대퇴사두근

[문형철]

관절기원성 근억제의 주인공 

buckling의 주인공 근육

1. 하지힘의 핵심 "대퇴사두근"

2. rectus femoris(대퇴직근), vastus intermidius(중간광근), vastus lateralis and medialis(내외측 광근)

3. 외측광근 위에 대퇴근막장근과 장경인대

4. 햄스트링과 반대로 type2 muscle, tonic muscle, 깁스로 쉽게 근위축이 일어나 쉽게 근력이 떨어지는 근육

5. quadriceps lag을 일으키는 근육

6. knee buckling(arthrogenic muscle inhibition)의 주인공!

7. 대퇴사두근 - 슬개골 - 슬개건으로 연결된 구조

8. 대퇴직근(rectus femoris는 AIIS에 부착)

9. 대퇴직근은 장요근, 봉공근과 함께 고관절 굴곡근

10. vastus medialis obliquus (VMO)은 슬개대퇴관절의 안정성 근육

참고) Knee pain is thought to be primarily associated with specific quadriceps muscle weakness or fatigue, especially in the VMO. Misfiring and fatiguing of the VMO causes mal-tracking of the patella and subsequent damage to surrounding structures creating increased force on the knees, often resulting in injuries such as patellofemoral pain syndrome, anterior cruciate ligament rupture, chondromalacia, and tendinitis.

panic bird...

대퇴사두근(quadriceps femoris muscle)

rectus femoris(대퇴직근), vastus intermidius(중간광근), vastus lateralis and medialis(내외측 광근)

The quadriceps femoris (/ˈkwɒdrɨsɛps ˈfɛmərɨs/) (Latin for "four-headed muscle of the femur"), also called simply the quadriceps, quadriceps extensor, or quads, is a large muscle group that includes the four prevailing muscles on the front of the thigh. It is the great extensor muscle of the knee, forming a large fleshy mass which covers the front and sides of the femur.

Structure[edit]

It is subdivided into four separate portions or 'heads', which have received distinctive names:

• Rectus femoris occupies the middle of the thigh, covering most of the other three quadriceps muscles. It originates on the ilium. It is named from its straight course.

• The other three lie deep to rectus femoris and originate from the body of the femur, which they cover from the trochanters to the condyles:
  • Vastus lateralis is on the lateral side of the femur (i.e. on the outer side of the thigh).
  • Vastus medialis is on the medial side of the femur (i.e. on the inner part thigh).
  • Vastus intermedius lies between vastus lateralis and vastus medialis on the front of the femur (i.e. on the top or front of the thigh), but deep to the rectus femoris. Typically, it cannot be seen without dissection of the rectus femoris.

All four parts of the quadriceps muscle ultimately insert into the tibial tuberosity of the tibia. This is via the patella, where the quadriceps tendon becomes the patellar ligament, which then attaches to the tibia.

There is a fifth muscle of the quadriceps complex that is often forgotten and rarely taught called articularis genu.

Innervation[edit]

Femoral nerve (L2, L3, L4).

Function[edit]

All four quadriceps are powerful extensors of the knee joint. They are crucial in walking, running, jumping and squatting. Because rectus femoris attaches to the ilium, it is also a flexor of the hip. This action is also crucial to walking or running as it swings the leg forward into the ensuing step. The quadriceps, specifically the vastus medialis, plays the important role of stabilizing the patella and the knee joint during gait.^[1]

Society and culture[edit]

Training
[edit]

In strength training, the quadriceps are trained by several leg exercises. Effective exercises include the squat and leg press. The isolation movement (i.e. targets solely the quadriceps) is the leg extension exercise. Sprinting, as well as intense anaerobic running, may be an effective muscle building exercise.

1. 앉아서 다리들기와 누워서 다리들 기 - 고관절을 굴곡하면 대퇴직근은 active insuffiency됨. 

2. Leg extension exercise

3. Leg press exercise

4. Squat exercise

5. Split squat exercise

6. One leg squat exercise

1. 대퇴직근(rectus femoris) 

The rectus femoris muscle (/ˈrɛktəs ˈfɛmərɨs/) is one of the four quadriceps muscles of the human body. The others are the vastus medialis, the vastus intermedius (deep to the rectus femoris), and the vastus lateralis. All four parts of the quadriceps muscle attach to the patella (knee cap) via the quadriceps tendon.

The rectus femoris is situated in the middle of the front of the thigh; it is fusiform in shape, and its superficial fibers are arranged in a bipenniform manner, the deep fibers running straight down to the deep aponeurosis. Its functions are to flex the thigh at the hip joint and to extend the leg at the knee joint.[1]

Structure[edit]

It arises by two tendons: one, the anterior or straight, from the anterior inferior iliac spine; the other, the posterior or reflected, from a groove above the rim of the acetabulum.

