Archive for May, 2007
Lower back pain| hip external rotation
May 25, 2007 6:30 pmFriday, May 25, 2007
Lower back pain is commonly due to irritation of the L5 and S1 nerve roots. Hip pain may result secondary to pain and spasm muscles of the lower back and all muscles that cross the hip.
Patients may have trouble with external rotation of the hip due to pain and spasm of muscles that perform external rotation or from pain and spasm of muscles that perform internal rotation and thus limiting the performance of the external rotators.
This week, we shall talk about muscles that perform external rotation. To test these muscles, the patient should lie on his stomach and bend the knee up. The patient then turns the leg and foot in toward midline. This motion produces external rotation of the hip. To test the strength of the external rotators, the examiner must try to push the leg outward away from the midline.
The hip external rotators are:
- gluteus maximus lower fibers (inferior gluteal nerve L5, S1 primarily S1)
- obturator internus (L5, S1, S2)
- superior gemellus (L5, S1, S2)
- inferior gemellus (L4, L5, S1)
- quadratus femoris (L4, L5, S1)
- obturator externus (obturator nerve, L2, L3, L4)
- adductor magnus, lower portion (sciatic nerve, L5, S1)
- adductor brevis (obturator nerve, L2, L3, L4)
- piriformis (S1, S2)
© 2007 copyright all rights reserved www.stopmusclepain.com Lower back pain| hip internal rotation
Adductor magnus is one of the hip external rotators (see below)
hip external rotation, hip muscles, hip pain, low back pain, lower body topics, nerve root irritation
Lower back pain| hip internal rotation
May 18, 2007 4:31 pmFriday, May 18, 2007
Lower back pain is commonly associated with irritation of the L5 and S1 nerve roots bilaterally. Depending on whether the L5 or the S1 nerve root is more irritated, there can be pain and spasm that causes tightening of the muscles that perform external rotation or muscles that perform internal rotation.
Dissection anatomy of hip internal rotators (see below)
Our topic today will be on muscles that perform internal rotation of the hip.
These muscles are:
- gluteus medius
- gluteus minimus
- tensor fascia latae muscles.
All these muscles are supplied by the superior gluteal nerve (L4, L5 with the L5 nerve root being more dominant). These muscles also receive contribution from the S1 nerve root.
We can test the strength of these muscles by having the patient lie on his stomach with his knee bent up. The patient can attempt to do turn the lower leg outward with the toes pointing inward toward the body. This will produce internal rotation of the hip.
The examiner can then attempt to force the lower leg inward toward the body to assess the strength of the hip internal rotators.
© 2007 copyright all rights reserved www.stopmusclepain.com Lower back pain| hip internal rotation
gluteus medius, gluteus minimus, hip internal rotation, low back pain, lower body topics, muscles, tensor fascia lataLower back pain| thigh abduction
May 11, 2007 4:36 pmMay 11, 2007
Patients with lower back pain often secondary to irritation of the L5 and S1 nerve roots will have difficulty not only due to the pain but due to weakness of the hip abductor muscles.
The most powerful hip abductor is the gluteus medius. It is supplied by the superior gluteal nerve (L4, L5 and S1). The L5 nerve root has the strongest representation in this muscle. The other hip abductors are the other muscles are tensor fascia latae and gluteus minimus which are also supplied by the superior gluteal nerve.
Hip abduction can be tested with the patient supine with the thighs spread apart. The examiner then pushes the thigh inward to the midline. The hip abductors can also be tested with the patient lying on his side with the tested side uppermost. The patient then lifts the thigh up against gravity.
The most functional way of testing for hip abduction is to have the patient stand on one limb. If he is standing on his right leg and if he has weakness in his right hip abductor muscles his opposite hip will drop. This testing is called the Trendelenburg testing. To prevent the left hip from dropping in the case of a right hip abductor weakness, the patient may lean over to the right. This is also an indicator of weakness of the hip abductors on the right side..
© 2007 copyright all rights reserved www.stopmusclepain.com Low back pain| thigh abduction
Photograph showing the hip abductor muscles (below)
Low back pain| hip pain | adduction
May 4, 2007 10:21 amFriday, May 04, 2007
Patients with lower back pain from irritation of the L5 and S1 nerve roots often have weakness from pain and spasm in the hip abductor muscles and the hip extensor muscles. This allows for imbalanced contraction of the hip adductor muscles since the opposition muscles are weak.
The hip adductors then become tight and shortened. This creates an even more unfavorable condition for the already weakened hip abductor and hip extensor muscles which must contract against tight and shortened hip adductor muscles. This creates a vicious cycle perpetuate the lower back pain symptoms.
