HB mwwMfiifnw

Unlock Your Hip Flexors

Unlock Your Hip Flexors

Get Instant Access

CONTENT S

Introduction 361

Section I: Innervation

Lumbar Plexus, Sacral Plexus 362, 363

Spinal Nerve and Muscle Chart 364

Spinal Nerve and Motor Point Chart 365

Chart of Lower Extremity Muscles 366, 367

Nerves to Muscles: Motor & Sensory 368

Cutaneous Nerves of the Lower Limb 369

Section II: Joint Movement

Movements of Toes, Foot, Ankle and Knee 370, 371

Movements of Hip Joint 372, 373

Joint Measurement Chart 374

Treatment of Muscle Length Problems 375 Test for Length of Ankle Plantar Flexors 375

Test for Length of Hip Flexor Muscles 376-380

Hip Flexor Stretching 381

Problems with Hamstring Length Testing 382

Tests for Length of Hamstring Muscles 383-384

Short Hamstrings 385, 386

Effect of Hip Flexor Shortness 387

Errors in Testing Hamstring Length 388, 389

Hamstring Stretching 390

Ober and Modified Ober Test 391-394

Hip Flexor Length Testing 395-397

Tensor Fasciae Latae Stretching 398

Section III: Muscle Strength Tests

Hamstrings and Gracilis Quadriceps Femoris Hip Flexors Sartorius

Tensor Fasciae Latae

Hip Adductors

Medial Rotators of Hip Joint

Lateral Rotators of Hip Joint

Gluteus Minimus

Gluteus Medius

Gluteus Medius Weakness

Trendelenberg Sign & Hip Abductor Weakness

Gluteus Maximus

Leg Length Measurement

Apparent Leg Length Discrepancy

Section IV: Painful Conditions

Foot Problems

Shoes and Shoe Corrections

Knee Problems

Leg Pain

Tight Tensor Fasciae Latae and 1TB Stretched Tensor and ITB Protruded Intervertebral Disk Piriformis Muscle and Sciatic Pain Neuromuscular Problems Case 1: Peroneal Nerve Injury

417-419 420,421

422,423

426-428 429

430,431

436,437

440-443 444-446 447,448 449

449.450

450.451 452

453,454

Section III: Muscle Strength Tests

Chart for Analysis of Muscle Imbalance 399

Case 2: Lumbosacral Nerves

456,457

Strength Test: Toe Muscles

400-409

Case 3: L5 Lesion

458

Tibialis Anterior

410

Case 4: Guillain-Barre

459

Tibialis Posterior

411

Case 5: Guillain-Barre

460

Peroneus Longus and Brevis

412

Case 6: Polio

461

Ankle Plantar Flexors

413-415

Exercise

462,463

Popliteus

416

References

The lower extremities provide both support and mobility for the body as a whole Fulfilling these roles requires that good muscle balance of the lower extremity muscles be established and maintained.

Unlike the upper extremity where one plexus supplies the arm muscles, the lower extremity is supplied by both the lumbar and sacral plexes. Differential diagnosis of joint movement problems in the hip region requires particular attention because of the different origins of the nerves and the multitude of muscles that can be involved. Many of the muscles cross the hip and the knee, and distinguishing problems of tightness among the muscles can be challenging. Different problems can give rise to similar symptoms.

Effective treatment of musculoskeletal problems depends upon an accurate assessment of the length and strength of the muscles. Serious mistakes can result from failure to pay attention to details. An example of such an error is described on page 389.

Because actions of the muscles of the hip are closely related, there can be substitution in cases of muscle weakness, or accommodation in cases of muscle shortness. Failure to detect such substitutions, or enabling them through incorrect test positions or movements will render a test invalid.

In order to begin the problem-solving process of making a differential diagnosis and developing a successful treatment plan, it is necessary to have a comprehensive knowledge of the innervation, joint movements, alignment of body segments, and precise testing procedures for length and strength of these muscles. In addition unique case studies with charts showing test findings are included in this chapter to demonstrate special problems related to lower extremity dysfunction.

Lumbar Plexus Muscles

LUMBAR PLEXUS

The lumbar plexus is formed by the ventral primary rami of LI, 2, and 3, a part of L4, and frequently, with a small contribution from T12. Within the substance of the psoas major muscle, the rami branch into anterior and posterior divisions. Peripheral nerves from the anterior divisions innervate adductor muscles on the medial side of the thigh; those from the posterior divisions innervate hip flexors and knee extensors on the anterior aspect of the thigh.

