I am very privileged. This past week I have been a part of a great team from the Norwegian School of Sport Sciences and the department of Anatomy and Cell biology at the University of Heidelberg. We are making educational material for students of medicine and sport sciences. It is exciting to work with dedicated, intelligent and motivated professionals that execute and make things happen.
This past week we dissected the lower extremities. This was documented with film and pictures. We were unable to complete the entire lower extremity, with maybe some the most exciting stuff to come, namely opening up the joints of the feet. The arbitrary description of anatomical function of different muscles becomes very apparent during dissection. The fascial attachments are so strong and the lateral force transmission between different muscles becomes quite obvious. Maybe muscles all work synergistically to solve a task.
Iliotibial band syndrome, which is a symptomatic description, is often associated with patellafemoral pain or dysfunction. This syndrome becomes quite interesting in the light of understanding true structural and functional anatomy. The tractus iliotibialis is only something that exist in a anatomy atlas. This is a lateral thickening, or reinforcement, of the fascia lata, which is the fascial structure surrounding the thigh. There is an increased mechanical stress laterally which results in this thickening, or there is a thickening to be able to absorb or transmit a mechanical force. However one has to bear in mind that this is a continuous structure with the fascia of the rest of the thigh. Some of the mechanical stress introduced to this structure comes from the posterior, lateral and anterior thigh, also known as the tensor fascia lata and the gluteus maximus.
This thickening of the tractus iliotibialis could have been anterior, but it is not, it could have been posterior, but it is not. It is lateral. The question then becomes why? Could this be a direct mechanism of controlling the knee in all three planes of motion? The extension of the knee from the structures feeding into the tractus iliotibialis is important and it exists. The gluteus maximus will assist in the control of knee flexion. But what about the control of the valgus and internal rotation that also constitutes the loading response of the knee together with knee flexion. Could the structures that feed into the tractus have a role here? If one considers the line of force from the tractus iliotibialis relative to that of the biceps femoris we see that the line and insertions are similar and very close together. It has been established that the biceps femoris will control knee internal rotation. Therefore the gluteus maximus together with the tensor fascie lata will do the same thing. Could these same structures also control the valgus of knee during the same loading response? A lateral force on the tibial plateau in a closed chain function will create varus, thus controlling valgus. In open chain it will be the exact opposite. With this in mind, is not function in the anatomy book described based upon open chain function? Just some thoughts from Heidelberg Germany.