대퇴근막장근, 장경인대

[문형철]

runner's knee의 주인공 장경인대 

1. tension band principle때문에 iliotibial band syndrome 주인공 장경인대

2. snapping hip의 주인공

3. 무릎 외측부 통증의 대부분은 장경인대증후군

4. 대퇴근막장근은 고관절 굴곡근, 외전근

5. 무릎외측부 통증 대부분은 장경인대 문제, 다음으로 측부인대, 슬와근 건병증

6. 말탈때, 스키탈때, 허들넘을때 사용하는 근육은 TFL

panic bird...

Structure[edit]

It arises from the anterior part of the outer lip of the iliac crest; from the outer surface of the anterior superior iliac spine, and part of the outer border of the notch below it, between the gluteus medius and sartorius; and from the deep surface of the fascia lata.

It is inserted between the two layers of the iliotibial band of the fascia lata about the junction of the middle and upper thirds of the thigh. The tensor fasciae latae tautens the iliotibial band and braces the knee, especially when the opposite foot is lifted.^[1] The terminal insertion point lies on the lateral condyle of the tibia.^[2]

Innervation[edit]

Tensor fasciae latae is innervated by the superior gluteal nerve, L5 and S1. At its origins of the anterior rami of L4, L5, and S1 nerves, the superior gluteal nerve exits the pelvis via greater sciatic foramen superior to the piriformis. The nerve also courses between the gluteus medius and minimus. The superior gluteal artery also supplies the tensor fasciae latae.^[1] The superior gluteal nerve arises from the sacral plexus and only has motor innervation associated with it. There is no cutaneous innervation for sensation that stems from the superior gluteal nerve.^[2]

The tensor fasciae latae is a hip flexor and abductor muscle, meaning it assists in moving the hip forward and outward. Rotating the hips inward is another action the TFL muscle does. Because it's used for so many movements and is in a shortened position when seated, the TFL becomes tight easily. TFL stretches lengthen this important muscle.^[3] The TFL is often involved in lateral meniscus and or knee pain/ problems. Eval‎uating for strain-sprain and trigger point in the TFL and then correcting with Jones and or Travell technique will significantly aid recovery and reduce pain.

Function[edit]

The tensor fasciae latae is a tensor of the fascia lata; continuing its action, the oblique direction of its fibers enables it to stabilize the hip in extension (assists gluteus maximus during hip extension). The fascia latae is a fibrous sheath that encircles the thigh like a subcutaneous stocking and tightly binds its muscles. On the lateral surface, it combines with the tendons of the gluteus maximus and tensor fasciae latae to form the iliotibial band, which extends from the iliac crest to the lateral condyle of the tibia.^[1]

In the erect posture, acting from below, it will serve to steady the pelvis upon the head of the femur; and by means of the iliotibial band it steadies the condyles of the femur on the articular surfaces of the tibia, and assists the gluteus maximus in supporting the knee in a position of extension.

The basic functional movement of tensor fascia latae is walking. The tensor fascia lata is heavily utilized in horse riding, hurdling and water skiing. Some problems that arise when this muscle is tight or shortened are pelvic imbalances that lead to pain in hips, as well as pain in the lower back and lateral area of knees.^[4]

Because of its insertion point on the lateral condyle of the tibia, it also aids in the lateral rotation of the tibia. This lateral rotation may be initiated in conjunction with hip abduction and medial rotation of the femur while kicking a soccer ball. The tensor fasciae latae works in synergy with the gluteus medius and gluteus minimus muscles to abduct and medially rotate the femur.

The TFL is a hip abductor muscle. To stretch the tensor fascia latae, the knee may be brought medially across your body (adducted). If one leans against a wall with crossed legs (externally/laterally rotated hips) and pushes the pelvis away from the wall (leaning the upper body towards it) sidebending the lumbar spine (i.e.: curving the spine to the side) should be avoided as it stretches the lumbar region rather than the tensor fascia latae and other muscles which cross the hip rather than the spine.

Clinical significance[edit]

Injury[edit]

Common TFL injuries are diagnosed by having the patient stand with the opposite leg raised. Since the TFL engages to maintain balance in this position, it is a way to isolate the source of any hip/knee pain. If there is pain near the hip and knee and difficulty maintaining balance while the opposite leg is raised, it usually indicates a TFL strain.^[5]

장경인대

- tension band principle의 이해와 연관된 연부조직

The iliotibial tract or iliotibial band (also known as Maissiat's band or IT Band) is a longitudinal fibrous reinforcement of the fascia lata. The action of the ITB and its associated muscles is to extend, abduct, and laterally rotate the hip. In addition, the ITB contributes to lateral knee stabilization. During knee extension the ITB moves anterior, while knee flexion moves the ITB posterior. It originates at the anterolateral iliac tubercle portion of the external lip of the iliac crest and inserts at the lateral condyle of the tibia at Gerdy's tubercle. The figure shows only the proximal part of the iliotibial tract. The part of the iliotibial band which lies beneath the tensor fasciae latae is prolonged upward to join the lateral part of the capsule of the hip-joint. The gluteus maximus muscle and the tensor fasciae latae insert upon the tract.

Clinical significance[edit]

It stabilizes the knee both in extension and in partial flexion, and is therefore used constantly during walking and running. In leaning forwards with slightly flexed knee the tract is the main support of knee against gravity.

Iliotibial Band Syndrome (ITBS or ITBFS, for Iliotibial Band Friction Syndrome) is a common thigh injury generally associated with running. It can also be caused by cycling or hiking.

It is usually developed by people who suddenly increase their level of activity, such as runners who increase their mileage. Other risk factors for ITBS include gait abnormalities such as overpronation, leg length discrepancies, or bow-leggedness. ITB Syndrome is an overuse condition of the distal ITB near the lateral femoral condyle and at Gerdy's tubercle. The most vulnerable range of knee flexion for this condition is at 30-40 degrees; this is where the ITB crosses the lateral femoral condyle.

대퇴근막장근 Trp탐구

장경인대 스트레칭의 다양한 방법들

중둔근부터 ITB 스트레칭

에반스 스트레칭

[heoss]

감사합니다.

[정기홍]

근육 중에 궁금한 게 생겼을 때 검색창에 치면 되네. 정말 좋다. 고마워!

[문형철]

대박이지 ㅎㅎㅎ