L(1). 2, 3, 4
Sacral Nerves

SACRAL PLEXUS

The sacral plexus arises from the smaller part of the ventral primary ramus of LA and from the entire ventral rami of L5, S1, 2 and 3. The LA and L5 ventral rami unite to form the lumbosacral trunk, which enters the pelvic cavity. There, it is joined by the ventral rami of S1, 2 and 3, forming the plexus, which then branches into anterior and posterior divisions. The anterior divisions, and the peripheral nerves arising from them, innervate the posterior aspect of the thigh and the leg as well as the plantar surface of the foot. The posterior divisions, and the peripheral nerves arising from them, innervate the abductor muscles on the lateral side of the thigh, a hip extensor muscle posteriorly, and the extensor (dorsiflexor) muscles of the ankle and toes anteriorly.

Gemellus inferior and Quadratus femoris L4. 5 S1.(2)

LOWER EXTREMITY

Name

Date

= a muscle

quad lumborum psoas minor psoas major

ILIACUS

PECT1NEUS

SARTORIUS

QUADRICEPS

adductor brev1s adductor longus gracelis a > :» I > >

obturator ext adductor magnus

GLUTEUS MEDJUS

GLUTEUS MINIMUS

TENSOR FAS LAT

gluteus maximus

FERFHERAL NERVES

spinal segment piriformis

gemellus sup

OBTURATOR INT

gemellus inf quad flatus fem biceps i short h) ] :

mrrpc m nuc ut biceps (long h)

semitendinous

SEMIMEMBRANOSUS

TIBIALIS ANTERIOR

ext hall long ext digit long peroneus tertl us ext digit brevis peroneus longus peroneus brevis

PLANTARIS

gastrocnemius popliteus i soleus i tibialis posterior

! flex digit long

FLEX HALL LONG

flex digit brevjs

ABDUCTOR HALL

flex hall brevis lumbricaus i abd digiti min

QUAD PLANTAE

flex digitl min opp digiti min adductors hall plant interossei dorsal interosse!

i lumb h.lit.iv key

D Dorsal Primary Ramus

V Ventral Primary Ramus

A Anterior Division

P Posterior Division spinal segment

Hi m ill

SilHl

SHSECFY

Nerve Chart Kendall

Lumbo- PosL hypogasrc ingyfial dy.

Lumbo- PosL hypogasrc ingyfial dy.

Peroneus Longus Motor Point
Lar planiBi

©1993 Florence P. Kendall. Author grams permission to reproduce for personal use but not for sale.

SPINAL NERVE AND MOTOR POINT CHART

Lumbar plexus Psoas minor -Psoas major-

Famoral N.

Iliacusj-

Sartorius -[Rectus femoris4-. Vast. med.-L Vast lat.

Vast, inter.

Vastus med.

i te

Obturator N.

Add. brevis -Add. longus *Add. magnus

Gracilis

LI La LJ

Sacral plexus

Piriformis i.

Gemellus sup — Obturator int-Gemellus inf.— Quad, fern — Sciatic N. Biceps. I h -Semitendin.-" Add. magnus Semimembran.-Biceps. s.h-

Sup.gluteal N. -Gluteus med. -Gluteus min. STen. fas. latae

Inf. gluteal N. -Gluteus max.

Superficial peroneal N.

Peroneus long.—

Green: Peripheral nerves and the posterior divisions from which they arise. Yellow: Peripheral nerves and the anterior divisions from which they arise.

Deep peroneal N.

-Tibialis anterior

Peroneus brev.

-Tibialis anterior -Ext. digit, longus

-Peroneus tertius

Tibial N. Plantans

-Gastrocnemius Popliteus -Soleus -Tibialis post. Flex, digit. I. .Flex. hall. I.

-Ext. digit, brevis

Lateral planter N. -Dorsal interossei

-Ext. digit, brevis

Lateral planter N. -Dorsal interossei

Medial plantar N. Flex. dig. brev Abd. hallucis

Lumbricalis icalis I—J

Lateral plantar N.

Quad, plantae

Add hall, obi

-Plantar interossei

Add hall, trans.

