Recently, my husband was experiencing some low back discomfort. He asked if I would mind taking a look at his movement patterns to see if anything jumped out at me. I had him lie down on his back, with his knees bent and his feet flat on the floor. His knees immediately flopped out to the sides. “Dude, you need to work on your adductors.”
The hip adductor muscle group consists of the adductor longus, adductor magnus, adductor brevis, pectineus, and gracilis. These muscles all have insertion points somewhere on the pubic bone and on the inside of the femur, with the exception of the gracilis. This long muscle runs from the pubic bone to the tibia. Based on just their anatomy, you would assume these muscles bring the femur to the midline of the body. While this is one of their actions, perhaps more importantly, the groin area where these muscles attach proximally is considered the transitional area between the lower limb and the abdomen (Valent, et.al, 2012). During movement, the pubic symphysis (think front bottom of the pelvis), is stabilized by the abdominals and paravertebrals working together, while the adductors work in opposition on the pubic symphysis, providing traction and rotation. Further, the position of the pelvis is going to affect the resting length of the adductors, which directly impacts motor coordination. If you look at the attachment points, you see that if the pelvis is tilted forward, the resting length of the adductors will be shorter than if the pelvis is neutral. Conversely, if the pelvis is posteriorly tilted, the adductors will be lengthened. The other critical muscle that attaches higher up on the pelvis and provides stability superiorly to the pubic symphysis is the transverse abdominis (http://www.amta.com.au/files/TheIntegratedPelvis.pdf). Its muscles attach at the iliac crest on either side of the pelvis and it interdigitates with the diaphragm. The muscle fibers run horizontally and in an ideal world, when movement occurs, these muscles contract (with others) to provide stability. There are more muscles involved in keeping this area balanced, but the coordination between these two muscle groups is a good one to begin to understand. In my husband’s case, his resting pelvic position is actually pretty neutral. However, he has been working on increasing hip external rotation in his exercise routine, and he naturally has legs that fall out when seated. He lacked balance in his pelvis, and when you throw in fatigue, stress, and other aspects of daily life, this can result in overactivity in some of the muscles in the low back.
Studying different movement systems, I notice similarities in the way certain things are taught. For example, yoga teachers often cue engaging the adductors in movements like handstand, when core engagement is necessary for success. Yoga teachers will also encourage a block between the legs in backbend. Given the anatomy presented above, this makes sense. Giving traction to the pubic symphysis reduces the amount of pressure exerted on the sacroiliac area- it creates more balance. In her book, “Core Awareness,” Liz Koch uses a ball between the knees to allow for more de-compression of the sacral-iliac joint. Again, when we think about the anatomy of the pelvis, we can see that by engaging the muscles that attach to the front of the pelvis, namely the adductors and the TrA, by narrowing the front, we open the back, often relieving tension. Pilates uses tools such as the Magic Circle to teach this concept, and the Gyrotonics system discusses this idea of narrowing in the front to create space in the back. Of course, you can overwork this pattern as well, leading to a separate set of issues. Ultimately, maintaining a sense of balance between your inner and outer thighs in the frontal plane and between the front and back of your pelvis should be the goal. If you are squatting high loads, for example, your hip external rotators are going to be extremely strong. Make sure you balance your pelvis with some internal rotator work. Understand the sensation of adduction and how that creates a line of strength up your abdomen to your ribs, and maybe even begin playing with an expiratory rib position to maximize TrA and diaphragm utilization. Just like you like you need strength to balance mobility, you need stability to balance mobility. For my husband, his mobility came with a price; creating more balance will improve his overall movement quality and hopefully reduce some of his discomfort. (Update: I began writing this a week ago, when his low back pain was giving him quite a bit of discomfort. I gave him some supine breathing and adduction exercises and told him to pay attention to his position while sitting and standing. His back pain gradually decreased, and as of yesterday morning, was completely gone. Only time will tell whether or not it remains gone).There is no one answer, and pain is multi-faceted; however, assessing daily habits and creating more options is generally a good thing.
Yours in health and wellness,
Valent, A., Frizziero, A., Bressan, S., Zanella, E., Giannotti., E., & Massiero, S., (2012). Insertional tendinopathy of the adductors and rectus abdominis in athletes: a review. Muscle, Ligaments, and Tendons Journal, 2(2), 142-148.