The adductor muscles are the problem children of the hip and pelvic floor family. The quads, hamstrings and glutes get all the attention, while the shy adductors hang around in obscurity. I get it; they are difficult to reach prone or supine, and they run embarrassingly close to the genitals. As a result, most practitioners avoid treating this muscle group in a thorough and satisfying way.
No more! Take on the challenge and reap the rewards of confident work on the inseam of the thigh.
This article lays out how versatile the adductors are in moving, stabilizing and adjusting the hip joint. I will also show why the adductors are so important to pelvic stability and multiple hip functions, including distinct roles of each of the six hip adductors.
Then, with a newfound respect for their role, we explain how to set the client up correctly to make it easy to get there, with strategy options for more effective treatment.
The Six Adductor Muscles
The adductors are a large triangle of muscle occupying the inside of your thigh. The heavy bone just above the inside of your knee (the medial femoral epicondyle, if you must know) is the bottom of the triangle. The top is the strip of bone alongside your genitals, the ischiopubic ramus, running from your sitting bones to your pubic bone. In your groin, the adductors fill the space on the medial side of the hip joint, tapering on down the inner thigh (Fig. 1).
I hear you say, “I looked and there are only three muscles named adductor. Why are you saying six?”
Yes, you are correct. We will look at adductor longus and brevis, and include pectineus with this group, to get three in front. In the back, we will divide the mighty adductor magnus into three separate functional units, to make a total of six (Fig. 2).
Some anatomists include the gracilis as an adductor, since it is positioned with these other muscles and, indeed, it can help adduct. Gracilis, however, is more superficial than the adductor group and crosses the knee as well, while all the adductors under discussion only affect the hip. Third and most important, the gracilis functions as part of a trio of muscles that stabilize the inside of the knee (pes anserinus), to the front (sartorius), bottom (gracilis) and back (semitendinosus) of the hip bone.
Michelle Kwan would be employing those muscles as she floated on one skate and one hip, as would someone in ardha chandrasana (Half Moon pose). You could call the pes and its muscles the outer stability system for the hip and the adductors the inner stability system. All the adductors we are about to discuss only cross the hip. They are single-joint muscles that do not cross the knee or sacroiliac joint.
There is a bit of controversy about what movements the adductors can produce in the hip joint they cross. Of course, they all adduct the thigh toward the midline, keeping the legs together, so the one movement they definitely cannot do is abduction.
For abduction, the adductors are antagonized by (meaning have a cooperative relationship with) the abductors, the three glutei and the tensor fasciae latae. These muscles form a deltoid of the hip. The two groups working together stabilize the hip joint in the coronal plane with side-to-side swinging, a movement we all perform while walking (Fig. 3).
So, adduction and abduction are fairly straightforward and usual: They are muscle groups balancing each other across a joint, either easily or with tightened compensation. That leaves us to discuss the adductors’ role in hip flexion, extension, medial rotation and lateral rotation. Here is the punch line takeaway: The adductors have a role in all of these movements (Fig. 4).
“Ridiculous!” you say. “How can a muscle do two opposing movements? That’s impossible.” Nevertheless, it is true, and before we explain, one fact from our evolution can help our understanding.
Our legs, of course, developed from the pelvic fin of a fish. The first muscles necessary, and thus the first leg muscles to develop, were the adductors, which pulled the fin toward the body and propelled the fish forward. Abductors pulled the fin out again to be ready for the next push, but they required very little strength, as the fish rarely tried to propel itself backward.
“OK, I get that,” you might now respond. “The adductors were first and needed to be versatile. But how mechanically can they participate in both sides of opposing movements?”
Here’s how: The flexion and extension part is pretty easy, because we are not talking about a single muscle but a muscle group. Even a single muscle can oppose itself. Think of your deltoid. Try holding your arm out to the side and rolling it in and out. The anterior and posterior deltoid are acting as antagonists for the medial and lateral rotation, while the middle deltoid acts as a fixation muscle to keep your arm abducted.
If we consider the adductors as acting from their insertion on the femur to their origin on the lower pelvis, we see how the anterior adductors (longus, brevis and pectineus) could contribute to hip flexion, or anterior tilt in posture. Most of the posterior adductors—the various parts of the adductor magnus—are in the position to reinforce posterior tilt of the pelvis or hip extension, like one-joint hamstrings (Fig. 5).