Dorsal interossei (see dorsum)

Listed According to Spinal Segment Innervation and Grouped According to Joint Action

Spinal Segment

Lu

mb

Sac

HIP

KNEE

2

3

41

5

1

2

3

Muscle

Flexion

Adduction

Med. Rotat

Abduction

Lai Rotat

Extension

Extension

Infle

xion

1

2

3

4

Psoas major

Psoas mai

Psoas ma

Psoas ma |

.1)

2

3

4

lliacus

lliacus

lliacus

lliacus

2

3

4)

Sartorius

Sartorius

Sartorius

SanoTius

SfWvi |

2

3

4

Pectineus

Pectineus

Pecnneus

2

3

4

Adductor long.

Add long

Add. long

Add long

-

2

3

4

Adductor brev.

Add brev

Add brev

Add brev

—-

3

4

Gracilis

Gracilis

Siuts 1

2

3

4

Quadriceps

Red. rem.

Quadriceps

fl

2

3

4

Add. mag. (ant.)

Add m (ant.

Add. mag.

]

3

4

Obturator ext.

Obt. ext.

Obt. ext.

—\

4

5

1

Add. mag. (post.

Add mag.

Ad m post

-

-

4

5

1

Tibialis ant.

4

S

1

Ten (as. i at

Tensor 11

Tensor 11

Tensor fI

Tensor 11

4

5

1

Gluteus minimus

Glut, mm

Glut. mm.

Glut. min.

4

5

1

Gluteus medius

G med ant

G. med- ant.

Glut. med.

G med post

G. med.. post

4

S

1

Popliteus

4

5

1

Ext. dig. long

-

4

5

1

Peroneus tertius

---

4

S

—f

-

Ext. hall. long.

^

S

1

J

Ext. dig. brev.

-

- B

L

4

S

1

_

Flex. dig. brev.

' 1

4

s

1

Flex. hall. brev.

4

i

1

Lumbricalis I

4

!>

1

- H

Abductor hall

--

—-1

4

5

1

Peroneus longus

--

4

5

1

Peroneus brevis

--■

(4)

5

1

Tibialis post.

-H

4

5

1(2»

Gemelli inferior

Gem. inf.

Gem mf.

-■

4

5

1

(2)

Quadratus fern.

Quadratus f

--1

4

5

1

(2

Plantaris

_-----

-1

——

4 4

I 5 5

1 1

2 2

Semimembranosus Semitendinosus

Sei^wfiCfTb

Semilend

_

Seovnwt Fl

S

1

12

Flex. dig. long.

-

Senutend

i

1

2

Gluteus maximus

G. max.. low

G max.. upp

Glut, max

Glut, max

-1

S

1

2

Biceps, short h.

Bic.. s.h

--H

__

5

1

2

Flex. hall. long.

-9

W-

i (S

1

2 7

1—

Soleus

-

- —

5

1

2

Gemelli superior

-

Gem sup.

Piriformis Gem. sup.

Piriformis

--

---

-il

F

S

1

2

Obturator int.

Obt int.

Obt. int.

" "■ ■

--J|

-—

5

1

2

3

Biceps, long h.

-1-

Biceps I h

Biceps l.h.

Bic. l.h.

i-9

L

(4

ib

1

2

Lumb. II. III. IV

!--II

L

1

2

Gastrocnemius

f-—

2

Dorsal inteross.

--1-

" --

--41

2

Plantar inteross.

r

---j|

! 5

Abd. dig. min. Adductor hall.

-

_

-1

J_L_J_

J_

L-

--

©1993 Florence P. Kendall. Author grants permission to reproduce for personal use but not for sale.

©1993 Florence P. Kendall. Author grants permission to reproduce for personal use but not for sale.

Listed According to Spinal Segment Innervation and Grouped According to Joint Action (Continued)

Digs-1-5 Distal toiarphal Jis

Kendall Innervation Chart
01993 Florence P. Kendall. Author grants permission to reproduce for personal use but not for sale

Source

Spinal Segment

Nerve

Motor/Sensory to Muscle

Muscle

Lumbar plexus -

Ventral primary ramus

T12. L1 LI. 2. 3. 4

Iliohypogastric Lumbar plexus

Motor and sensory Motor and sensory

Internal oblique, transversus abdominis

Quadratus lumborum, psoas major, psoas minor

Posterior division

L2, 3,4

Femoral

Motor and sensory

lliacus, pectineus, sartorius, quadriceps

Anterior division

L2, 3,4

Obturator

Motor and sensory

Hip adductors

Lumbosacral plexus

Sciatic Nerve

Posterior division

L4, S, S1

Gluteal, superior

Motor'