The two unite at an acute angle, and spread into an aponeurosis which is prolonged downward on the anterior surface of the muscle, and from this the muscular fibers arise.

The muscle ends in a broad and thick aponeurosis which occupies the lower two-thirds of its posterior surface, and, gradually becoming narrowed into a flattened tendon, is inserted into the base of the patella.

Innervation[edit]

The neurons for voluntary thigh contraction originate near the summit of the medial side of the precentral gyrus (the primary motor area of the brain). These neurons send a nerve signal that is carried by the corticospinal tract down the brainstem and spinal cord. The signal starts with the upper motor neurons carrying the signal from the precentral gyrus down through the internal capsule, through the cerebral peduncle, and into the medulla. In the medullary pyramid, the corticospinal tract decussates and becomes the lateral corticospinal tract. The nerve signal will continue down the lateral corticospinal tract until it reaches spinal nerve L4. At this point, the nerve signal will synapse from the upper motor neurons to the lower motor neurons. The signal will travel through the anterior root of L4 and into the anterior rami of the L4 nerve, leaving the spinal cord through the lumbar plexus. The posterior division of the L4 root is the Femoral nerve. The femoral nerve innervates the quadriceps femoris, a fourth of which is the rectus femoris. When the rectus femoris receives the signal that has traveled all the way from the medial side of the precentral gyrus, it contracts, extending the knee and flexing the thigh at the hip. ^[1]

Function[edit]

The rectus femoris, sartorius, and iliopsoas are the flexors of the thigh at the hip. The rectus femoris is a weaker hip flexor when the knee is extended because it is already shortened and thus suffers from active insufficiency; the action will recruit more iliacus, psoas major, tensor fasciae latae, and the remaining hip flexors than it will the rectus femoris.

Similarly, the rectus femoris is not dominant in knee extension when the hip is flexed since it is already shortened and thus suffers from active insufficiency. In essence: the action of extending the knee from a seated position is primarily driven by the vastus lateralis, vastus medialis, and vastus intermedius, and less by the rectus femurs.

- 무릎을 굴곡하면 대퇴직근은 짧아지면서 active insufficiency가 되어 무릎신전에 dominant하지 않음. 

In the other extreme, the muscle's ability to flex the hip and extend can be compromised in a position of full hip extension and knee flexion, due to passive insufficiency.

The rectus femoris is a direct antagonist to the hamstrings, at the hip and at the knee. Rectus femoris can be torn which can be extremely painful and potentially debilitating if there is a complete rupture.

Clinical significance[edit]

Strain[edit]

Rectus femoris strain, referred to as hip flexor strain,^[2] is an injury commonly at the tendon that attaches to the patella or in the muscle itself. The injury is usually a partial tear but could be a full tear. The injury is caused by a forceful movement related to sprinting, jumping, or kicking and is common in sports like football or soccer. The rectus femoris is prone to injury since it crosses both the knee and the hip. Symptoms include a sudden sharp pain at the front of the hip or in the groin, swelling and bruising, and an inability to contract the rectus femoris with a full tear.^[3]

2. Vastus medialis(내측광근)

The vastus medialis (vastus internus or teardrop muscle) is muscle located medially in the thigh that extends theknee. The vastus medialis is part of the quadriceps muscle.

Structure[edit]

The Vastus Medialis muscle originates from a continuous line of attachment on the femur, which begins on the front and middle side (anteromedially) on the intertrochanteric line of the femur. It continues down and back (posteroinferiorly) along the pectineal line and then descends along the inner (medial) lip of the linea aspera and onto the medial supracondylar line of the femur. The fibers converge onto the inner (medial) part of the quadriceps femoris tendon and the inner (medial) border of the patella. ^[1]

Function[edit]

The Vastus Medialis is one of five muscles that reside in the anterior compartment of the thigh. The vasti muscles appear to act largely in a co-ordinated manner throughout the control of knee extension. The vastus medialis contributes to correct tracking of the patella^[2] and characteristics of the vastus medialis, including its angle of insertion, correlate with presence of patellofemoral joint pain.^[3] However, this syndrome is complex and definitive evidence of causality has not yet been published.

A division of the vastus medialis muscle into two populations of fibers has been hypothesized:

1. one population is thought to be long and relatively inline with the quadriceps ligament: the vastus medialis longus (VML)
2. the other is thought to be shorter and more obliquely oriented with respect to the quadriceps ligament: the vastus medialis obliquus (VMO).

