Anterior Adductors Static Manual Release

Differentiation

1. The adductor mass comprises the entire inner thigh from the quadriceps to the semimembranosus and semitendinous (semi's) .
2. These muscles are easiest to palpate with the hip flexed to 60-90° of horizontal abduction, knee at 90° of flexion, and foot resting on your outer anterior superior iliac spine (ASIS) or foot resting against the patient's opposite knee (as pictured above).
3. In this position, the adductors can be located by feeling for a contraction using broad palpation (web space from index finger to thumb) on the inner thigh and asking the patient to adduct against manual resistance. Assuming that your palpation is at approximately mid-point of the length of the thigh. The muscles that will be felt are the gracilis and adductor longus .
4. The pectineus and adductor brevis , specifically trigger points in these muscles, can be felt at the bottom of the femoral triangle.
5. The femoral triangle can be located by falling off laterally and inferiorly from the pubis, feeling for the adductor tendons, and depressing into the area just lateral and superior these tendons.
6. Or, the medial side of the femoral triangle can be identified by manually resisting hip adduction and identifying the gracilis and adductor longus , and the lateral side of the femoral triangle can be located by manually resisting knee extension and identifying the rectus femoris .
   • Note, special care should be taken to prevent irritation of "sensitive tissues (discussed below)" when palpating the pectineus and adductor brevis .

Potentially Sensitive Tissues

• The inguinal lymph nodes, femoral artery and vein, femoral and saphenous nerve, and additional distributions of these vessels and nerves in the femoral triangle and adductor canal may be palpated during this technique. If a pulse is felt, or the patient complains of numbness, tingling, burning or searing pain, or pain that is diffuse and uncomfortable and unlike trigger point pain, adjust hand placement. Keep in mind, lymph nodes, nerves, veins, and arteries are fairly narrow, a small adjustment in finger placement should be sufficient to continue performing the release technique without further insult to delicate structures.

Trigger Points

• Common trigger points for the gracilis and adductor longus are roughly 1/3rd and 2/3rd the length of the inner thigh.
• Common trigger points for the pectineus and adductor brevis can be located in approximately the middle of the floor of the femoral triangle.

Release Technique

1. This technique is likely easiest to perform, the hip at 90° of horizontal abduction, the knee at 90° of flexion, and the foot resting on your outer anterior superior iliac spine (ASIS) (as pictured above).
2. These muscles are easiest to palpate with the client in supine, and the hip flexed to 60-90° of horizontal abduction, knee at 90° of flexion, and foot resting on your outer anterior superior iliac spine (ASIS) or foot resting against the patient's opposite knee (as pictured above).

Gracilis and Adductor Longus

1. In this position, feel for a contraction using a broad palpation (web space from index finger to thumb) on the inner thigh, and ask the patient to adduct against manual resistance. Assuming that your palpation is at approximately mid-point of the length of the thigh. The muscles that will be felt are the gracilis and adductor longus .
2. Use a "thumb over thumb" or "thumb in thenar groove" hand position, strum fibers from posterior to anterior to identify taut bands in this tissue.
3. Once a taut band is located, the length of the band is explored for a dense nodule and consistent pressure is applied.
4. The practitioner may press down with the hands to increase abduction or add distal to proximal pressure to take up tissue slack; aiding in controlling the amount of tension to pin dense nodules.
5. Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).

Pectineus and Adductor Brevis

1. The pectineus and adductor brevis , specifically trigger points in these muscles, can be felt at the bottom of the femoral triangle.
2. The femoral triangle can be located by falling off laterally and inferiorly from the pubis, feeling for the adductor tendons, and depressing into the area just lateral and superior to the adductor tendons.
3. Or, the medial side of the femoral triangle can be identified by manually resisting hip adduction and identifying the gracilis and adductor longus , and the lateral side of the femoral triangle can be located by manually resisting knee extension and identifying the rectus femoris .
4. Pressing into the floor of the femoral triangle should be done with care, and exploration of tissue texture should be done with small, gentle compressions. Lift the fingers out of the tissue before moving to the next point to prevent dragging sensitive structures during the technique.
5. It is unlikely that fascicles or nodules will be identifiable. Attempt to identify dense regions or sensitive regions that replicate "trigger point like" pain.
6. Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).