Gluteus medius, gluteus minimus, tensor fasciae latae

Posterior division

LS, SI, 2

Gluteal, inferior

Motor

Gluteus maximus

Posterior division

L4, S, Si, 2

Peroneal

Motor and sensory

Short head of biceps, tibialis anterior, toe extensors, peroneals

Anterior division

L4, S, 81,2,3

Tibial

Motor and sensory

Semimembranosus, semitendinosus, long head of biceps, 19 ankle and foot muscles

Sacral plexus

Ventral primary ramus

L4, S, SI, 2, 3

Sacral plexus

Motor and sensory

Piriformis, gemelli superior and inferior, obturator internus, and quadratus femoris

'Sensory to hip joint

© 1993 Florence P. Kendall. Author grants permission to reproduce for personal use but not for sale.

'Sensory to hip joint

© 1993 Florence P. Kendall. Author grants permission to reproduce for personal use but not for sale.

Femoral: Pierces the psoas major at the distal part of the lateral border, and supplies the iliacus, pectineus, sartorius, and quadriceps. The largest and longest branch of the femoral nerve is the saphenous nerve, which supplies the skin over the medial side of the leg.

Obturator: From L2 through L4. Through its muscular branch, it supplies the obturator externus, adductor magnus, and sometimes, adductor brevis. Through its articular branch, it is distributed to the synovial membrane of the knee joint.

Sciatic: From L4, 5 and SI, 2, 3. In most instances, the sciatic nerve lies beneath the piriformis muscle and crosses the obturator internus, gemelli, and quadratus femoris. (See illustration, p. 453.) Variations exist, however, in which the muscle is split and either one (usually the peroneal) or both parts of the sciatic nerve pass through the muscle belly.

Peroneal: Passes between the biceps femoris and the lateral head of the gastrocnemius to the head of the fibula and deep to the peroneus longus. (See illustration, p. 449.) It supplies the ankle dorsiflexors and everters.

CUTANEOUS NERVES OF THE

3 f i «

LOWER LIMB

Lateral cutaneous i of subcostal nerve (Ti2)

Femoral branch

Genital branch

Lateral femoral DUS nerve, anterior branches termediate femoral cutaneous nerves

Infrapatellar branch of saphenous nerve aneous branches of common fibular m (peroneal) nerve

EWai

Superficial fibular (peroneal) nerve becoming dorsal digital nerves

Dorsal lateral cutaneous nerve of foot (termination of sural nerve)

Femoral branch

Genital branch

Lateral cutaneous i of subcostal nerve (Ti2)

Lateral femoral DUS nerve, anterior branches termediate femoral cutaneous nerves

Infrapatellar branch of saphenous nerve aneous branches of common fibular m (peroneal) nerve

Perforating Cutaneous Inerveation

Deep fibular (peroneal) nerve

Genitofemoral nerve

Perforating cutaneous nerve

Cutaneous branch of obturator nerve

Medial femoral cutaneous nerve

Saphenous nerve

Deep fibular (peroneal) nerve

Cutaneous branches:

Genitofemoral nerve

Perforating cutaneous nerve

Cutaneous branch of obturator nerve

Medial femoral cutaneous nerve

Saphenous nerve

Medial calcanean branches of tibial nerve

Perforating Cutaneous Nerve

Lateral cutaneous branch of iliohypogastric nerve

Lateral femoral cutaneous nerve

Posterior femoral cutaneous nerve, end branch

Lateral sural cutaneous nerve (from common fibular nerve)

Medial sural cutaneous nerve (from tibial nerve)

Dorsal lateral cutaneous nerve of foot (termination of sural nerve)

Branch of saphenous nerve nerve) Lateral plantar nerve

Branch of saphenous nerve

Medial calcanean branches of tibial nerve

Lateral cutaneous branch of iliohypogastric nerve

Lateral femoral cutaneous nerve, posterior branches

Branches of posterior femoral cutaneous nerve

Lateral femoral cutaneous nerve

Posterior femoral cutaneous nerve, end branch

Lateral sural cutaneous nerve (from common fibular nerve)

Medial sural cutaneous nerve (from tibial nerve)

Dorsal lateral cutaneous nerve of foot (termination of sural nerve)

Medial plantar nerve nerve) Lateral plantar nerve

A, Anterior view

B, Posterior view

Note in Figure B, sural is Latin for the calf. In this illustration, the medial sural cutaneous nerve is here joined

From Grant's Atlas of Anatomy (1); with permission.

just proximal to the ankle by a communicating branch (not labeled) of the lateral sural cutaneous nerve to form the sural nerve. The level of the junction is variable, however, being very low in Figure B.