The hip adductor muscles are:
- adductor magnus
- adductor brevis
- adductor longus
These muscles are supplied by the obturator nerve from L2, L3 and L4 nerve roots. The adductor magnus is also supplied by the sciatic nerve (L4, L5, S1).
Other muscles that also perform hip adduction are:
- gluteus maximus (lower fibers)
- quadratus femoris.
Gluteus maximus is supplied by the inferior gluteal nerve (L5, S1 especially S1 nerve root).
Quadratus femoris is supplied by the nerve to the quadratus femoris from the sciatic nerve (L4, L5, S1).
© 2007 copyright all rights reserved www.stopmusclepain.com Low back pain| hip pain| adductors
Photograph showing the hip adductor muscles namely adductor longus and gracilis (below)
adductor brevis, adductor longus, adductor magnus, gluteus maximus, hip adduction, low back pain, lower body topics
Low back pain| Hip flexion| Sartorius
May 3, 2007 3:30 pmThursday, May 03, 2007
Patients with lower back pain often have hip flexor tightness. The hip flexor that is very easy to locate is the sartorius due to its strap-like form stretching from the outer aspect of the hip to the medial aspect of the knee joint. This muscle allows us to sit in the taylor sit position or the lotus position.
The sartorius muscle flexes the hip as well as rolls the hip outward (external rotation). It is also a knee flexor.
To test this muscle, the patient places the heel of the tested side on the opposite knee. Patients with pain and tightness of the sartorius tend to have difficulty placing the heel on the opposite knee.
However, difficulty in performing this function also depends on presence of pain and spasm in the lower back muscles, hip extensor muscles, hip abductor and internal rotator muscles.
Tightness and shortening of these muscles will produce difficulty performing this motion which is also called the FABERE testing (this is a combination of ability of the hip to flex, abduct and externally rotate).
Nerve supply: Femoral nerve
Spinal segments: L2, L3 and L4 nerve roots
© 2007 copyright all rights reserved www.stopmusclepain.com Low back pain| hip pain| Sartorius
Low back pain| hip flexion
May 2, 2007 10:35 amWednesday, May 02, 2007
Patients with lower back pain often have tightness of the hip flexor muscles. This is aggravated by the presence of a forward bent posture from lower back pain and presence of weak and shortened paraspinal muscles. This places the abdominal wall and the hip flexor muscles in an advantageous position to bring the trunk and hips into flexion.
The hip flexor muscle tightness is favored by the presence of weakness of the hip extensor muscles such as the gluteus maximus, adductor magnus and the hamstring muscles. Muscles that perform hip flexion are:
- Iliopsoas
- rectus femoris
- sartorius
- pectineus
These muscles are supplied by the femoral nerve (L2, L3 and L4 spinal nerve roots).
Muscles that also perform hip flexion are:
- gluteus medius and minimus-
tensor fascia latae
- adductor longus and brevis
The gluteus medius and minimus (L5, S1 spinal nerve roots) and tensor fascia latae (L4, L5 spinal nerve roots) are supplied by the superior gluteal nerve.
Adductor longus and brevis are applied by the obturator nerve (L2, L3 and L4 spinal nerve roots).
© 2007 copyright all rights reserved www.stopmusclepain.com Low back pain| hip flexors
Photograph of some hip flexor muscles (below)
Low back pain| abdominal wall
May 1, 2007 5:48 pmTuesday, May 01, 2007
Low back pain| abdominal wall
Patients with chronic lower back pain caused by lower back muscles in spasm results in patients having difficulty in straightening the spine. In such a situation, the abdominal wall muscles have less opposition and become tight and shortened aggravating the forward bent posture.
To test the strength of the abdominal wall, the patient can lie on his back and attempt to lift the head forward against resistance.
Often, abdominal wall pain may be the presenting feature in a patient who has had lower back pain and stiffness for some time. He may have gotten used to these lower back symptoms and a careful history for such must be uncovered to get to the root of the abdominal wall symptoms.
Palpation for presence of tender muscle knots and bands in the abdominal wall should always be performed for consideration of presence of myofascial syndrome.
The muscles that comprise the abdominal wall are:
- Rectus abdominis
- External oblique
- Internal oblique.
Nerve supply: Lower thoracic nerves from T6 to L1.
© 2007 copyright all rights reserved www.stopmusclepain.com Low back pain| abdominal wall pain
Photograph showing the abdominal wall muscles
abdominal wall pain, external oblique, internal oblique, low back pain, lower body topics, rectus abdominis
