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==                                                                                           Description ==
== Description ==
The Adductor Magnus muscle is one of six muscles in the medial compartment of the thigh. Adductor Magnus is a broad triangular muscle<ref>The Anatomist's Vade Mecum: A System of Human Anatomy; Erasmus Wilson; Page No. 261.
[[File:Adductor_magnus_thigh.gif|alt=|thumb]]
</ref> 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.   
The Adductor Magnus muscle is one of [[Hip Adductors|hip adductors]]. The adductor magnus is the largest, most powerful and the most complex, of the adductor group. This muscle is complex in that  part derived from the fact that it divides into an adductor (pubofemoral) portion and a hamstring (ischiocondylar) portion. It lies deep to the [[Adductor Brevis|adductor brevis]] and the [[Adductor Longus|adductor longus]].<ref name=":1">Jeno SH, Schindler GS. [https://www.ncbi.nlm.nih.gov/books/NBK534842/ Anatomy, bony pelvis and lower limb, thigh adductor magnus muscles.]Available: https://www.ncbi.nlm.nih.gov/books/NBK534842/<nowiki/>(accessed 20.1.2022)</ref>  


[[File:Adductor magnus.png|center|thumb]]  
The adductor magnus muscle has a dual role being a dynamic stabilizer of the [[pelvis]] and femur as well as a prime mover of the femur into adduction. 
 
The adductor magnus is similar to the [[deltoid]] muscle in that: 
 
* One portion flexes the thigh and works as a medial rotator 
* Another extends the thigh and is a lateral rotator 
* Both portions adduct the thigh. 


== Anatomy ==
== Anatomy ==
[[File:Adductor magnus muscle - Kenhub.png|alt=Adductor magnus muscle (highlighted in green) - anterior view|right|frameless|500x500px|Adductor magnus muscle (highlighted in green) - anterior view]]


=== Origin: ===
=== Origin ===
Inferior pubic ramus, ramus of ischium (anterior fibres), and ischial tuberosity (posterior fibres)<ref name=":0">Kendall, McCreary, Provance; Muscle Testing and Function with Posture and Pain 4th Edition; Hip adductors; Page No.228.</ref>.
=== Insertion: ===
Medial to gluteal tuberosity, middle of linea aspera, medial supracondylar line, and adductor tubercle of medial condyle of femur.<ref name=":0" />


=== Nerve Supply<ref name=":0" />: ===
# The part of the muscle that is considered the adductor portion has its proximal attachment on the inferior ramus of the [[pubis]] and the ramus of the [[ischium]].
Obturator nerve, L2,3,4 and 
# The part of the muscle considered the [[Hamstrings|hamstring]] portion has its proximal attachment on the [[Pelvic Landmarks|ischial tuberosity.]]


Sciatic nerve, L4,5,S1.  
Each portion of the muscle has separate and distinct distal attachment points.<ref name=":1" /> <ref name=":0">Kendall, McCreary, Provance; Muscle Testing and Function with Posture and Pain 4th Edition; Hip adductors; Page No.228.</ref>


=== Action: ===
Image: Adductor magnus muscle (highlighted in green) - anterior view<ref >Adductor magnus muscle (highlighted in green) - anterior view image - © Kenhub https://www.kenhub.com/en/library/anatomy/adductor-magnus</ref>
1.Adduction of the hip joint<ref name=":0" />.
=== Insertion ===
Adductor part: posterior surface of proximal [[femur]],  middle of linea aspera, medial supracondylar line


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.<ref name=":0" /> 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.<ref>https://www.strengthandconditioningresearch.com/muscles/adductors/#REF</ref>
Hamstring part:  adductor tubercle of medial condyle of femur and supracondylar line.<ref name=":0" />


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 <ref>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</ref>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:
=== Nerve Supply ===
* 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.
Adductor part: [[Obturator Nerve|obturator nerve]] (L2-L4)   


* During Terminal Stance and Preswing phase: these muscles may also '''concentrically produce external rotation''' of the femur at the hip.
Hamstring part: [[Sciatic Nerve|sciatic nerve]] (L4-S1)<ref name=":2">Radiopedia Adductor Magnus Available: https://radiopaedia.org/articles/adductor-magnus-muscle<nowiki/>(accessed 20.1.2022)</ref>


Physical therapists should consider this important function of the hip adductors during gait when evaluating a patient and designing an intervention program.
=== Action ===
[[File:Adductor magnus anterior thigh.png|thumb|Adductor magnus: Largest hip adductor]]
Its most basic function is to adduct and medially rotate the thigh at hip joint. Its functional roles are listed below.