A Role in Every Step
It is a bit more complicated to understand how adductors could be both medial and lateral rotators. Arguments have been made for either one or the other; my own finding is they have very little rotational impact in either direction in standing.
This poised position allows them—and I find this by palpation in movement, not via any solid research—to return the hip joint from strong medial rotation to neutral, and also from strong lateral rotation to neutral. This is a great talent for the pelvic fin of a fish to make so many righting adjustments. But by standing up on those fins, we took the whole idea to the next level.
This unique position gives the adductors a role in every step, not merely keeping the hips from splaying out into the splits, but managing the medial and lateral rotation of the pelvis on the femur that accompanies swinging each of our hips forward.
So, if you are looking at any of the postural distortions in any of the movement planes—lateral or anterior/posterior tilt or pelvic rotation—the adductors will almost certainly be part of the solution.
Another reason for getting sensitively deep with the adductors is how much emotional trauma can be stored there, awaiting release. Commonly, sexual history can be lodged in the adductors, as they act as the gate to the lower openings of the body and all that goes with “down there.” This is, for obvious reasons, more common in women than men. For less-obvious reasons, impotent rage is also stored here, and more often in men.
How to Reach the Adductors
So, for both biomechanical and full self-expression reasons, the adductors are an important area to touch, to release and to reconnect into the body image; however, the difficulty remains in reaching them without discomfiting you or the client. Here’s how:
Lie your client on their side, with a pillow for their head and a thick bolster between their knees (Fig. 6). The upper knee goes on the bolster, the leg on the table is out straight. Now you have access to the whole inner line of the inner leg from ankle to groin.
For best results, have the two hips directly on top of each other. Don’t let the client roll toward lying on their belly or twist their upper body around to talk to you.
• I work on clients who remain clothed in underwear, so I do not face the challenge of draping. If your client is nude, there are ways to pull the draping up around the upper thigh that work well, but I recommend practicing first on someone you know.
Often, letting them adjust the drape themselves is best. It is fine to work through cloth if you prefer, as long as it isn’t Spandex.
• Start a bit up the thigh from the knee with full permission and consent. This is so important in approaching this area with any gender. I give the client lots of reassurance and total control over my movements.
Given that you have less opportunity for eye contact and the client cannot use their hands to guide your hands in this instance, there is often a yielding or letting go right at the beginning that allows you to work—and that yielding comes about only with full consent.
• Ease away from the inner thigh’s midline, toward the quads in the front and the hamstrings in the back, working your way slowly and thoughtfully up the thigh. Have the client do anterior and posterior tilts with their pelvis as you work. Which muscles are working harder or feeling denser—your front hand or your back hand? This is a clue into the client’s tilt preference.
• As you get closer to the pelvis, you will be able to feel the big, round tendon of the adductor longus, easily seen when you are sitting cross-legged. That is your anterior boundary. By all means, release this often-short muscle, but do not venture more forward than that into the femoral triangle.
• The big muscle under the ischial tuberosity is the upper adductor magnus, a key connection to the pelvic floor and lumbo-pelvic stability. You can work more strongly back here, generally working tissue from up to down toward the ankle, encouraging the client to drop their leg out of the hip.
Release the Adductor Muscles’ Benefits
In some people, this area will produce strong emotions—but more often the result will be a freer gait, the feeling of the legs being longer, and more resilience in the pelvic floor. Also, in daily life, standing to do your work, such as over the sink or the baby’s cradle or the massage table with your hips bent a bit often gets easier to maintain for a longer time without discomfort.
All these are great benefits, but if you always avoid the adductors, your clients won’t feel them. If you are new to working this area, try it with someone you trade with, or a client you know well. If you learned it but now skip around the adductors, rededicate yourself to the whole body, not just the easy parts.
About the Author
Thomas Myers is the author of “Anatomy Trains” (Elsevier 4th edition 2020) and co-author of “Fascial Release for Structural Balance” (North Atlantic Books, 2nd edition 2017), and many articles and online learning programs on structural anatomy, the fascial network and applications to manual therapy. Myers and his faculty offer continuing education for a variety of practitioners worldwide, and a complete certification program in Anatomy Trains Structural Integration.