Adductor Magnus

Original Editor - Vidya Acharya

Top Contributors - Vidya Acharya and Kim Jackson  

Description

The Adductor Magnus muscle is one of six muscles in the medial compartment of the thigh. Adductor Magnus is a broad triangular muscle[1] forming a septum which divides the anterior muscles from the posterior aspect of the thigh. It is the largest muscle in the medial compartment. It lies deep to the adductor brevis and the adductor longus.

Adductor Magnus

Anatomy

Origin:

Inferior pubic ramus, ramus of ischium (anterior fibres), and ischial tuberosity (posterior fibres)[2].

Insertion:

Medial to gluteal tuberosity, middle of linea aspera, medial supracondylar line, and adductor tubercle of medial condyle of femur.[2]

Nerve Supply[2]:

Obturator nerve, L2,3,4 and

Sciatic nerve, L4,5,S1.

Action:

1.Adduction of the hip joint[2].

2. The anterior fibres which originate from the rami of pubis and ischium may assist in flexion, while the posterior fibres that arise from the ischial tuberosity may assist in extension.[2] The adductor magnus has a large hip extensor muscle moment arm, making it an unappreciated hip extensor. The hip extension moment arm length of the adductor magnus changes with hip angle and it is a more effective hip extensor than either the hamstrings or gluteus maximus when the hip is flexed. The peak contractions of the muscle are seen in positions of hip flexion for eg. full squats.[3]

3. Some anatomical text lists an action of Adductor Magnus along with other adductors as internal rotators, whereas others list an action of external rotators. The analysis of EMG [4]activity of the adductors and kinematics during gait presents a functional model in support of the external rotation. It suggests that in the transverse plane:

  • During Loading response: the adductors may be eccentrically controlling internal rotation of the femur at the hip rather than the previously reported role as concentric internal rotators.
  • During Terminal Stance and Preswing phase: these muscles may also concentrically produce external rotation of the femur at the hip.

Physical therapists should consider this important function of the hip adductors during gait when evaluating a patient and designing an intervention program.

4. Adductor Magnus is a major stabilizer of pelvis. While walking and running adductors stabilize hips and lower limbs to avoid excessive internal rotation.

Adductor canal

Adductor Canal

Also known as Hunter’s canal or subsartorial canal. It is a narrow conical tunnel located in the thigh. It is 15cm long, extending from the apex of the femoral triangle to the adductor hiatus of the adductor magnus. The canal serves as a passageway from structures moving between the anterior thigh and posterior leg - the femoral artery, femoral vein, nerve to the vastus medialis and the saphenous nerve (the largest cutaneous branch of the femoral nerve). The apex of the adductor canal is marked by the adductor hiatus – a gap between the adductor and hamstring attachments of the adductor magnus.[5]

Blood supply:

Adductor magnus is supplied[6] by the:

  • obturator artery
  • femoral artery
  • medial femoral circumflex
  • direct and perforating branches of the deep femoral artery.

Clinical Relevance

Groin injury:

The commonest type of groin strain or injury is believed to be adductor related. They are seen mostly in athletes, ice hockey, and football players[7]. Predominant in male athletes. The source of groin pain is difficult to diagnose due to the involvement of many muscles; iliopsoas, adductors and glutei and also due to proximity to the pelvis, hip joint and sacrum.

Mechanism of injury[8]:

  • It has been suggested that mechanism by which adductor muscle strains occur is the requirement for rapid deceleration of the lower limb undergoing rapid abduction and external rotation as occurs in ice-skating or during fast changes of direction. When skating, the body has an increased need for stabilization at the hip and thigh due to the thin blade that skaters must balance on. In addition to the inherent instability of skating, these athletes use explosive movements into extension, abduction and rotation at the hip, relying on an eccentric contraction of the adductors to decelerate the leg during a stride.  These repeated eccentric contractions of the adductors during both fast and slow skating can lead to inflammation of the adductors.
  • Main symptoms following an injury are: pain, tender swelling, any action which holds the knees together will be painful and outward movement of the hip will be restricted by spasm and pain.
  • Complete ruptures are uncommon.

Joint pain:

Tight adductors can cause knee pain, especially seen in runners. The function of the adductor muscles is to pull the thighs together and rotate the upper leg inwards, as well as stabilising the hip. The adductor magnus appears to display a relatively mixed muscle fibre type proportion[9], albeit with a greater proportion of type I muscle fibres. Postural (type 1)[10] have the tendency to shorten when chronically stressed. These muscles may be torn at their origin from the pelvis or in their bulk on the inside of the thigh[11].

Adductor canal syndrome:

It is an unusual cause of acute arterial occlusion[12] in younger men. It is the result of arterial compression (superficial femoral artery)[13] by an abnormal musculotendinous band arising from the adductor magnus muscle and lying adjacent and superior to the adductor tendon. The pathogenetic mechanism of this syndrome resembles that of popliteal fossa entrapment and can become manifest after exercise.

Since this syndrome occurs in younger men in whom acute arterial occlusion can lead to limb loss, recognition of the presence of apparent ischemic symptoms after exercise in an otherwise healthy young man is important. The treatment consists of the division of the abnormal band and restoration of arterial continuity by appropriate means. A search for bilateral lesions can help avoid future problems even when the symptoms are unilateral.

Assessment

Palpation

The tendon of Adductor Longus is the most proximal tendon amongst the adductors of the hip joint, Gracilis is medial to the Adductor Longus. Adductor Magnus lies posterior to Gracilis muscle[14]. Adductor Magnus is palpated on the medial aspect of the thigh while resisting the hip adduction against resistance and feeling for the engagement of the musculature.