4. Adductor Magnus is a major stabilizer of pelvis. While walking and running adductors stabilize hips and lower limbs to avoid excessive internal rotation.
The adductor magnus muscle is both a dynamic stabilizer of the pelvis and femur as well as a prime mover of the femur into adduction.  


=== Adductor canal ===
# The adductor magnus plays a similar function to the deltoid muscle; one portion flexes the thigh and works as a medial rotator while the other extends the thigh and is a lateral rotator, and both portions adduct the thigh. 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.<ref name=":0" /> 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|gluteus maximus]] when the hip is flexed. The peak contractions of the muscle are seen in positions of hip flexion for eg. full squats.<ref>https://www.strengthandconditioningresearch.com/muscles/adductors/#REF</ref>
[[File:Thigh cross section.svg showing adductor canal.png|center|thumb|Adductor Canal]]
# The curvilinear attachment of the adductor magnus on the pelvis is like the attachment of the deltoid on the spine of the scapula, acromion, and clavicle. Both muscles serve as dynamic stabilizers of the ball and socket joints (shoulder or hip, respectively). <ref name=":1" /><ref name=":0" />


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.<ref>The Lower Limb/The Adductor Canal
=== Blood Supply ===
Adductor magnus is supplied<ref>Ortho Bullets; Adductor magnus,https://www.orthobullets.com/anatomy/10067/adductor-magnus
</ref> by the:
* obturator artery
* femoral artery
* medial femoral circumflex
* direct and perforating branches of the deep femoral artery.


http://teachmeanatomy.info/lower-limb/areas/adductor-canal/
== Physiotherapy Relevance ==
</ref>
[[File:Baseball.jpeg|thumb|A groin injury in the making?]]


== Clinical Relevance ==
* [[Adductor Tendinopathy|Adductor tendinopathy]] is a common cause of [[Groin Strain|groin injury]] and pain among athletes. They are seen mostly in athletes, ice hockey, and football players<ref>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</ref>. Predominant in male athletes. The source of groin pain is difficult to diagnose due to the involvement of many muscles; [[Hip Adductors|hip adductors]] and [[Gluteal Muscles|gluteals]] and also due to proximity to the pelvis, hip joint and [[sacrum]]<ref>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</ref>.


=== Groin injury: ===
* Knee Joint pain
The commonest type of [[Groin strain|groin]] strain or injury is believed to be adductor related. They are seen mostly in athletes, ice hockey, and football players<ref>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</ref>. 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<ref>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</ref>: 
[[File:Running .jpeg|thumb|Runners are at risk of tight adductors|left|200x200px]]
* 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.
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 stabilizing the hip.
* 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: ===
* The adductor magnus appears to display a relatively mixed muscle fibre type proportion<ref>Science Direct, Adductor, The hip; Leon Chaitow ND DO, Judith DeLany LMT, in Clinical Application of Neuromuscular Techniques, Volume 2 (Second Edition), 2011
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<ref>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</ref>, albeit with a greater proportion of type I muscle fibres. Postural (type 1)<ref>Adductors; Muscle Fibre Type; Adductor magnus
https://www.sciencedirect.com/topics/neuroscience/adductor-hiatus</ref>, albeit with a greater proportion of type I muscle fibres.
* Postural (type 1)<ref>Adductors; Muscle Fibre Type; Adductor magnus


https://www.strengthandconditioningresearch.com/muscles/adductors/#REF</ref> 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<ref>BODYWORKS: ADDUCTOR INJURIES
https://www.strengthandconditioningresearch.com/muscles/adductors/#REF</ref> 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<ref>BODYWORKS: ADDUCTOR INJURIES


https://www.runnersworld.co.uk/health/injury/bodyworks-adductor-injuries</ref>.  
https://www.runnersworld.co.uk/health/injury/bodyworks-adductor-injuries</ref>.  
=== Adductor canal syndrome: ===
Adductor Canal Compression Syndrome[[File:Thigh cross section.svg showing adductor canal.png|thumb|Adductor Canal|alt=]][[Hunter's Canal|Adductor canal]] syndrome is an unusual cause of acute arterial occlusion in younger men. It is the result of arterial compression by an abnormal musculotendinous band arising from the adductor magnus muscle and lying adjacent and superior to the adductor tendon.<ref>Verta MJ, Vitello J, Fuller J. [https://pubmed.ncbi.nlm.nih.gov/6696630/ Adductor canal compression syndrome.] Archives of Surgery. 1984 Mar 1;119(3):345-6.Available: https://pubmed.ncbi.nlm.nih.gov/6696630/<nowiki/>(accessed 20.1.2022)</ref>
It is an unusual cause of acute arterial occlusion<ref>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</ref> in younger men. It is the result of arterial compression (superficial femoral artery)<ref>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/</ref> 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.
Near the base of the adductor magnus muscle is the adductor hiatus which is the terminal portion of the adductor canal. The canal serves as a passageway from structures moving between the anterior thigh and posterior leg ( the [[Femoral Artery|femoral artery]], femoral vein, nerve to the [[Vastus Medialis|vastus medialis]] and the saphenous nerve).<ref>The Lower Limb/The Adductor Canal
 
http://teachmeanatomy.info/lower-limb/areas/adductor-canal/
</ref><ref name=":2" />


