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Capitis Semispinalis Thoracis Cervicis $GGXFWRUORQJXV 3HFWLQHXV 5HFWXVIHPRULV 9DVWXVODWHUDOLV OTHER UNUSUAL SUSPECTS This feature presented and went into some depth discussing six unusual suspect muscles, each one of which may be the underlying cause of client conditions. However, there are many more unusual suspects that could have been presented. Following is a brief discussion of a few more unusual suspects. Vastus Lateralis The vastus lateralis is a member of the quadriceps femoris group. As such, it is often thought of as being located only in the anterior thigh. However, the vastus lateralis attaches to the lateral lip of the linea aspera of the femur located all the way on the posterior side of the bone (Image C). Therefore, even though the vastus lateralis is superficial anterolaterally, it is also located in the lateral and posterolateral thigh. It is the lateral thigh where it is often overlooked as the causative agent of the client's pain. Because the iliotibial band is located superficial to the vastus lateralis, the iliotibial band is often blamed as the cause of the pain when the deeper vastus lateralis is the true culprit. When the iliotibial band is the cause of the client's condition, the pain will usually be felt at the lateral femoral condyle. If the client's pain is anywhere mid-thigh, look instead to locate and assess the vastus lateralis. This is easy. To locate it, simply resist the client from trying to extend the leg at the knee joint and feel for the vastus lateralis to engage. Once the muscle is located, have the client relax it and assess its tone. Semispinalis Capitis The semispinalis capitis of the posterior cervical spine is often overlooked as the cause of pain and tightness in the neck (Image A). It is actually the thickest muscle in the back of the neck and often tight and symptomatic. It lies directly deep to the upper trapezius, so the upper trapezius is often blamed when the semispinalis is the offending culprit. When assessing clients with neck tightness and pain, look for the semispinalis. Deep work over the laminar groove, directly lateral to the spinous processes, is often the key to helping clients with a tight semispinalis capitis. Pectineus The pectineus is a transitional muscle between the hip flexor and hip adductor compartments. It is located between the psoas major of the flexor compartment and adductor longus of the adductor compartment (Image B). It is often missed because the therapist's focus is so often on the psoas major. And because the pectineus sits a bit deeper than its neighbors, it is more challenging to find. The easiest way to locate the pectineus is to first find the proximal tendon of the adductor longus, and then drop immediately lateral to it. Keep pressure close to the pubic bone and ask the client to try to move the thigh at the hip joint, against your resistance, in an oblique plane that is a combination of flexion and adduction. B A Right pectineus. C Right vastus lateralis (lateral view). Semispinalis group.