Sartorius B.I.G.
The sartorius is the longest muscle in the body but is often overlooked, given its muscle function synergistic nature. In this episode, I share a bit more about its structure and anatomical connections that reveal some lesser known but important functions like the role it plays in peripheral nerve entrapment, fascial containers of the thigh, biotensegrity, and why it is often my go-to spot for treatment.
Gain a deep understanding of its relationship with the fascial compartments of the leg and its impact on the nerve structures of the thigh. I'll share with you the techniques I employ to treat the Sartorius and how it can offer significant relief to the entire lower extremity.
Resources mentioned in this episode-
Swelling Reduction Protocol that Works Like Magic episode: https://www.movementrev.com/podcast/seasion-1-episode-3-swelling-reduction-protocol
Spiral Line stretch: https://vimeo.com/manage/videos/454568690/3ff28ad319
Dynamic cupping: https://www.instagram.com/p/B9hlrHnHARC/
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Hey there, and welcome. I'm Anna Hartman, and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs and the nervous system on movement, pain, and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hello, hello, welcome to another episode of the Unreal Results Podcast. I'm your host, Anna Hartman. Um, today we're talking about the Sartorius. Or as I like to call it, Sartorius B. I. G. You know, cause S S Sartorius. Anyways, if you don't get that reference, I'm not sure we're in the same age bracket. Or friend group.
But, uh, maybe I can find, uh, free audio. to link that Notorious B. I. G. beat. Anyways, uh, so the sartorius, the sartorius is a favorite muscle of mine. I think a commonly overlooked muscle. And, um, I wanted to just sort of riff a little bit on why I think it's important, how I like to treat it, um, all the connections to it.
And I thought I'd show you two just cause. This is how my brain works. No matter what topic, I would think of one thing and then there's like all these different pieces that I could talk about it almost, you know, like a brainstorming thing. So this is like what my show notes look like. So that if you're listening, you can't see it.
If you're watching on YouTube, you see it, it's basically like, you know, the old brainstorm map, like Sartorius is in the middle. And then there's like arrows pointing to all the different connections. And that's No matter which way I work it, that's sort of like how my brain works in terms of like, here's a thing, let's think about all the ways it relates to stuff.
And, um, then, uh, In case you haven't noticed, I don't, I'm not a big, like, detail oriented person, and so I am never a big, like, let's write out my, uh, script for the podcast. It's just what do I want to talk about, what I think is relevant. So, to give you some detail on what's on this list, you know, it's like, okay, Sartorius, talk about, it's, it's function.
Um, What nerve innervates it? Uh, what it's another sort of function that's important to talk about connection to anatomy trains or fascial connections, or even embryologically, what other muscles is it related to? Um. And then specifically because it's anatomy, it is really important from a visceral and neural standpoint, and we'll talk about that.
So, not just the nerves that innervate the sartorius, but the nerves that the sartorius sort of are a protector of, and how that relates to common, pathologies as well. So, talk about all things. Oh, and then also, you know, and why I'm even talking about it is because the sartorius ends up being a really common area for me to treat on everyone for different reasons.
And that's because of when we look at the anatomy and how it lives in the thigh compartments becomes a real sweet spot for treatment. So I talked about that. I've talked about that before when we discussed the lower leg and how there's just a couple areas that tend to be a little bit like magical sweet spots that give you reflexively a response within all the compartments Of that limb and this is one of them in the thigh So, um also I guess that's a spoiler alert if you didn't know the thigh Also, it is, has compartments just like the lower leg and, um, though it's less common to get to compartment syndrome, basically, you know, any way you sort of slice it, when you have a neurovascular entrapment, it is basically a compartment syndrome if you.
Think of it that way. It's just not classically a compartment syndrome because of like swelling. Though it can be, especially in the cases of like, um, thigh contusions and things like that in the sport. So, I just jumped right in. Um, the, um, Sartorius. Some fun facts, of course. Fun facts about the Sartorius as well.
I always like, um, talking about the root of the words that describe the muscles, um, or nerves or whatever. Um, Sartorius, the root sart, uh, means tailor. So it's often originally referred to as the tailor muscle. There's... argument on why it's the tailor's muscle. One, it's like how tailors sit, often in like a turned out leg position, kind of like a diamond shape.
