둔근, 이상근, 대퇴방형근 등의 촉진과 TrP진단

[문형철]

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골반의 superficial layer!

골반의 deeper view

골반의 옆구조 superficial layer

대둔근 촉진에 대하여

대둔근 촉진

- 저항에 대하여 신전, 외회전 대응하면서 촉진

Palpation steps:

1. Ask the client to extend and laterally rotate the thigh at the hip joint, and feel for the contraction of the gluteus

maximus (Figure 17-8).

2. With the muscle contracted, strum perpendicular to the fibers to discern the borders of the muscle.

3. Continue palpating the gluteus maximus laterally and inferiorly (distally) to its distal attachments by strumming

perpendicular to its fibers.

4. If desired, you may add resistance to the client's thigh extension to better engage the gluteus maximus.

5. Once the gluteus maximus has been located, have the client relax it and palpate to assess its baseline tone.

옆으로 누워서 대둔근 촉진

P a l p a t i o n Notes:

1. The gluteus maximus is superficial and easy to palpate.

2. The gluteus maximus is known as the principle muscle of the posterior buttock. However, it does not cover the

entire buttock. The gluteus medius is superficial superolateral^. When following the gluteus maximus from the

sacrum toward its distal attachment, be sure to follow it laterally and interiorly (distally).

대둔근 TrP

1. Trigger points (TrPs) in the gluteus maximus often result from or are perpetuated by acute or chronic overuse

(often with a strong eccentric contraction, such as walking uphill, especially if leaning over; or by concentric contraction, such as swimming the crawl stroke), prolonged lengthened position (e.g., sleeping with the hip joint flexed), prolonged sitting (especially if sitting on a thick wallet), direct trauma, irritation from injections, and Morton's foot.

2. TrPs in the gluteus maximus may produce restlessness and pain with prolonged sitting, difficulty sleeping, pain

walking uphill (especially if leaning over), pain when bending over, and restricted hip joint flexion. 

3. The referral patterns of gluteus maximus TrPs must be distinguished from the referral patterns of TrPs in the

gluteus medius, gluteus minimus, piriformis, tensor fasciae latae, vastus lateralis, semitendinosus, semimembranosus,

quadratus lumborum, and pelvic floor muscles.

4. TrPs in the gluteus maximus are often incorrectly assessed as sacroiliac joint dysfunction, lumbar facet joint

syndrome, trochanteric bursitis, coccygodynia, or disc compression upon a nerve. 

5. Associated TrPs often occur in the gluteus medius, gluteus minimus, hamstrings, erector spinae group, rectus

femoris, and iliopsoas.

대둔근 스트레칭

중둔근 촉진과 진단에 대하여

Starting position (Figure 17-13):

o Client side lying

o Therapist standing behind the client

o Palpating hand placed just distal to the middle of the iliac crest, between the iliac crest and the greater trochanter of

the femur

o Support hand placed on the lateral surface of the distal thigh

중둔근 촉진

Palpation steps:

1. Palpating just distal to the middle of the iliac crest, ask the client to abduct the thigh at the hip joint and feel for the

contraction of the middle fibers of the gluteus medius (Figure 17-14). If desired, resistance can be added to the

client's thigh abduction with the support hand.

2. Strum perpendicular to the fibers, palpating the middle fibers of the gluteus medius distally toward the greater

trochanter. Gluteus medius Piriformis Figure 17-12 Lateral view of the right gluteus medius. The piriformis has been ghosted in.

3. To palpate the anterior fibers, place palpating hand immediately distal and posterior to the ASIS, ask the client to

flex and medially rotate the thigh at the hip joint, and feel for the contraction of the anterior fibers of the gluteus

medius (Figure 17-15, A) (see Palpation Note #1). It may be necessary to add resistance.

4. To palpate the posterior fibers, place palpating hand over the posterosuperior portion of the gluteus medius, ask the

client to extend and laterally rotate the thigh at the hip joint, and feel for the contraction of the posterior fibers of the gluteus medius (Figure 17-15, B) (see Palpation Note #1). It may be necessary to add resistance.

5. Once the gluteus medius has been located, have the client relax it and palpate to assess its baseline tone.

소둔근

이상근 촉진과 진단에 대하여

Starting Position (Figure 17-21):

o Client prone with the leg flexed to 90 degrees at the knee joint

o Therapist standing to the side of the client 

o Palpating hand placed just lateral to the sacrum, halfway between the posterior superior iliac spine (PSIS) and the

apex of the sacrum,

o Support hand placed on the medial surface of the distal leg, just proximal to the ankle joint

Palpation Steps:

1. Begin by finding the point on the lateral sacrum that is halfway between the PSIS and the apex of the sacrum. Drop just off the sacrum laterally at this point and you will be on the piriformis.

2. Resist the client from laterally rotating the thigh at the hip joint and feel for the contraction of the piriformis (Figure 17-22). Note: Lateral rotation of the client's thigh involves the client's foot moving medially toward the midline (and opposite side) of the body.

3. Continue palpating the piriformis laterally toward the superior border of the greater trochanter of the femur by strumming perpendicular to the fibers as the client alternately contracts (against resistance) and relaxes the piriformis.

4. Once the piriformis has been located, have the client relax it and palpate to assess its baseline tone.

P a l p a t i o n N o t e s :

1. As soon as the midline of the sacrum is found, it is helpful to find the greater trochanter of the femur and trace the course of the piriformis from the midline of the sacrum to the greater trochanter before beginning the palpation. This way, you do not have to interrupt the palpation protocol to find the greater trochanter. 

2. When giving resistance to the client's lateral rotation of the thigh at the hip joint, do not let the client contract too

forcefully, or the more superficial gluteus maximus (also a lateral rotator) may be engaged, blocking palpation of

the deeper piriformis.