INTERPHALANGEAL JOINTS OF TOES

The interphalangeal joints are ginglymus or hinge joints that connect the adjacent surfaces of phalanges.

Flexion and extension are movements about a coronal axis, with flexion being movement in a caudal direction and extension being movement in a cranial direction.

METATARSOPHALANGEAL JOINTS

The metatarsophalangeal joints are condyloid, formed by joining the distal ends of the metatarsals with the adjacent ends of the proximal phalanges.

Flexion and extension are movements about a coronal axis. Flexion is movement in a caudal direction; extension is movement in a cranial direction. The range of motion in adults is variable, but 30° of flexion and 40° of extension may be considered an average range for good function of the toes.

Adduction and abduction are movements about a sagittal axis. The line of reference for both adduction and abduction of the toes is the axial line projected distally in line with the second metatarsal and extending through the second digit. Adduction is movement toward the axial line, and abduction is movement away from it, as in spreading the toes apart. Because abduction of the toes is restricted by the wearing of shoes, this movement is markedly limited in most adults, and little attention is paid to the lack of ability to abduct.

SUBTALAR JOINT AND TRANSVERSE TARSAL JOINTS

The subtalar joint is a modified plane or gliding joint connecting the talus and calcaneus. The talus also connects with the navicular, and the talonavicular joint is involved in movements of the subtalar joint

Supination and pronation are movements permitted by the subtalar and talocalcaneonavicular joint. Supination is rotation of the foot in which the sole of the foot moves in a medial direction; pronation is rotation in which the sole of the foot moves in a lateral direction.

The transverse tarsal joints are formed by the union of the talus with the navicular and the calcaneus with the cuboid.

Adduction and abduction of the forefoot are movements permitted by the transverse tarsal joints. Adduction is movement of the forefoot in a medial direction, and abduction is movement of the forefoot in a lateral direction.

Inversion is a combination of supination and forefoot adduction. It is more free in plantar flexion than in dorsiflexion.

Eversion is a combination of pronation and forefoot abduction. It is more free in dorsiflexion than in plantar flexion.

Flexion ol toes

Extension of toes

Flexion ol toes

Freundschaftsbilder Zeichnen

Dorsiflexion of ankle (Anatomically—ankle extension)

Extension of toes

Plantarltexion ot ankle (Anatomically—ankle t(exion)

Dorsiflexion of ankle (Anatomically—ankle extension)

Plantarltexion ot ankle (Anatomically—ankle t(exion)

The ankle joint is a ginglymus or hinge joint uniting the tibia and fibula with the talus. The axis about which motion takes place extends obliquely from the posterolateral aspect of the fibular malleolus to the anterome-dial aspect of the tibial malleolus.

Flexion and extension are the two movements that occur about the oblique axis. Flexion is movement of the foot in which the plantar surface moves in a caudal and posterior direction. Extension is movement of the foot in which the dorsal surface moves in an anterior and cranial direction.

Confusion has arisen regarding the terminology of these two ankle joint movements. An apparent discrepancy occurs because decreasing an angle frequently is associated with flexion whereas increasing it is associated with extension. Bringing the foot upward to "bend the ankle" seems to connote flexion; pointing the foot downward to "straighten the ankle" connotes extension. (In a review of 48 authors, 12 of them had the wrong definitions for ankle flexion and extension.) To avoid confusion, use of the terms dorsiflexion for extension and plantar flexion for flexion has been widely accepted. This text will adhere to these generally accepted terms.

The knee should be flexed when measuring dorsi-flexion. With the knee flexed, the ankle joint can be dor-siflexed approximately 20°. If the knee is extended, the gastrocnemius will limit the range of motion to approximately 10° of dorsiflexion. The range of motion in plantar flexion is approximately 45°.

MOVEMENTS OF KNEE JOINT

The knee joint is a modified ginglymus or hinge joint formed by the articulation of the condyles of the femur with the condyles of the tibia, and by the patella articulating with the patellar surface of the femur.