== Assessment ==
== Assessment ==
[[File:Adductor magnus.png|thumb|Adductor magnus in relation to other hip adductors]]
'''Palpation'''


=== 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<ref>Art of Kinesiology;Joe Muscolino<nowiki/>https://learnmuscles.com/blog/2017/01/27/assess-diagnose-client-adductor-strain/</ref>. 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.
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<ref>Art of Kinesiology;Joe Muscolino<nowiki/>https://learnmuscles.com/blog/2017/01/27/assess-diagnose-client-adductor-strain/</ref>. 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 ===
'''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 thigh in the direction of abduction i.e downward towards the thigh.<ref name=":0" />
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.<ref name=":0" />
 
'''Length'''


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


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== Treatment ==
== Treatment ==
Examples listed below


=== Stretching exercises to maintain the length of the muscle: ===
'''Stretching exercises to maintain the length of the muscle:'''


==== The [[Adductor Tendinopathy|long adductors stretch]]: ====
The long adductors stretch
* Stand and open the legs to a wide stance.
* Stand and open the legs to a wide stance.
* Flex the opposite knee leaning to this side until the stretch is felt
* Flex the opposite knee leaning to this side until the stretch is felt
* Hold for 20-30 seconds<gallery>
* Hold for 20-30 seconds
File:236.jpg
</gallery>


==== Frog Pose: ====
==== Frog Pose ====
{{#ev:youtube|watch?v=0Dt8RnTh4xk}}
{{#ev:youtube|watch?v=0Dt8RnTh4xk}}


==== Myofascial release: ====
==== Myofascial Release ====
{{#ev:youtube|watch?v=h5DenVCiPSk}}
{{#ev:youtube|watch?v=h5DenVCiPSk}}


=== Strengthening Exercises: ===
=== Strengthening Exercises ===


Various exercises can strengthen the Adductor Magnus muscle:
Various exercises can strengthen the Adductor Magnus muscle:


==== Isometric adduction with knees bent: ====
==== 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<ref>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</ref>
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<ref>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</ref>
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{{#ev:youtube|watch?v=bmjGd7z7fHc}}
{{#ev:youtube|watch?v=bmjGd7z7fHc}}


==== Concentric adduction exercises: ====
==== Concentric adduction exercises ====
{{#ev:youtube|watch?v=jn22rqsaeV8}}
{{#ev:youtube|watch?v=jn22rqsaeV8}}


==== Resisted exercises with elastic band: ====
==== Resisted exercises with elastic band ====
{{#ev:youtube|watch?v=HE-8qeIZo3o|300}}<ref>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</ref>
 
==== Eccentric adduction exercises ====


{{#ev:youtube|watch?v=NiiskLOOFBo}}
====  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. <ref>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</ref>
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. <ref>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</ref>
{{#ev:youtube|watch?v=lBIcQzr-cQs}}


== Resources ==
== Resources ==
https://simplifaster.com/articles/copenhagen-adduction-exercise-groin-injuries/
This 2 minute video is a good summary of the adductor magnus muscle.<ref>Adductor magnus muscle video - © Kenhub https://www.kenhub.com/en/library/anatomy/adductor-magnus</ref>{{#ev:youtube|7b_sw2Z8mEA}}[[Adductor Tendinopathy]]


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


== References ==
== References ==
<references />
[[Category:Muscles]]
[[Category:Anatomy]]
[[Category:Hip]]
[[Category:Hip - Anatomy]]
[[Category:Hip - Muscles]]

Latest revision as of 19:59, 7 January 2024

Original Editor - Vidya Acharya

Top Contributors - Vidya Acharya, Kim Jackson, Lucinda hampton and Joao Costa  

Description[edit | edit source]

The Adductor Magnus muscle is one of hip adductors. The adductor magnus is the largest, most powerful and the most complex, of the adductor group. This muscle is complex in that part derived from the fact that it divides into an adductor (pubofemoral) portion and a hamstring (ischiocondylar) portion. It lies deep to the adductor brevis and the adductor longus.[1]

The adductor magnus muscle has a dual role being a dynamic stabilizer of the pelvis and femur as well as a prime mover of the femur into adduction.