Also, um, in Philip Beach's work called Neanderthal sit, um,
but cross leg would be also a version of that. Um, and Maybe people whose job was a tailor. Obviously there was more tailor back in the day there than there is now. But, um, tailors tend to have well-developed sartorious. Uh, but then the other thing is, um, It spans your whole length of your inseam, in fact, more than the length of your inseam, so that's potentially why it's called Sartorius too, but, um, that is the root of the word, is tailor, and, um, it is the, so the name of this podcast is Sartorius B I G, not just because I love to do the whole notorious thing, but, um, because it is the largest muscle They're not largest, it's the longest muscle in our body.
So it goes from the top of our pelvis at the, typically, um. Originating on the A S I S of the ilium, all the way to the tibia on the medial side of the lower leg. So it expands our entire length of our thigh, plus the majority of the height of our pelvis. Um, so it's pretty long. Um, and it's also a two joint muscle, much like the rectus femoris.
Because the rectus femoris has that shared origin at the, um, Iliac spine, so there are some variations and some people the sartorius attaches more into the IT band and the TFL, uh, as well as down at the knee and sometimes it just attaches into the knee retinaculum versus. below on the tibia. But for the most part, those are its origins and insertions.
It is like an s curve because of that. Obviously it goes from the latter, most lateral part of your body to a medial part of your leg. And, um, so it has this nice sweeping s curve. Um, I'd say that the, the thing that most people miss is it's a little bit more. The S curve happens higher up than down below, so some people think it kind of is like the middle of your leg, but the, it stays pretty, um, medial, it like goes medial pretty proximal, um, as it, um, goes over, and you'll notice this border typically more so in people with hypertrophied quadriceps muscles than people without hypertrophied quadriceps muscles, though everybody typically has one, um, there's always those quadriceps.
It's a little outlier variance that these long synergistic muscles, you know, you tend to, it can actually be an anatomical variation not to have it. But for the most part, I, I'd say it's not so common to not have one. Um, the, I, the thing that, well, let's talk about like the traditional, you sartorius. Its function is hip flexion.
Uh, hip flexion, hip external rotation, and slightly hip abduction, as well as tibial internal rotation when the knee is flexed, um, when the knee is straight. It's just that long axis external rotation. So this is the function because it doesn't. Because it crosses the hip, but doesn't touch the femur, if this makes sense.
So, it crosses the hip joint, but it doesn't originate or insert on the femur itself. It doesn't have the greatest leverage to control the hip joint. So, it is a very synergistic way to flex the hip. With that said, plenty of my athletes, um, Like, like, you know, have a pretty strong sartorius as a primary hip flexor, I'd say, if anything, that tends to be its dominance, hip flexion, external rotation.
So, um, I'd imagine. Your athletes who have, like, powerful adductors as hip flexors, um, have powerful sartoriuses too. So the athletes that make, this makes me think of red alligator is hockey athletes, but, um, my sprinters all have real strong sartoriuses as well. Um. Then, the other common, um, thing we know that the sartorius plays a role in is medial knee stability.
Because of its attachment on the inside of the knee and its origin more lateral, it really controls that medial collapse of the knee, especially in the absence of good, good, yeah, medial hip stability. And the sartorius does this, controls medial knee stability, along with the gracilis, which is our long adductor muscle, as well as the semitendinosus, uh, so one of our hamstring muscles.
Oftentimes, when this is a primary... I don't want to say primary medial knee stabilizer, but when this complex, the sartorius are getting, um, overstretched because of this medial knee stability, um, tends to create some medial pes anserine bursitis. And, um, So this is probably most people's, I'd say this is most people's, um, knowledge of the Sartorius here, and, um, I'm not going to argue with that, that is something that we see fairly commonly, um, and I'd say sometimes I see it from the Sartorius just not Maybe even being kind of a little bit bound down in that fascial container, um, more so than necessarily hip weakness, but this goes back to sort of to how I see weakness of muscles is the first thing is, is the muscle really weak or is the neural activity to it not?
Not being optimized. All right. So, um, the other thing from a functional standpoint of the Sartorius, which is probably got me most interested at first is the role of Sartorius plays as part of our consciousness. spiral anatomy train, or fascial line. So, um, our spiral line, described by Thomas Myers, is a line of muscles and fascia that's primary role is to balance the arches and, um, rotate, create our, our bipedal Rotation, right?
