Stretches for the Lower Extremity
Chapter 4
Hip Extensors: Hamstrings and Gluteus Maximus
• Anatomy: Chronically shortened
hamstrings can contribute to these
conditions:
•
•
•
•
•
Low back pain
Knee pain
Leg length differences
Restricted stride length
Overworked quadriceps
• Gluteus maximus is a powerful hip
extensor that can be involved in low
back pain.
Hamstrings and Gluteus Maximus: Review
Origins, Insertions, and Actions
Adapted, by permission, from R.S. Behnke, 2005, Kinetic anatomy, 2nd ed. (Champaign, IL: Human
Kinetics), 180.
Functional Assessment: Hip Flexion to 90
Degrees With the Knee Straight Is Ideal
Hip Rotators: Piriformis
• One of six deep lateral hip rotators, all of which
insert on some portion of the greater trochanter.
• When these muscles are hypertonic, they
contribute to a toe-out gait seen in dancers, and
they restrict internal rotation of the hip. Stretching
the piriformis also stretches the other lateral
rotators.
• Although the piriformis is considered a lateral
rotator of the hip, it may be more of a postural
muscle, stabilizing the spine and maintaining
pelvic balance in conjunction with the psoas
(Myers 1998).
Piriformis: Review Origin, Insertion, and Action
Functional Assessment (Piriformis): The Path of
the Sciatic Nerve Through the Lateral Rotators
Hip Abductors
• Primary abductors of the hip are the
tensor fasciae latae (TFL) and the
gluteus medius and minimus.
• These muscles abduct the hip and also
stabilize it during weight-bearing
activities.
• Tightness in these muscles can
contribute to pelvic imbalances, which
can cause pain in the hips, low back,
and knees.
Hip Abductors: Review Origins, Insertions, and
Actions
Hip Abductors: Functional Assessment
Abductor tightness test (modified
Ober’s test). Excessive tightness
in the hip abductors prevents this
position.
Typical pain sites for iliotibial
band syndrome.
Fig. 4.14 (right): Adapted, by permission, from R.S. Behnke, 2005, Kinetic anatomy, 2nd ed.
(Champaign, IL: Human Kinetics), 202.
Anatomy: Hip Adductors
• When you bring your legs together
(toward your midline), you use adductor
muscles.
• Adductor muscles can be divided into
the short adductors (pectineus,
adductor brevis, and adductor longus)
and the long adductors (adductor
magnus and gracilis).
• We’ve provided one illustration showing
all the adductors.
Hip Adductors: Review Origins, Insertions, and
Actions
Adapted, by permission, from R.S. Behnke, 2005, Kinetic anatomy, 2nd ed. (Champaign, IL: Human
Kinetics), 183.
Hip Adductors: Functional
Assessment
50°
50°
Normal range of hip abduction is 45 to 50 degrees from the
midline. Limited range is usually due to tight adductors.
Hip Flexors: Quadriceps Group
• Quadriceps consist of four muscles and
are powerful extensors of the knee.
• One of the quads, the rectus femoris,
also crosses the hip joint and acts as a
hip flexor, assisting the psoas.
• Chronically short quads can contribute
to low back pain. The quadriceps are
usually involved in any type of knee
pain or instability.
Quadriceps Group: Review Origins, Insertions,
and Actions
Adapted, by permission, from R.S. Behnke, 2005, Kinetic anatomy, 2nd ed. (Champaign, IL: Human
Kinetics), 198.
Quadriceps: Functional Assessment
Normal range of knee extension. (a) The quadriceps should
fully extend the knee. (b) The arc of motion should be
smooth, with no hesitation or jerkiness.
Hip Flexors: Psoas and Iliacus
• Iliopsoas is the primary hip flexor.
• Because of its attachment along the lumbar
spine, it affects the angle of the lumbar curve.
A psoas that is too tight can cause an
increase in the curve, which leads to
swayback and low back pain.
• However, sometimes a tight psoas will flatten
the lumbar curve, which can also lead to low
back pain. For a more detailed discussion of
this seeming contradiction, see Tom Myers’
article “Poise: Psoas-Piriformis Balance”
(1998).
Psoas and Iliacus: Review Origins, Insertions,
and Actions
Adapted, by permission, from R.S. Behnke, 2005, Kinetic anatomy, 2nd ed. (Champaign, IL: Human
Kinetics), 178.
Psoas and Iliacus: Functional Assessment
120°
a
30°
b
Normal range of (a) hip flexion and (b) hip extension.
Plantarflexors: Gastrocnemius and Soleus
• Gastrocnemius-soleus muscles are also
called the triceps surae.
• They insert into the heel via the Achilles
tendon, the strongest tendon in the
body. The gastrocnemius is a twoheaded muscle that gives the calf its
shape.