3. It can be challenging to discern the borders between the piriformis and the gluteus medius superiorly and superior

gemellus interiorly, because these muscles are also lateral rotators of the thigh at the hip joint and may be engaged when the client contracts the piriformis.

4. The sciatic nerve usually exits from the anterior pelvis into the buttock between the piriformis and the superior gemellus.

Approximately 10% to 20% of the time, all or part of the sciatic nerve emerges through the belly of the piriformis itself. With either representation, be aware of the proximity of the sciatic nerve when palpating the piriformis.

5. The sacral attachment of the piriformis can be palpated on the anterior sacrum. To accomplish this, the therapist

must use a gloved hand and access the piriformis through the rectum. However, local licensure laws may not allow this palpation.

6. If the thigh is first flexed at the hip joint approximately 60 degrees or more, the piriformis can abduct the thigh at

the hip joint and also changes from being a lateral rotator to a medial rotator of the thigh at the hip joint. This change

in action can change how the piriformis is stretched (Figure 17-23).

이상근 TrP

1. Trigger points (TrPs) in the piriformis often result from or are perpetuated by acute or chronic overuse of the muscle, prolonged shortening of the muscle (e.g., driving with foot on the gas pedal, sleeping on one's side with the upper thigh flexed and adducted), sacroiliac joint sprain, hip joint arthritis, Morton's foot, leg length discrepancy, and hyperpronation of the foot at the subtalar joint.

2. TrPs in the piriformis may produce restlessness and discomfort when sitting, lateral rotation of the thigh at the hip joint resulting in turn-out of the foot, restricted medial rotation of the thigh at the hip joint, and sacroiliac joint dysfunction.

3. The referral patterns of piriformis TrPs must be distinguished from the referral patterns of TrPs in the gluteus maximus, medius, and minimus; quadratus lumborum; and pelvic floor muscles.

4. TrPs in the piriformis are often incorrectly assessed as sacroiliac joint dysfunction, piriformis syndrome (compression

of the sciatic nerve), herniated disc compression upon spinal nerves L5 or SI, or facet syndrome.

5. Associated TrPs often occur in the gluteus minimus, superior and inferior gemelli, obturator internus, coccygeus,

and levator ani.

이상근 스트레칭

대퇴방형근의 촉진과 진단에 대하여

대퇴방형근 촉진법

대퇴방형근 스트레칭

[윤연우]

잘보았습니다~^^

[송영석]

이상근 스트레칭이 대퇴방형근도 같이 스트레칭 시켜주겠네요. 참 좋은 스트레칭 방법이었군요...

[한지혜]

# 대둔근 촉진
- 저항에 대하여 신전, 외회전 대응하면서 촉진
- 대둔근 스트레칭
# 중둔근 촉진
# 이상근 촉진
- 이상근 스트레칭
# 대퇴방형근 촉진
- 대퇴방형근 스트레칭

[09정문권]

대둔근- 둔부의 가장 큰 근육으로 표면을 덮고 있음, 대둔근보다 더 심부에 중둔근, 소둔근, 이상근, 대퇴방형근 등이 위치, 따라서 근육들의 위치를 보다 잘 파악하여 접근하는 것이 요구됨,
중둔근은 가쪽에 위치, 따라서 기능적으로도 대둔근과 차이가 있고, 치료적접근에 있어서도 차이를 보임

대둔근의 티피는 천골가까이 혹은 엉덩선 위쪽에서 찾아볼수있음
중둔근 티피나 연관통은 담경, 방광라인으로 허벅지를 따라 종아리까지 타고간다는 것이 특징
이상근은 대전자에서 천골의 앞면에 이름, 따라서 이상근에 대한 촉진은 대전자에서 천골방향으로 나가는 대각선에서 접근하는 것이 합리적. 환도혈에 해당함

[09정문권]

즉 환도혈의 취혈법과 동일,
대퇴방형근은 대전자에서 좌골결절방향으로 붙어감. 즉 이상근보다 밑에서 촉지해나가야 함
이상근이나 대퇴방형근은 장침을 통하여 접근가능. 특히 이들이 sciatic nerve를 포착하는 경우 이들에 대한 자침이 효과적일 수 있음

[이영호]

1. 대둔근 가.촉진 : 저항에 대하여 신전, 외회전 대응하면서 촉진(옆으로 누워서 할때는 보조 손으로 신전에 대한 저항 가함)
나. TrP : 천골쪽 좌골결절 쪽 3개소
다. 스트레칭 : 한발로 서서 고관절, 무릎 굴곡하고 양손 깍지 끼고 무릎을 감싼후 몸쪽, 대각선 방향으로 당긴다.
2. 중둔근 가. 촉진 : 옆으로 누워 외전을 시킨다. 장골능의 중간 부분을 촉진
3. 소둔근 : 중둔근 안쪽 깊숙히 있어서 촉진어려움

[이영호]

4. 이상근 : 천골 외측에서 PSIS와 천골 apex의 중간에 손대고(대전자까지) 대퇴 외회전에 대한 저항으로 찾음.
TrP는 천골외측과 대전자의 외측 1/3지점, 천골 외측 등 2개소, 이상근 스트레칭은 오른발을 왼쪽 대퇴에 크로스하고, 양손을 햄스트링에 깍지끼어 몸쪽으로 당긴다.
5. 대퇴방형근 : 좌골결절 - inter trochanteric crest, 외회전에 저항 촉진, 고관절과 무릎의 굴곡하고 양손으로 무릎 깍지끼어 몸쪽으로 당김.

[박수홍]

햄스트링부터 이상근 대퇴방형근까지 같은 자세로 움직여 주면서 진동건으로 쭉 풀어주면 좋을 것 같아요!!