So it actually takes the rotation from our trunk and transfers it to the legs or vice versa, takes that spring action that's inherent in the legs and transfers it to the trunk. So, um. I look to the Sartorius as a way to connect into our, um, Spiral Lion and our good movement patterns too. It's the main connector, in my opinion, between the, um, foot and the trunk.
Um, so having this as a, like, healthy, mobile, muscle that can do its thing is important. Um, the rest of the spiral line, it goes from sartorius and it goes peroneus longus underneath the, or, I'm sorry, posterior tibialis underneath the arch of the foot connecting to peroneus longus up the lateral side of the leg connecting into that IT band meeting back up at that um, iliac.
Spine of the pelvis and then connecting with the oblique sling system up into the serratus Through the rhomboids and then to the same side neck. So that is our spiral joint and we have one on both sides. So The interesting thing too is the the beautiful thing about that spiral Or the sartorius, as you can see, the spiral of the shape of the muscle ray is that nice S curve coming from, um, lateral to medial in the knee.
And this is, um, mirrors the spiral of our leg that is inherent to us from an embryological standpoint. So you may have heard me talk about this before, but from an embryo standpoint, before we're born, you know, after our limb buds, our leg limb buds have. come from the embryo and start to grow into legs.
Um, the front of the leg and the back of the leg sort of switch because what happens is the leg twists and it's on itself. And so the front of the leg becomes the back of the leg and the back of the leg becomes the front of the leg. This is why if you've ever thought about it, the term dorsiflexion, when you dorsiflex your foot, you're moving your foot towards the front of the shin.
That's actually our dorsum. That's our dorsal surface of our leg. And so that spiral going into internal rotation is what gives us that bounce, that spring back into external rotation, right? So the winded up spring is internal rotation, and the, the recoil of it is external rotation. So you can really see that in these.
In the sartorius to win this, the leg is fully internally rotated. It really stretches out that sartorius. And if we think about it as a rubble rubber band, it recoils it and pulls it into actual rotation. And so I think this too is why so many of my athletes have such a, um. More prominent or easier to find sartorius is because in general most of them do a lot more elastic recoil activities than general population So with that said too that means it's probably an important part of our elastic recoil function of the lower extremity Alright, so that's sort of the, um, that's sort of the, I'd say, more common things we know about the Sartorius, and usually why I'm treating it is for these reasons.
So, the Sartorius is very superficial. It's like skin. Not a whole lot of adipose tissue, typically, between the skin and the sartorius. It is a very superficial, it's within the superficial fascia, or the first container of the fascial compartments of the leg. And, um, very similar to the relationship, a very similar looking container to what the erector spinae look like in the, in the trunk.
So the erector spinae are enveloped in a fascia. Um, like, all around it, basically, right? And then, all that, those three layers of fascia come together, hooked to the spine, and then three layers of fascia come together on the other side, and then invest into the three layers of the abdominal muscles. Same thing.
Sort of the sartorius it is within the fascial container and has a connection to the medial compartment It is in the anterior compartment, but it's compartmentalized on its own as well Even though it's technically part of the anterior compartment. It's kind of its own little compartment So it has two interfacial triangles on each side of it, medial and lateral, and then it also has a connection to the posterior compartment.
So it joins with the posterior and lateral intermuscular septum, as well as the medial intermuscular septum. So it actually, Sartorius actually influences and has a pull or relationship on each of the three compartments of the thigh. Because of... That it can influence the neurovascular structures in all the compartments.
So this means a sartorious a tight, if you wanna use the word tight, I don't love that, but it's kind of the best way to think about it. A tight sartorious or sarti sartorious that is not sort of free in its own compartment, free to pull on those compartments, can create tension in the sciatic nerve, the femoral nerve, the saphenous nerve, as well as the obterator nerve.
So it can affect function of the quads, um, sensation to the entire thigh, the medial part of the low leg and toe, and the, um, posterior side of the thigh, as well as, like, general function of the entire lower extremity, and then the inside medial thigh via the obturator nerve. Um, so... That's super important to realize and because it's so superficial and so Related to the skin.