• The soleus muscle, which lies
underneath the gastrocnemius, is more
often the reason for calf tightness.
Gastrocnemius and Soleus: Review Origin,
Insertion, and Action
Adapted, by permission, from R.S. Behnke, 2005, Kinetic anatomy, 2nd ed. (Champaign, IL: Human
Kinetics), 202.
Gastrocnemius and Soleus: Functional
Assessment
20°
a
b
(a) Normal range of dorsiflexion at the ankle. (b) With the
knee bent, the gastrocnemius is slack, and any limitation in
dorsiflexion is probably due to a tight soleus.
Gastrocnemius and Soleus: Functional
Assessment (continued)
50°
Normal range of ankle plantarflexion is 50 degrees.
Toe Flexors: Flexor Hallucis Longus, Flexor
Digitorum Longus
• We discuss only two of the six toe flexors
(flexor hallucis and flexor digitorum
longus). The muscle table lists all six toe
flexors.
• With the foot on the ground, flexor hallucis
and digitorum longus assist in maintaining
balance by keeping the toe pads on the
ground.
• Flexor hallucis longus helps support
longitudinal arch and exerts a strong
propulsion action during toe-off phase of
gait.
Flexor Hallucis Longus and Flexor Digitorum
Longus: Review Origins, Insertions, and Actions
Flexor Hallucis Longus and Flexor Digitorum
Longus: Functional Assessment
Normal range of motion of the great toe: 80 degrees of
extension, 25 degrees of flexion.
Dorsiflexors: Tibialis Anterior
• When the foot is free to move, tibialis
anterior dorsiflexes and inverts it.
• When the foot is on the ground, tibialis
anterior assists in maintaining balance.
• During walking or running, it helps
prevent the foot from slapping onto the
ground after heel strike and lifts the foot
to clear the ground as the leg is
swinging forward.
Tibialis Anterior: Review Origin, Insertion, and
Action
Adapted, by permission, from R.S. Behnke, 2005, Kinetic anatomy, 2nd ed. (Champaign, IL: Human
Kinetics), 216.
Tibialis Anterior: Functional Assessment
Toe Extensors: Extensor Hallucis Longus, Extensor
Digitorum Longus
• We illustrate and discuss only two of the four
toe extensors (extensor hallucis longus and
extensor digitorum longus). The muscle table
lists all four toe extensors.
• Extensor hallucis longus and extensor
digitorum longus help control the speed of
descent of the forefoot to the ground following
heel strike, preventing the foot from slapping
onto the ground.
• They also contribute to postural stability by
controlling posterior sway.
• With the foot anchored to the ground, they
pull the leg forward at the ankle.
Extensor Hallucis Longus and Extensor Digitorum
Longus: Review Origins, Insertions, and Actions
Extensor Hallucis Longus and Extensor Digitorum
Longus: Functional Assessment
Normal range of motion of the great toe: 80 degrees
of extension, 25 degrees of flexion.
Evertors: Peroneal (Fibularis) Group
Invertors: Tibialis Anterior and Posterior
• Eversion (pronation) and inversion (supination) of the
foot occur with every step.
• Proper function of evertors and invertors is critical for
biomechanics and stability.
• Invertors and evertors often control movement rather
than initiate it.
• Primary evertors are two of the three peroneal
muscles (also known as fibularis muscles): peroneus
longus and peroneus brevis. They make up the
lateral compartment of the leg. The peroneus tertius
is in the anterior compartment with the tibialis
anterior.
• Although peroneals are most often considered
evertors, they also stabilize the foot, ankle, and leg.
• Primary invertors are tibialis anterior and posterior.
The tibialis posterior is the deepest muscle in the calf.
Evertors and Invertors: Review Origins, Insertions and
Actions
Adapted, by permission, from R.S. Behnke, 2005, Kinetic anatomy, 2nd ed. (Champaign, IL: Human
Kinetics), 216, 217.
Evertors and Invertors: Functional Assessment
Normal ROM for inversion (supination) is 45 degrees; for
eversion (pronation) it is 20 degrees.
Spiral–Diagonal Patterns for the Lower
Extremity
• Not all spiral patterns for the leg lend themselves to
stretching. Extension end of the D2 pattern is
awkward.
• Compared to single-plane stretches, the patterns
require more concentration from both the stretcher
and you.
• Illustrate what you want the stretcher to do by taking
him through the pattern passively.
• You’re trying to improve ROM at the end of the
pattern. Start with the stretcher at the end of his
range in all three planes of motion. In isometric
phase, stretcher attempts to move toward the
opposite three planes (toward the shortened
direction).
• After isometric effort, stretching occurs as the
stretcher moves farther in all three planes of motion
toward lengthened direction.