Transcript Slide 1

Lateral and Medial Hip Rotators
Case Study
• Crystal has come to
you to get into shape
for the upcoming golf
season.
– What types of
exercises would you
recommend for her
to improve her golf
swing?
– Why?
Lateral Hip Rotators
• Deep to gluteus
maximus are six
muscles that laterally
rotate the femur at the
acetabular joint
• They each:
– Lie horizontal in the
transverse plane
– Insert into the
greater trochanter of
femur
Lateral Hip Rotators
From superior to inferior
they are:
• Piriformis
• Superior Gemellus
• Obturator Internus
• Inferior Gemellus
• Obturator Externus
• Quadratus Femoris
Piriformis
Piriformis means
shaped like a pear
Origin: Anterior Sacrum
Insertion:
GreaterTrochanter
of Femur
Action:
• Lateral Hip Rotation
• Holds head of femur in
acetabulum (hip
socket)
Piriformis
• Integrated Function:
– Assists in eccentric
deceleration of medial rotation
of the hip
-Assists in eccentric
deceleration of hip flexion
-Assists in eccentric
deceleration of hip adduction
when the hip is flexed
-Assists in dynamic stabilization
of the lumbo-pelvic-hip complex
-Assists in providing pelvofemoral dynamic stabilization
during functional movements
Piriformis Syndrome
• Piriformis Syndrome is a
condition caused by
compression (pinching) of
the sciatic nerve
• The sciatic nerve is the
longest and largest nerve in
the body.
• It originates in the lumbar
spine and its nerve branches
travel down the thigh, knee,
calf, ankle, foot, and toes to
allow movement and feeling
(motor and sensory
functions)
Piriformis Syndrome
• There are two exits of the sciatic nerve:
– Inferior to the piriformis and superior to the
superior gemellus
• Compression in this area may be due to
tightening of the piriformis and superior
gemellus
– Sciatic nerve actually pierces the piriformis
muscle itself. This can occur in about 10% of
all people. In this case, tightening of the
piriformis may lead to pain, numbness, and
tingling in the posterior thigh, knee, and foot
Causes of Piriformis Syndrome
• Overuse
– Cyclists, rowers, runners
• Prolonged Sitting
– Truck/taxi drivers, office workers, long distance
cyclists
• Weak Hip Abductors
• Tight Hip Flexors
• Tight Hip Adductors
• Tight Hamstrings
• Foot Eversion or
pronation
• Poor Running Form
Symptoms of Piriformis Syndrome
• Pain after prolonged
sitting, running, or
walking
• Chronic pain in the
gluteal region,
posterior thigh and
calf
• Pain when walking
up stairs or inclines
Piriformis Syndrome Treatment
•
•
•
•
Rest
Ice
Cross Train
Strengthen:
– Core/lumbo-pelvic-hip complex
– Gluteus medius and minimus
– Perform light lateral hip rotation active range of
motion (AROM) exercises
• Stretch:
– Lateral Hip Rotators
– Hip Flexors
– Hip Adductors
– Hamstrings
Sciatica
• The term Sciatica describes pain, weakness,
numbness or tingling originating from the lumbar spine
traveling down the gluteal region into the posterior
thigh
• It is not a disorder but commonly a result of a lumbar
herniated (bulged or slipped) disk, piriformis
syndrome, degenerative disk disease, pregnancy, or
spinal tumor
• A herniated disc occurs when the soft inner core of the
disc (nucleus pulposus) leaks out, or “herniates”,
through the fibrous outer core (annulus) of the disc
and irritates the nerve root as it exits the spine
Superior Gemellus
Gemellus means twin
Origin:
• Ischial Spine of
Pelvis
Insertion:
• Greater Trochanter
of Femur
Action:
• Lateral Hip
Rotation
Inferior Gemellus
Origin:
•
Ischial Tuberosity
Insertion:
•
Greater Trochanter of
Femur
Action:
•
Lateral Hip Rotation
Superior and Inferior Gemellus
• Integrated Function:
–Assists in eccentric deceleration
of medial hip rotation
–Assists in dynamic stabilization
of the lumbo-pelvic-hip complex
Obturator Internus
Obturator means to obstruct
Origin:
• Internal Surface of Pelvic
Bone Surrounding the
Obturator Foramen
Insertion: Greater
Trochanter of Femur
Action:
• Lateral Hip Rotation
• Holds head of femur in
acetabulum
Obturator Externus
Origin:
• External Surface of Pelvic
Bone Surrounding the
Obturator Foramen
Insertion:
• Greater Trochanter of
Femur
Action:
• Lateral Hip Rotation
• Holds head of femur in
acetabulum
Obturator Internus and Externus
• Integrated Function:
–Assists in eccentric deceleration
of medial hip rotation
–Assists in dynamic stabilization
of the lumbo-pelvic-hip complex
Quadratus Femoris
Origin:
• Ischial Tuberosity
Insertion:
• Intertrochanteric Crest of
Femur (between greater
and lesser trochanter)
Action:
• Lateral Hip Rotation
• Hip Adduction
Quadratus Femoris
• Integrated Function:
–Assists in eccentric deceleration of
medial hip rotation
–Assists in eccentric deceleration of
hip abduction
–Assists in dynamic stabilization of
the lumbo-pelvic-hip complex
Exercises for Lateral Hip Rotators
• Supine/standing lateral rotation of the hip with
tubing
• Single-leg opposite reach
• Lunge with opposite reach
Lateral Hip Rotator Tightness
• Tightness of the lateral hip rotator muscles
will limit medial rotation of the hip
• Shortening of the medial hip rotators
decreases lateral hip rotation
• For some hip problems, improving the
flexibility of short and tight muscles is
necessary
• Frequent, gentle, and sustained stretching
of either the medial or lateral hip rotators
should be performed
Supine Piriformis Stretch
Seated Stability Ball Lateral Hip Rotator
Stretch
Pull up, don’t
push down,
with hand on
knee
Supine Lateral Hip Rotator Stretch
Supine Stability Ball Lateral Hip Rotator
Stretch
Medial Hip Rotators
(Same as Hip Abductors)
• Gluteus Medius
• Gluteus Minimus
• Tensor Fascia Latae
• Adductor Magnus Anterior Head
Gluteus Medius
Gluteus Minimus
Tensor Fascia Latae
Adductor Magnus Anterior Head
Stretches for Medial Hip Rotators