It is unclear to me how to facilitate an “Adductor Magnus (ER) -> obturator”. It seems to me that for ipsilateral FA instability the suggested movements are using AF IR/FA IR/FA ADD (left Adductor exercises in appendix). I don’t understand how the ER function of the Adductor Magnus is facilitated!? And are the same movements used for the right hip? In the treatment hierarchy for lumbo-pelvic-femoral control the suggested exercise for (only) the right side “Adductor Magnus (ER)->obturator” is one of the right Gluteus Maximus exercises from the appendix. I can understand that with this movement ER is facilitated, but I can’t really see any big involvement of the Adductors.
In the treatment hierarchy, the Right Adductor Magnus, an ER muscle is co-contracted with the Right Glute Max in the transverse plane initially to gain “Hole Control” and position the right obturator from a lengthened passive insufficient position to an optimal position as an external rotator. This comes first in this hierarchy as you do not have instability of the left femoral acetabular joint.
On the application of the Adductor Magnus, you see it is activated later in the progression as an external rotator muscle. Initially you do need (as you nicely describe), left AF IR/FA IR/F ADD to position the left obturator from a short actively insufficient state with the left IC Adductor along with the left glute max. These patients once securing the left hip and ligamentous muscles (left adductor and left anterior glute med) now need “dual hole control” so the exercises are less one sided and more concomitant with the right side. You are going to activate the transverse fibers of the Adductor Magnus with the transverse fibers of the right glute max. You will then in turn activate the right obturator. So in short, you are not going to isolate the transverse fibers of the Adductor Magnus without the glute max.
-Jennifer Poulin, PT, PRC