This is actually why treat it so much is because it's really easy to treat You could technically Depending on again, this is like depending on how free it is to move when it's free to move Use you can use your fingers to pick up someone sartorius and kind of separate from the quadriceps which is really cool to see.
If someone's not that free to move, I use the silicone cups, which I call dynamic cupping. It's the more flexible cup. I do the cup, and I do a skin lift technique with the cup to sort of help lift that. I get a two fold response here. I get a reflexive response within all of the compartments, but then I also get a response directly to the sartorius itself from the cup.
Because of the relationship to the skin. So I get this reflexive relaxation and of the Sartorius itself and everything beneath it and around it. And the cool thing is the things that are beneath it and why I care, like why it becomes also so important. The Sartorius is one of the main borders of, and I say Sartorius, not just the muscle, but the fascial container itself, the fascia beneath it.
is sort of the border of the adductor canal, or also the sometimes called the femoral canal. The adductor canal contains the femoral artery, the femoral vein, the lymphatic structures, and then branches of the femoral nerve. The biggest branch being the saphenous nerve, which is the large cutaneous nerve of the femoral nerve.
The saphenous nerve gives sensation to the lower leg. Um, It can mimic medial achilles pain, big toe pain, shin splints, um, there is also a branch in this area off the saphenous nerve that innervates the patellar tendon, so patellar tendonitis, the infrapatellar branch goes here, it's a very common, um, pain referral as well, so the sartorius, Basically, there is an area of the sartorius that, uh, called the subsartorial plexus, that this, these structures tend to be entrapped under.
And it's about, I'd say it's more on the proximal side, but if you looked at the sartorius and went about, Halfway up it, right at that halfway point above that, that's usually right around where the subsartorial plexus gets entrapped. And so, um, some of the other little branches of the femoral nerve here that get entrapped is the, um, intermediate cutaneous nerve.
which is sensation to the thigh, medial cutaneous nerve, sensation to the thigh, and then the anterior branch of the obturator nerve. That's all in that subsartorial plexus area. And not part of the subsartorial plexus, but beneath the sartorius is the adductor canal, and that's the, the area where the saphenous nerve is going to be entrapped.
And then also that adductor canal I've talked about shouldn't be new to you. I talked about it in the swelling reduction protocol because it's a really important spot that ends at the adductor hiatus. The adductor hiatus is where the femoral artery and vein go from the anterior thigh and go through the adductor hiatus to the posterior thigh and become the popliteal artery and vein.
So that area is a really important sort of, um, uh, drainage point or like, um, hose area that can be kind of a kink in it and limit our blood flow to and from the lower extremity. So it's a really important spot for me, um, Uh, fluid congestion standpoint. The femoral nerve, the main part of the femoral nerve, or the motor branches, are going to be more on the top of the adductor canal, which is technically the femoral triangle.
And I read something online today, a research article in an anesthesia journal, and the title of it was, like, same door, different spaces. And I thought that was interesting. So, the femoral triangle and the adductor canal, they share the same opening. But there are two different spots, right? So, and that is what we see is the femoral nerve is in the femoral triangle, which is the beginning of the adductor canal, but it does not continue through the adductor canal because almost immediately underneath the inguinal ligament and branches out into a bunch of different motory and sensory branches to all the different muscles of the leg and the different.
Parts of the skin. And so that's why that subsartorial plexus area and lower down in the adductor canal around the adductor hiatus
now, they're all a branch of the femoral nerve and so Whenever we treat a distal branch, we're going to have an effect higher up in the nerve, too. So we're still affecting the main part of the femoral nerve. So we're still going to see a change in things related to the femoral nerve. So strength of the quadriceps, strength of some of the shorter hip flexor, muscles, that kind of thing.
Because of the relationships, right? And then also, if we look at the proximal end of the sartorius, this is also can be a common entrapment site of the lateral femoral cutaneous nerve, too. And so we've got multiple entrapment sites along the sartorius that can affect various cutaneous nerves, motor branches, and other nerves of the lumbar plexus.