The adductor magnus is similar to the deltoid muscle in that:

  • One portion flexes the thigh and works as a medial rotator
  • Another extends the thigh and is a lateral rotator
  • Both portions adduct the thigh.

Anatomy[edit | edit source]

Adductor magnus muscle (highlighted in green) - anterior view

Origin[edit | edit source]

  1. The part of the muscle that is considered the adductor portion has its proximal attachment on the inferior ramus of the pubis and the ramus of the ischium.
  2. The part of the muscle considered the hamstring portion has its proximal attachment on the ischial tuberosity.

Each portion of the muscle has separate and distinct distal attachment points.[1] [2]

Image: Adductor magnus muscle (highlighted in green) - anterior view[3]

Insertion[edit | edit source]

Adductor part: posterior surface of proximal femur, middle of linea aspera, medial supracondylar line

Hamstring part: adductor tubercle of medial condyle of femur and supracondylar line.[2]

Nerve Supply[edit | edit source]

Adductor part: obturator nerve (L2-L4)

Hamstring part: sciatic nerve (L4-S1)[4]

Action[edit | edit source]

Adductor magnus: Largest hip adductor

Its most basic function is to adduct and medially rotate the thigh at hip joint. Its functional roles are listed below.

The adductor magnus muscle is both a dynamic stabilizer of the pelvis and femur as well as a prime mover of the femur into adduction.

  1. The adductor magnus plays a similar function to the deltoid muscle; one portion flexes the thigh and works as a medial rotator while the other extends the thigh and is a lateral rotator, and both portions adduct the thigh. 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.[5]
  2. The curvilinear attachment of the adductor magnus on the pelvis is like the attachment of the deltoid on the spine of the scapula, acromion, and clavicle. Both muscles serve as dynamic stabilizers of the ball and socket joints (shoulder or hip, respectively). [1][2]

Blood Supply[edit | edit source]

Adductor magnus is supplied[6] by the:

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

Physiotherapy Relevance[edit | edit source]

A groin injury in the making?
  • Adductor tendinopathy is a common cause of groin injury and pain among athletes. 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; hip adductors and gluteals and also due to proximity to the pelvis, hip joint and sacrum[8].
  • Knee Joint pain
Runners are at risk of tight adductors

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 stabilizing 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 Compression Syndrome

Adductor Canal

Adductor canal syndrome is an unusual cause of acute arterial occlusion in younger men. It is the result of arterial compression by an abnormal musculotendinous band arising from the adductor magnus muscle and lying adjacent and superior to the adductor tendon.[12]

Near the base of the adductor magnus muscle is the adductor hiatus which is the terminal portion of the adductor canal. 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).[13][4]

Assessment[edit | edit source]

Adductor magnus in relation to other hip adductors

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[edit | edit source]

Examples listed below

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[edit | edit source]

Myofascial Release[edit | edit source]

Strengthening Exercises[edit | edit source]

Various exercises can strengthen the Adductor Magnus muscle:

Isometric adduction with knees bent[edit | edit source]

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[edit | edit source]

Resisted exercises with elastic band[edit | edit source]

[16]

Eccentric adduction exercises[edit | edit source]

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[edit | edit source]

This 2 minute video is a good summary of the adductor magnus muscle.[18]

Adductor Tendinopathy

Groin Strain

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Jeno SH, Schindler GS. Anatomy, bony pelvis and lower limb, thigh adductor magnus muscles.Available: https://www.ncbi.nlm.nih.gov/books/NBK534842/(accessed 20.1.2022)
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Kendall, McCreary, Provance; Muscle Testing and Function with Posture and Pain 4th Edition; Hip adductors; Page No.228.
  3. ↑ Adductor magnus muscle (highlighted in green) - anterior view image - © Kenhub https://www.kenhub.com/en/library/anatomy/adductor-magnus
  4. ↑ 4.0 4.1 Radiopedia Adductor Magnus Available: https://radiopaedia.org/articles/adductor-magnus-muscle(accessed 20.1.2022)
  5. ↑ https://www.strengthandconditioningresearch.com/muscles/adductors/#REF
  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 MJ, Vitello J, Fuller J. Adductor canal compression syndrome. Archives of Surgery. 1984 Mar 1;119(3):345-6.Available: https://pubmed.ncbi.nlm.nih.gov/6696630/(accessed 20.1.2022)
  13. ↑ The Lower Limb/The Adductor Canal http://teachmeanatomy.info/lower-limb/areas/adductor-canal/
  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
  18. ↑ Adductor magnus muscle video - © Kenhub https://www.kenhub.com/en/library/anatomy/adductor-magnus
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