Power

Position: Side-lying.

Test: Adduction of the underneath extremity from the table without rotation, flexion, or extension of the hip, or tilting of the pelvis. Strength is graded by pressure applied over the medial aspect of the thigh in the direction of abduction i.e downward towards the thigh.[2]

Length

Insufficient length of muscles results in contracture of the hip adductors or hip adduction deformity.

In standing, the pelvis is laterally tilted, it is high on the side of contracture; making it necessary to plantarflex the foot on the same side so that toes touch the ground. As an alternative, if the foot is flat on the floor, the opposite extremity is either flexed at hip joint or abducted in-order to compensate for the apparent shortness of the adducted side.[2]

Treatment

Stretching exercises to maintain the length of the muscle:

The long adductors stretch:

  • Stand and open the legs to a wide stance.
  • Flex the opposite knee leaning to this side until the stretch is felt
  • Hold for 20-30 seconds

Frog Pose:

Myofascial release:

Strengthening Exercises:

Various exercises can strengthen the Adductor Magnus muscle:

Isometric adduction with knees bent:

One study by Lovell et al. (2012) explored a number of common rehabilitation tests for the adductors and found that the supine isometric hip adduction in 0 or 45 degrees of hip and knee flexion were the best positions for producing maximal EMG amplitude in the adductor magnus[15]

Concentric adduction exercises:

Resisted exercises with elastic band:

[16]

Eccentric adduction exercises:

A simple adduction strengthening programme based on Copenhagen Adduction Exercise reduced the risk of groin problem in footballer players according to this study published in British Journal of Sports Medicine. [17]

Resources

Adductor Tendinopthy

Groin strain

https://simplifaster.com/articles/copenhagen-adduction-exercise-groin-injuries/

https://www.yogauonline.com/yoga-anatomy/neglecting-your-hip-abductors-and-adductors-can-mess-your-walk-sleep-and-balance

References

  1. The Anatomist's Vade Mecum: A System of Human Anatomy; Erasmus Wilson; Page No. 261.[accessed on 3rd July 2018]
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Kendall, McCreary, Provance; Muscle Testing and Function with Posture and Pain 4th Edition; Hip adductors; Page No.228.
  3. https://www.strengthandconditioningresearch.com/muscles/adductors/#REF
  4. Leighton RD. A functional model to describe the action of the adductor muscles at the hip in the transverse plane. Physiotherapy theory and practice. 2006 Jan 1;22(5):251-62.https://www.ncbi.nlm.nih.gov/pubmed/17118893
  5. The Lower Limb/The Adductor Canal http://teachmeanatomy.info/lower-limb/areas/adductor-canal/
  6. Ortho Bullets; Adductor magnus,https://www.orthobullets.com/anatomy/10067/adductor-magnus
  7. Ishøi L, Sørensen CN, Kaae NM, Jørgensen LB, Hölmich P, Serner A. Large eccentric strength increase using the Copenhagen Adduction exercise in football: A randomized controlled trial. Scandinavian journal of medicine & science in sports. 2016 Nov 1;26(11):1334-42.https://www.ncbi.nlm.nih.gov/pubmed/26589483
  8. Kujala UM, Taimela S, Antti-Poika I, Orava S, Tuominen R, Myllynen P. Acute injuries in soccer, ice hockey, volleyball, basketball, judo, and karate: analysis of national registry data. Bmj. 1995 Dec 2;311(7018):1465-8.https://www.ncbi.nlm.nih.gov/pubmed/19620912
  9. Science Direct, Adductor, The hip; Leon Chaitow ND DO, Judith DeLany LMT, in Clinical Application of Neuromuscular Techniques, Volume 2 (Second Edition), 2011 https://www.sciencedirect.com/topics/neuroscience/adductor-hiatus
  10. Adductors; Muscle Fibre Type; Adductor magnus https://www.strengthandconditioningresearch.com/muscles/adductors/#REF
  11. BODYWORKS: ADDUCTOR INJURIES https://www.runnersworld.co.uk/health/injury/bodyworks-adductor-injuries
  12. Verta Jr MJ, Vitello J, Fuller J. Adductor canal compression syndrome. Arch Surg. 1984 Mar 1;119(3):345-6.https://www.ncbi.nlm.nih.gov/pubmed/6696630
  13. Zhou Y, Ryer EJ, Garvin RP, Irvan JL, Elmore JR. Adductor canal compression syndrome in an 18-year-old female patient leading to acute critical limb ischemia: A case report. International journal of surgery case reports. 2017 Jan 1;37:113-8.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5487298/
  14. Art of Kinesiology;Joe Muscolinohttps://learnmuscles.com/blog/2017/01/27/assess-diagnose-client-adductor-strain/
  15. Lovell GA, Blanch PD, Barnes CJ. EMG of the hip adductor muscles in six clinical examination tests. Physical Therapy in Sport. 2012 Aug 1;13(3):134-40.https://www.ncbi.nlm.nih.gov/pubmed/22814446
  16. eHowFitness How to Do Thigh Abduction & Adduction Exercises With Bands : Stretching & Exercise. Available from https://www.youtube.com/watch?time_continue=6&v=HE-8qeIZo3o
  17. Harøy J, Clarsen B, Wiger EG, Øyen MG, Serner A, Thorborg K, Hölmich P, Andersen TE, Bahr R. The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med. 2018 Jun 8:bjsports-2017.https://www.ncbi.nlm.nih.gov/pubmed/29891614