At the present time, there is insufficient evidence to conclusively confirm‎ or deny this hypothesis.^[4] For clinical and rehabilitation purposes, the vastus medialis is often referred to simply as the VMO in reference to its potentially important role in correct patellar tracking and prevention of patellofemoral joint syndrome.

Clinical significance[edit]

Knee pain[edit]

Knee pain is thought to be primarily associated with specific quadriceps muscle weakness or fatigue, especially in the VMO. It is known that fatigue can be caused by many different mechanisms, ranging from the accumulation of metabolites within muscle fibers to the generation of an inadequate motor command in the motor cortex.^[5] 

Misfiring and fatiguing of the VMO causes mal-tracking of the patella and subsequent damage to surrounding structures creating increased force on the knees, often resulting in injuries such as patellofemoral pain syndrome, anterior cruciate ligament rupture, chondromalacia, and tendinitis.^[6]Through the use of electromyography, researchers can eval‎uate and record the electrical activity produced by the skeletal muscle of the VMO to analyze the biomechanics and detect any possible abnormalities, weakness, or fatigue. With an analysis of muscle activity of the VMO through the use of electromyography, proper rehabilitative plans and goals can be established to not only correct the already established abnormality, but even prevent such injuries if tested sooner. Preventing injuries is crucial as well as teaching proper training techniques to ensure there are no valgus collapse forces causing unplanned stress on other structures of the knee, causing asymmetry, and predisposing that individual for injury.

3. 외측광근 vastus lateralis

The Vastus lateralis (vastus externus) is the largest part of the quadriceps femoris. It arises by a broad aponeurosis, which is attached to the upper part of the intertrochanteric line, to the anterior and inferior borders of the greater trochanter, to the lateral lip of the gluteal tuberosity, and to the upper half of the lateral lip of the linea aspera; this aponeurosis covers the upper three-quarters of the muscle, and from its deep surface many fibers take origin.

A few additional fibres arise from the tendon of the gluteus maximus, and from the lateral intermuscular septum between the vastus lateralis and short head of the biceps femoris. The fibers form a large fleshy mass, which is attached to a strong aponeurosis, placed on the deep surface of the lower part of the muscle: this aponeurosis becomes contracted and thickened into a flat tendon inserted into the lateral border of the patella, blending with the quadriceps femoris tendon, and giving an expansion to the capsule of the knee-joint.

4. 중간광근(vsatus intermedius)

The vastus intermedius (/ˈvæstəs ˌɪntərˈmiːdi.əs/) (Cruraeus) arises from the front and lateral surfaces of the body of the femur in its upper two-thirds, sitting under the rectus femoris muscle and from the lower part of the lateral intermuscular septum. Its fibers end in a superficial aponeurosis, which forms the deep part of the quadriceps femoris tendon.

The vastus medialis and vastus intermedius appear to be inseparably united, but when the rectus femoris has been reflected^{[when defined as?]} a narrow interval will be observed extending upward from the medial border of the patella between the two muscles, and the separation may be continued as far as the lower part of theintertrochanteric line, where, however, the two muscles are frequently continuous.

Due to being the deeper middle-most of the quadriceps muscle group, the intermedius is the most difficult to stretch once maximum knee flexion is attained. It cannot be further stretched by hip extension as the rectus femoris can, nor is it accessible to manipulate with massage therapy to stretch the fibres sideways as the vastus lateralis and vastus medialis are.

대퇴사두근 Trp 탐구

에반스의 대퇴직근 고립스트레칭

내외측 광근의 고립 스트레칭

[heoss]

감사합니다.

[태엽감는새]

감사합니다

[본과 3학년 황욱진]

1)rectus femoris muscle(넙다리곧은근)
기시: anterior inferior iliac spine(AIIS)과 acetabulum의 위쪽 illium
2)vastus lateralis muscle
기시:greater trochanter와 linea aspera의 lateral lip
3)vastus medialis muscle
기시:intertrochanteric line과 linea aspera의 medial lip
4)vastus intermedius
넙다리뼈의 앞면과 가쪽면
1)2)3)4)
종지: 서로 합쳐진 넙다리네갈래근 힘줄을 통해서 종속적으로 base of patella에 닿음. 무릎인대를 통해서 간접적으로 정강뼈거친면에 닿음. vastus lateralis(내측 광근)와 vastus medialis(외측 광근)도 aponeurosis(널힘줄)을 통해서 tibia와 patella에 닿음
신경지배: 넙다리 신경(L2,L3,L4)