So this is... Again, sartorius is a huge one. So besides cupping, the thing that I tend to do, um, I'd say the thing that I tend to do from a treatment standpoint besides the cupping part to the sartorius is to stretch it. Um, and to stretch it, I do it in prone. So first, you got to make sure that people have enough hip extension from their other hip flexor muscles to like be in a prone position or you can add some pillows so they're relatively in a little bit more hip flexion but maintaining femur adduction so I bring the femur towards the midline of the body and then I actually do this in full knee flexion even though, even though the sartorius does cross the um, actually because the saurus Sartorius crosses the knee joint.
I wind it up a little bit there. But um, then, I also do it in full knee flexion to protect the tibiofemoral joint, because then I take the whole femur and I internally rotate it. And if you're using the lower leg to internally rotate the femur, if you're not careful, you can drive hypermobility through the tibiofemoral, the knee joint, and cause a lot of knee problems.
So I'm really conscious when I'm doing this stretch, that is the thigh bone moving in an internal rotation. And when I hold that adduction to the midline and then add an internal rotation, I really get a good stretch of the proximal end of the saphen, or saphenous, the proximal end of the sartorius, which is really nice.
I don't typically do that stretch, though, until after I've done the cupping along the whole length of the sartorius because I don't want to add more tightness to it and clamp down on all of those nerves that are underneath the sartorius and then within the, um, adductor canal or even create more tension through the compartments and irritate even the sciatic nerve on the posterior part of the leg.
So, um, the sartorius stretch is sort of one of the last things I do. And you can do like regular massage to the sartorius. I don't think it works quite as well as the cups because of the skin lift reaction. So Hilton's law just provides some reflexive relaxation to all the structures underneath and that's really what I'm Getting that is a neurological, um, like the nerves being free to move and act and do their part to give more space to the containers.
And, um, but some, uh, you know, key spots that I tend to do if I'm teaching self massage to my athletes, I'll have them do it at the adductor hiatus. So about four fingers medial to the middle of the knee joint on the inside border of the sartorius. And the saphenous nerve is right here, right above on the, on the, on the superior border of the sartorius.
So you got to be careful that you're not just smashing the nerves. And then I'll do a prone on the yoga blocks double ball technique right at the proximal Proximal attached to the sartorius right up by the um, iliac spine. So those tend to be kind of my spots. Sometimes I'll do it along the, uh, border of the sartorius in their area of the subsartorial plexus, but not as common.
Again, that's a spot that needs a skin lift really, or a skin stretch. So maybe if I'm not doing like deep tissue with the balls, maybe using the gorgeous ball to create a little bit of a skin stretch. And doing a skin stretch mobilization technique instead of there. So, from a strengthening standpoint, it's a synergist.
So, it's gonna get strong when you're doing things that involve something that needs knee stability, elastic recoil, and hip flexion. So, you know, knock yourself out. But, I, I haven't noticed that isolating the sartorius really Does much to be honest, you know, so, um, let it act how it needs to act in terms of like a vascular container to pensioner.
So. With that said, because it is a big tensioner piece into the fascial containers, it's going to respond more of like the hydraulic amplifier effect and respond to where our weight shifting is to, to create this hydraulic amplifier effect within the fascial containers. Remember, I compared it to the erector spinae in the thoracolumbar, um, fascial.
relationship there. So I think it plays a really similar role. Has someone researched this? I have no idea. This is me looking at anatomy and looking at the similarity in structure and extrapolating that if it has that similarity in structure and it is Part of our spiral line and it has to do with locomotion that chances are it has a lot to do with our, um, tensioning our fascial tensegrity and providing this body wide biotensegrity, um, connection.
So that's sort of how I would, um, strengthen it. Other ways you can try to sort of mobilize it is just part of the spiral line. So, um, doing some spiral line stretches, which I'll drop in the show notes, sort of my favorite, but it's basically like a quadruped with one leg straight, um, doing some different positions with the thorax.
So, relating to rotation. I think that covers all my little pieces that I had, um, laid out. And I hope you, um, take a look at the anatomy. I'll see if I can edit some of these clips and add in some of the pictures of the anatomy, but I'm sure I'll be posting about it on Instagram too. So, um, but also it's easy.
Just go to your Google browser and, or whatever your favorite browser is, and type in Sartorius. Click images or type in cross section of the thigh. Click images. I think you're going to be blown away when you look at the cross section and you see that relationship to the fascial containers, much similar to that of the trunk.
So have a great week. We'll see you next time. Thank you for being here. Peace out.
