Healthcare and Medicine Reference
In-Depth Information
The back of the leg
Once onto the fibularis, we pass easily along it to the
head of the fibula, as we did with the LL, but this time
we take the more obvious route from the head of the
fibula onto the biceps femoris, the lateral hamstring (Fig.
6.17). The long head of the biceps carries us up to the
ischial tuberosity. This whole complex - TFL to ITT to
anterior tibialis to fibularis longus to biceps femoris -
can be seen as a conjoined 'jump rope' that travels from
hip to arch down the anterolateral portion of the leg,
and then arch to hip up the posterolateral aspect of the
leg (Figs 6.13, 6.18 and 6.19).
The 4th hamstring
Deep to the biceps femoris long head, which is an
express crossing both hip and knee, lies an important
and not so obvious set of locals. This underlying con-
nection can sometimes provide the answer to recalci-
trant hamstring shortness and limitations to hip flexion
and hip-knee integration. The first of these two locals is
the short head of the biceps, which starts from the same
tendinous attachment at the head of the fibula as the
long head and passes to the linea aspera about one-third
of the way up the femur (Figs 6.19 and 6.20). Here there
is a fascial continuity with the middle section of the
adductor magnus, which passes up beneath the rest of
the biceps femoris to attach to the inferior aspect of
the ischial ramus, just anterior to the hamstring
attachments.
The short head of the biceps component may be over-
active in chronically flexed knees or with a laterally
rotated tibia, while the adductor magnus component
may contribute to a posteriorly tilted pelvis, or the
inability of the hip joints to flex properly.
Reaching this '4th hamstring' requires precision in
getting under the superficial hamstrings. Find the sin-
gular biceps femoris tendon outside the knee, coming
up from the fibular head. The short head of the biceps
can be found by reaching around this tendon on both
its medial and lateral sides. With your client lying prone
with the knee flexed, pin the muscle against the back of
the femur, which will be stretched and lengthened as
your client slowly lowers the leg and foot to full knee
extension. The short head can also be reached side-lying,
still using the knee extension to stretch it
Line, 29:33-33:49).
The adductor magnus (which makes another
appearance as part of the Deep Front Line in Ch. 9) can
most easily be reached by having your client side-lying
with the upper knee and hip flexed (and the thigh
resting on a pillow) so that the medial aspect of the leg
is open for work (DVD ref: Deep Front Line - Part 1,
37.32-11:59).
Find the hamstring attachments on the posterior
aspect of the ischial tuberosity, and palpate along the
bottom edge of the ischial tuberosity anterior about an
inch to find the strong adductor magnus attachment.
Instructing the client to lift the knee toward the ceiling
will isolate this tendon from the hamstrings. Once
found, work the adductor magnus down from its attach-
ment toward the middle of the femur, remembering that
this is a substantial piece of myofascia and several
passes may be necessary to achieve the necessary
depth.
Movement teachers can isolate this part of the adduc-
tor magnus by having their students stretch into hip
flexion while keeping the knees slightly flexed. The
stretch will be felt to run a bit deeper in the back of the
thigh than the usual straight-legged forward bend.
Fig. 6.17 There is a clear and direct fascial connection at the
head of the fibula between the fibularis longus and the biceps
femoris muscle.
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