supine position. Patient: Lies on his back with straight legs. Doctor: supports the straightened leg of the patient slightly above the level of the couch. Execution: the doctor performs leg extension in the hip joint, lowering the leg down towards the floor. When hip extension is limited, the doctor straightens the leg at the knee joint, along with hip abduction and internal rotation, and re-extends the leg. Evaluation of the results of the study: if straightening the leg at the knee joint, together with abduction and internal rotation of the hip, increases the amount of hip extension, then this indicates that hip extension is also or only limited by the tensor fascia lata. If, when performing such actions, the volume of hip extension does not increase, then there is no shortening of the tensor fascia lata, and hip extension is limited to the iliopsoas muscle.

Iliopsoas muscle - A differentiated test that distinguishes muscle shortening from shortening of the rectus femoris muscle, tensor fascia lata - supine position. Patient: lying on his back. The healthy leg is bent at the knee and hip joint, the patient grabs this leg and pulls it to the chest. The leg on the side of the lesion hangs freely. Evaluation of the results of the study: with shortening of the iliopsoas muscle, the hanging leg rises above the horizontal, with shortening of the rectus femoris, the hanging leg rises above the horizontal and straightens at the knee joint, with shortening of the muscle, tensor fascia lata of the thigh, the hanging leg rises above the horizontal with the patella displaced outward .