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In this 5th and final post on the major muscle groups of the body, we’ll discuss muscles of the lower leg, the back of the thigh, and hip.

The lower leg can be divided into three compartments, the anterior (front), lateral (side), and posterior (back). There are a total of eleven muscles in the lower leg, all of which operate the foot. These muscles are referred to as extrinsic muscles, while the muscle located on the foot itself are referred to as intrinsic muscles. There are three in the front, three on the side, and five in the back. We’ll focus on two of theses muscles, which form the superficial layers of the calf.

Gastrocnemius: Located just below the back of the knee, the two bellies of the Gastrocnemius are what give the calf muscles their contoured shape. They descend about half way down the lower leg and are easily the most superficial and accessible muscle of the lower leg. Due to the fact that Gastrocnemius crosses both the knee and ankle joint, it can just as effectively flex the knee as it can plantarflex the foot. The lower portion of the muscle blends with another lower leg muscle known as Soleus to form the Achilles tendon. The Gastrocnemius is a powerful muscle capable of lifting your entire body weight, making it most active when running or jumping.

Gastrocnemius Soleus

Soleus: Sometimes referred to as the body’s “second heart”, the Soleus muscle plays a very prominent role in pumping blood back to heart. The upper portion of the muscle is buried beneath the superficial bellies of the Gastrocnemius, but its lower half is easily accessible and palpable. Although Soleus does not cross the knee joint, it does blend with Gastrocnemius to form the Achilles tendon. The main function of this muscle is to plantarflex the foot. Unlike the Gastrocnemius, which is known for its short bursts of power, the Soleus is a workhorse muscle, essentially working anytime you’re on your feet.

Hamstrings: The hamstrings as they’re commonly referred to, are the major muscle group found in the back of the upper leg and thigh. There are three distinct and individually named muscles, which surprisingly occupy less space at the back of the leg than one would imagine. The lateral portion of the Quadriceps and the medial Adductors fill in a big portion of the posterior thigh. Yet these three slender muscles are capable of performing several actions that affect the hip and knee in variety of ways.

Hamstrings

  1. Biceps Femoris: The most lateral of the hamstrings, Biceps Femoris has two distinct bellies. One belly originates at the sitz bones and the other shorter head, starts half way down the femur. Both heads then blend together to form a common tendon, which crosses the knee joint to attach on the fibula. This portion of the hamstrings can: flex the knee, laterally rotate the knee (when flexed), extend the hip, laterally rotate the hip, and tilt the pelvis posteriorly.
  1. Semitendinosus & Semimembranosus: The only major difference between these two muscles, which happen to form the medial hamstrings, are their insertion points. They both originate on the sitz bone and they both perform the exact same functions. Semitendinosus overlies the deeper Semimembranosus, but they both cross the knee joint. Instead of blending together to form on common tendon and one insertion point, they each maintain their tendon and attach at slightly different points on the tibia. The Semis can: flex the knee, medially rotate the knee (when flexed), extend the hip, medially rotate the hip, and tilt the pelvis posteriorly.

Moving up the leg and into the hip, we come to an area with many layers of muscle collectively referred to as the ‘glutes’. There is of course Gluteus maximus, which is the most superficial layer of the glutes and one that we’re all familiar with. Beneath this muscle however, lie two other muscles named “gluteus”: Gluteus medius and Gluteus minimus. Both these muscles are key players in moving as well as stabilizing the hip. Then we have the deep six’ lateral rotators – a grouping of six slender muscles that fan out around the head of the femur in the hip socket. As the name implies, they laterally rotate or roll the leg and hip out. One of these lateral rotators is called Piriformis.

Piriformis: If you’ve ever had sciatica or experienced sciatica-like pain, then you’ve probably heard of the Piriformis. The reason for this is that, out of the deep six lateral rotators, the Piriformis is the only one the runs directly over the sciatic nerve. The other five lie beneath it. If for some reason the Piriformis becomes strained or inflamed from overuse or trauma, that extra bit tension could compress the sciatic nerve causing an entrapment.

The Piriformis muscle originates on the sacrum and attaches to a part of the femur called the greater trochanter. As mentioned, it’s a strong lateral rotator of the hip and leg. When the leg is stationary, it can also rotate the body to the opposite side. For that reason, an activity or sport that involves quick cutting or twisting movements could potentially cause trouble for the Piriformis.

Piriformis

Iliotibial Band: Although technically not a muscle, this thick band of fascia covers the outer part of the hip and thigh and serves as central tendon for two muscles: Gluteus maximus and a muscle called Tensor Fascia Lata (TFL). The vertical fibers of the IT band originate and are an extension of both these hip muscles. This thick tendon like structure runs the length of the outer leg and inserts just below the knee on the tibia. The IT band essentially transmits the power of the Gluteus maximus and TFL to help move the hip and leg. More importantly, the IT band helps to stabilize the hip and knee when standing, walking, and running.

IT Band


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

Sciatica is commonly referred to as pain that affects the low back, hips, buttocks, and backs of the legs due to compression and irritation of the sciatic nerve. An injury or impingement of the sciatic nerve can lead to a neuritis (inflammation of the nerve), neuralgia (pain along the course of the nerve), or a radiculopathy (nerve root involvement). Although sciatica can sometimes be the result of a herniated disc, there are other causes and contributing factors that can cause or mimic symptoms of sciatica. Such factors may include postural deviations, piriformis entrapment, and trigger points in the gluteal muscles, all of which are fairly common causes of sciatic pain.

