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July, 2012, Vol. 12, Issue 07

Pelvic Pain from The Adductor Magnus

By David Kent, LMT, NCTMB

Living with pelvic pain is a daily occurrence for many people. It is very unsettling for a patient to have undergone countless medical tests and procedures with no clear source of the pain identified.

Myofascial trigger points (TrPs) are one possible cause of pelvic pain. Trigger points 1 and 2 in the adductor magnus refer pain into the pelvic region (Image 2b and c). Let's talk about= the anatomy, trigger point locations, referral patterns and provide a link to an online video clip showing a treatment routine for the adductor magnus with the patient in a side lying position.

Tripartite

The adductor magnus is the largest muscle of the adductor group. It is tripartite, composed of three parts, an adductor minimus part, a middle part and an ischiocondylar or "hamstring" part (Image 1).The fibers of the adductor minimus part run almost horizontal. The fibers of the middle part run at an angle and the fibers of the isciocondylar or third part, run vertical (Image 1). Besides having three parts, the adductor magnus contains an opening.

Hiatus

Adductor magnus - Copyright – Stock Photo / Register Mark Image 1: Adductor magnus is tripartite, composed of three parts, an adductor minimus part, a middle part and an ischiocondylar or "hamstring" part. The word hiatus originates from the latin term, hiare, to stand open. A hiatus is a normal opening in a membrane or other body structure. The adductor hiatus is an opening in the distal attachment of the adductor magnus muscle and is located just superior to the adductor tubercle of the femur (Image 1). As the femoral artery and vein pass through the adductor hiatus, their names change to become the popliteal artery and vein.

Nerve

Two nerves innervate the adductor magnus muscle. The tibial part of the sciatic nerve supplies the ischiocondylar or "hamstring" part of the adductor magnus. This same nerve also innervates the hamstring muscles. The obturator nerve supplies the adductor minimus and middle parts of the adductor magnus.

Attachments

Proximally, the adductor magnus attaches on the inferior ramus of the pubis, as well as, the ramus of the ischium and the ischial tuberosity. Distally, it attaches on the back of the femur, from the gluteal tuberousity to the adductor tubercle.

Function

Since the adductor magnus has three parts, each with fibers pulling in differ directions and is innervated by two different nerves, the effects on posture and biomechanics are significant. For example, the middle part can rotate and tilt the pelvis, adduct and flex the thigh. While the ischiocondylar or "hamstring" part extends the pelvis. We will visit these dynamics in a future article. For now we will look at trigger points.

Trigger Points

trigger points - Copyright – Stock Photo / Register Mark Image 2: "X" indicates the common location of trigger points within the muscle. Solid red areas indicate an essential pain zone. The red dots indicate spillover pain zones.
2A Posterior view, locations of trigger point (TrP) 1 and 2.
2B Trigger point 1 (TrP 1) located at level of the mid thigh. It refers below the inguinal ligament, into the pelvic region, running distally to the medial knee.
2C Midsagittal view, Trigger point 2 (TrP 2) is located proximal referring pain into the pelvic region.
Trigger points can form in the adductor magnus for numerous reasons from physical trauma, activities like hiking, slipping on a wet or icy surface that causes the persons legs to extremely abduct, or from many hours of sitting in a hip flexed position on a plane, in a car or while working at a desk, to name a few.

Trigger point 1 (TrP 1) in the adductor magnus muscle is located at the level of the mid thigh. It refers an essential pain zone into the medial thigh, starting below the inguinal ligament, into the pelvic region, running distally to the medial knee (Image 2a - b), "X" indicating the common location of trigger points within the adductor magnus muscle. Solid red areas indicate an essential pain zone. Red dots indicate spillover pain zones. (Image 2 A-C) Trigger point 2 (TrP2) in the adductor magnus muscle is located proximally. It refers internal pelvic pain. Patients may describe the pain as referring into organs such as the vagina, rectum or bladder.

In addition to adductor magnus, other muscles with documented trigger points that refer into the pelvic region include the obturator internus, piriformis and obliquus internus abdominis, coccygeus and levator ani. Be sure you are properly trained, licensed and operating within your scope of practice prior to performing therapy.

Treatment

I wish you the best helping patients with pelvic pain. If the cause includes trigger points in the adductor magnus, you now have information to provide a soft tissue solution. Here is a link to an online video clip showing a treatment routine for the adductor magnus with the patient in a side lying position: www.youtube.com/KentHealth.


Click here for more information about David Kent, LMT, NCTMB.

 

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