Flexion and extension are movements about a coronal axis. Flexion is movement in a posterior direction, approximating the posterior surfaces of the lower leg and thigh. Extension is movement in an anterior direction to a position of straight alignment of the thigh and lower leg (0°). From the position of zero extension, the range of flexion is approximately 140°. The hip joint should be flexed when measuring full knee joint flexion to avoid restriction of motion by the rectus femoris, but the joint should not be fully flexed when measuring knee joint extension to avoid restriction by the hamstring muscles.

Hyperextension is an abnormal or unnatural movement beyond the zero position of extension. For the sake of stability in standing, the knee normally is expected to be in a position of only a very few degrees of extension beyond zero. If extended beyond these few degrees, the knee is said to be hyperextended. (See p. 81.)

Lateral rotation and medial rotation are movements about a longitudinal axis. Medial rotation is rotation of the anterior surface of the leg toward the midsagittal plane. Lateral rotation is rotation away from the mid-sagittal plane.

The extended knee (in zero position) is essentially locked, preventing any rotation. Rotation occurs with flexion, combining movement between the tibia and the menisci as well as between the tibia and the femur.

With the thigh fixed, the movement that accompanies flexion is medial rotation of the tibia on the femur. With the leg fixed, the movement that accompanies flexion is lateral rotation of the femur on the tibia.

With the thigh fixed, the movement that accompanies extension is lateral rotation of the tibia on the femur. With the leg fixed, the movement that accompanies extension is medial rotation of the femur on the tibia.

Knee Joint Flexion, Extension, and Hyperextension

Hyperextension

Ramon

The hip joint is a spheroid or ball-and-socket joint formed by the articulation of the acetabulum of the pelvis with the head of the femur.

Ordinarily, descriptions ofjoint movement refer to movement of the distal pan on a fixed proximal part. In the upright weight-bearing position, movement of the proximal part on the more fixed distal part becomes of equal—if not primary—importance. For this reason, movements of the pelvis on the femur are mentioned as well as movements of the femur on the pelvis.

Flexion and extension are movements about a coronal axis. Flexion is movement in an anterior direction. This movement may be one of bringing the thigh toward the fixed pelvis, as in supine alternate-leg raising. Or it may be bringing the pelvis toward the fixed thighs, as in coming up from a supine to a sitting position, bending forward from a standing position, or tilting the pelvis anteriorly in standing. Extension is movement in a posterior direction. This movement may be one of bringing the thigh posteriorly, as in leg-raising backward, or one of bringing the trunk posteriorly, as in returning from a standing forward-bent position, or as in tilting the pelvis posteriorly when standing or lying prone.

The range of hip joint flexion from zero is approximately 125°, and the range of extension is approximately 10°, making a total range of approximately 135°. The knee joint should be flexed when measuring hip joint flexion to avoid restriction of motion by the hamstring muscles, and the joint should be extended when measuring hip joint extension to avoid restriction of motion by the rectus femoris.

Abduction and adduction are movements about a sagittal axis. Abduction is movement away from a mid-sagittal plane in a lateral direction. In a supine position, the movement may be one of moving the thigh laterally on a fixed trunk or of moving the trunk so that the pelvis tilts laterally (i.e., downward) toward a fixed thigh. Adduction is movement of the thigh toward the midsagittal plane in a medial direction. In a supine position, the movement may be one of moving the thigh medially on a fixed trunk or of moving the trunk so that the pelvis tilts laterally (i.e., upward) away from a fixed thigh. (For abduction and adduction of the hip joints accompanying lateral pelvic tilt, see below.)

From zero, the range of abduction is approximately 45°, and the range of adduction is approximately 10°. making the total range approximately 55°.

Hip Joint Flexion

Thigh toward pelvis f

Thigh toward pelvis

Pelvis toward thigh Pelvts toward thigh

Hip Join! Extension

Hip Join! Extension

Thigh toward pelvis

Thigh toward pelvis

Pelvis toward thigh

Pelvis toward thigh

Pelvis toward thigh

Hip Joint Abduction and Adduction

Supine or standing Anterior view

Supine Anterior view

Standing Posterior view

Pelvis level

Was this article helpful?

0 0
31 Days To Bigger Arms

31 Days To Bigger Arms

You can have significantly bigger arms in only 31 days. How much bigger? That depends on a lot of factors. You werent able to select your parents so youre stuck with your genetic potential to build muscles. You may have a good potential or you may be like may of the rest of us who have averages Potential. Download this great free ebook and start learns how to build your muscles up.

Get My Free Ebook


Post a comment