The sciatic nerve is considered the largest nerve in the human body. Segments of the nerve are formed between L4 & S3 in the sacral plexus. The nerve, which is actually comprised of two divisions — the peroneal and tibial, travels through the greater sciatic foramen of the pelvis, under the piriformis muscle, and down the back of the leg to the foot. The peroneal branch and the tibial branch travel down the back of the thigh together until they reach the back of the knee. At this point, the peroneal branch splits from the tibial branch and travels down the back of the lower leg, around the inner ankle to the bottom of the foot. The tibial branch, once at the back of the knee, will wrap around the fibula bone and bifurcate once again into two other branches – the deep peroneal nerve (DPN) and the superficial peroneal nerve (SPN). The DPN travels down the front of the lower leg between the shin muscles and the tibia to the top of the foot. The SPN will travel down the lateral or outside part of the lower leg.

Piriformis

With the exception of the front and inner parts of the thigh, the sciatic nerve innervates all the other muscles of the leg. This includes the hamstrings and all the lower leg and foot muscles. The femoral nerve operates the hip flexors, namely the quadriceps, and the obturator nerve controls the adductor muscles. Due to the sciatic nerve’s origin and wide distribution, it can cause pain and discomfort in the low back, sacro-iliac joint, buttock, hip, back of the leg, and foot.

Signs & Symptoms:

  • Symptoms may be insidious or have a sudden onset
  • Unilateral in presentation
  • Radiating pain that can extend from the low back and buttock area, down the back of the leg, and into the foot
  • Paresthesias (i.e. burning, pins and needles, numbness), weakness, and muscle spasms anywhere along the course of the nerve
  • Pain can be a constant, dull ache or a shooting pain down the back of the leg
  • Pain may increase while sitting and diminish while standing or lying down
  • Coughing or laughing may exacerbate the pain
  • Standing in antalgic position: Depending on the site of the irritation, a person suffering from sciatic pain may hunch over and to the side to help alleviate pressure on the nerve

Causes:

  • A disk lesion, such as a protrusion or herniation at L4-L5 or L5-S1. The disk pushes into the nerve root and sacral plexus causing a radiculopathy
  • Stenosis: a narrowing of the vertebral canal in which the nerve passes through
  • Postural deviations: An anterior pelvic tilt, such as one that occurs during pregnancy, can decrease the space in the sciatic notch through which the nerve passes through. A posterior pelvic tilt can shorten the muscles the sciatic nerve must travel under
  • Piriformis syndrome: When this hip muscle shortens and begins to spasm, it can put direct pressure over the nerve
  • Sitting for extended periods of time with an object in your rear pocket, such as a wallet, can put direct pressure on the nerve. This is known as “back pocket sciatica”
  • Trigger points in one of the gluteal muscles can mimic sciatic pain
  • Joint dysfunction of the lumbo-sacral area
  • Inflammation of the nerve due to an infection or tumor

Another predisposing factor in the development of sciatica is the course the nerve takes once it exits out of the greater sciatic foramen in the pelvis. This congenital variance may explain why some people are more susceptible to developing sciatica than others.

In a majority of the population, the two branches of the sciatic nerve will exit out of the pelvis, through the greater sciatic foramen, and under the piriformis. This is true in about 85% of people. In approximately 10% of the population, one branch of the nerve passes through the piriformis, and the other underneath. In yet another small percentage, approximately 3%, one branch passes over the piriformis, and the other underneath. And finally, in less than 1% of people, both branches pass through the piriformis.

If the sciatica is a result of piriformis involvement or trigger points in the gluteal muscles, the pain may be more conscribed and only reach as far down as the knee. In a vertebral impingement the pain may be more widespread, radiating into the back and all the way down to the foot in severe cases.

Glute Medius TP

Diagnosis:

A history of unilateral low back pain that extends down the back of the leg is usually the defining symptom. A CT scan or MRI may show a disc herniation in the lumbar spine if one is present. The straight leg raise test, also known as Lasegue’s Sign, can be performed to determine the origin of the pain. On occasion, the pain may be due to a glute or hamstring strain. Other times, the pain may be due to some pathology of the lumbar spine or sacroiliac joint. While lying flat on your back, one leg is passively raised until the pain is elicited. Sciatic pain usually presents itself between 35 – 70 degrees of hip flexion.

Treatments:

If the sciatica is a result of a disk herniation, infection, or tumor, you should consult a doctor as to the appropriate form of treatment.

Mild cases of sciatica will often resolve themselves over time. Ice and heat applications are a great way of addressing the inflammation and muscle spasms associated with sciatica.

Anti-inflammatories and muscle relaxants may be prescribed by your doctor to help manage the pain. And if the pain is particularly acute, steroid injections may provide relief for a period of time.

Women who develop sciatica during pregnancy as a result of an excessive anterior pelvic tilt, will find that their symptoms abate once they deliver and the pelvis returns to normal.

Those suffering from sciatica resulting from obesity or faulty postures, will find that losing the extra weight and strengthening key muscle groups in the low back and abdominals will help correct pelvic imbalances.

Sciatica caused from prolonged periods of sitting and/or back pocket sciatica is easily addressed and typically of short duration.

Those with piriformis syndrome and/or trigger points in the glute muscles can greatly benefit from direct massage to the muscles of the low back and hips. Trigger points in the piriformis can shorten and irritate this key muscle. These changes can cause the piriformis to place direct pressure over the sciatica nerve, which runs underneath it. Trigger points found in other gluteal muscles can often mimic sciatic pain. And although these muscles may not be directly over the sciatic nerve, their pain pattern is very similar to that of an entrapment – such as the one created by the piriformis. Targeted stretches in combination with massage will help to restore extensibility and length to these muscles and help alleviate the pressure over the nerve.


joe-azevedo2Joe Azevedo is a New York State/NCBTMB Licensed Massage Therapist, ARCB Certified Reflexologist, and an Advanced Reiki Practitioner. He is a graduate of the Swedish Institute and is the owner and founder of Brooklyn Reflexology.

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