Healthcare and Medicine Reference
Fig. 9.16 Although the fascia has been removed in this dissection,
there is a connection from the adductor magnus (and the posterior
intermuscular septum represented by the dark space just behind
it) across the ischial tuberosity and the lower obturator internus
fascia to the arcuate line (horizontal line) where the levator ani joins
the lateral wall of the true pelvis. (© Ralph T Hutchings.
Reproduced from Abrahams et al 1998.)
Fig. 9.18 Deep Front Line, lower posterior tracks and stations
view as imaged by Primal Pictures. (Image provided courtesy of
Primal Pictures, www.primalpictures.com.)
rectus abdominis reaching down from above (described
later in this chapter - see Fig. 9.31).
Palpation guide 2: lower posterior track
The area of the DFL behind the knee is not easily ame-
nable to palpation or manual intervention due to the
passage of the neurovascular bundle and fat pad super-
ficial to these tissues. The medial femoral epicondyle on
the inside just above the knee is easily felt if you put
your thumb along the medial side of your thigh and
slide down with some pressure until you find the knob
of the epicondyle a couple of inches above the knee.
This station marks the beginning of a division
between the posterior septum that runs up the back of
the adductors, separating them from the hamstrings,
and the anterior (medial intermuscular) septum divid-
ing the adductors from the quadriceps. Taking the pos-
terior septum first, place your model on his side, and
find the medial femoral epicondyle (Fig. 9.14). You will
find a finger's width or more of space between this
condyle and the prominent medial hamstring tendons
coming from behind the knee.
Follow this valley upward as far as you can toward
the IT. In some people, it will be easy to follow, and you
Fig. 9.17 From the posterior intermuscular septum and adductor
magnus, the fascial track moves up inside the ischial tuberosity on
the obturator internus fascia to contact the pelvic floor (levator ani).
fascia blends into the anterior longitudinal ligament
running up the front of the spine, where it rejoins the
lower anterior track at the junction between the psoas
and diaphragmatic crura (Fig. 9.18).
The complex sets of connections here are difficult to
box into a linear presentation. We can note, for instance,
that the pelvic floor, in the form of the central pubococ-
cygeus, also connects to the posterior lamina of the