I’m hoping that Ludwig wilna be insulted by my reference to his Ninth Symphony but it seems verra apropos! Are ye ready for Anatomy Lesson #7: The Thighs and Knees? Perfect timing for the upcoming American Thanksgiving Holiday,ye ken? I am on me own knees right now giving thanks because, aye, I am doing the knees in this lesson even though the title doesna reflect it. Just to prove me own goodwill, take a gander at Jamie’s knees in the photo below. Will it tide ye over while we get on wit’ our lesson? Dinna fash yerselves about us moving on right away, as we’ll be seeing a lot of Jamie today!
So, to start this lesson, I’ll be having ye know a few more things about muscles and bones of the thigh and the knee otherwise some of this lesson is no gonna make sense! The hip and knee joints are sites where bones move relative to each other. Skeletal muscles attach to the participating bones and span the joints; the attachment site that is fixed (doesn’t move) is the origin of a muscle and the attachment site that does move is its insertion. Next, our brains direct these muscles to contract. If muscle contraction brings the bones of the joint closer together, this is flexion (the hip joint has other movements but they don’t concern us today). If muscle contraction straightens the joint, it is extension (Photo A).
Understand that anatomists don’t use the terms upper and lower leg. For the lower limb, the region between hip and knee joints is the thigh, the region between knee and ankle joints is the leg and the foot is the remainder (Photo B). The dashed blue line in photo B represents the vertical midline plane through the body. A medial structure is closer to the midline and a lateral structure is further away from the midline! Aye, that’s the gist of it!
Now, getting into the mood, the very first time we hear about Jamie’s thighs is in the Outlander book as Claire shares his saddle on the way to Castle Leoch. Herself writes:
“My companion seemed to be having little trouble, in spite of being unable to use his right hand. I could feel his thighs behind mine, shifting and pressing occasionally to guide the horse. I clutched the edge of the short saddle in order to stay seated; I had been on horses before, but was by no means the horseman this Jamie was.”
And yet another quote from the Outlander book – this one from Jamie:
”But then that ride through the dark together….with that lovely broad arse wedged between my thighs…”
Weel, now, I wouldna say that our Starz Claire has a broad arse, but it surely is curvaceous and pert and we all ken where it was wedged during this ride – day or night! Mmmphm!
Now, to understand the thighs let’s begin wit’ the bones. I love superlatives so here’s the first one for this lesson: the thigh contains the femur, the longest bone of the human body (Photo C –front of right femur). The top of the femur ends in an angled neck and a head that fits securely into the deep socket (acetabulum) of the hip bone. Unlike the glenohumeral joint (Anatomy Lesson #2) the hip joint is verra stable but it is also less moveable! The far end bears two sturdy knobs, the medial and lateral condyles (Greek for knuckle) both of which help form the knee joint.
The leg contains two bones (Photo D – right leg bones from front). The larger tibia is medial (closer to the body midline) and the smaller more lateral leg bone is the fibula. The upper end of the tibia ends in two flat surfaces, the medial and lateral condyles and lower down it bears a midline knob, the tibial tuberosity. Only the tibia helps form the knee joint; the fibula plays no role.
One last bone critical to knee anatomy is the patella or knee cap. The patella is the largest sesamoid bone in the body (there are others) meaning it is embedded in a tendon; its deep surface rides in a groove between the medial and lateral femoral condyles as the knee joint extends and flexes (Photo E – right knee joint from the front).
Wit’ the bones accounted for, let’s turn to the muscles of the thigh. Thigh muscles are massive because they support most of our weight and help secure our bipedal state against the pull of gravity. Thigh muscles are divided into three compartments but as this post must be shorter than a bloody master’s thesis, I will address only one muscle of the front compartment: the quadraceps femoris (four-headed muscle of the femur). In reality, the quads as trainers call ‘em, are four muscles per thigh: rectus femoris, vastus lateralis, vastus intermedius and vastus medialis. Three of them are seen in Photo F. The fourth muscle, vastus intermedius, is visible only after rectus femoris is removed (Photo G). Each quad muscle has a different origin but they join to form a common quadracep tendon that inserts on the patella and then continues as the patellar ligament to insert on the tibial tuberosity (Photos F & G).
Rectus femoris takes origin off the hip bone and crosses both hip and knee joints (Photo H) before its common insertion. The three vasti (pl. for vastus) muscles take origin from different parts of the femur and cross only the knee joint (Photo H). Thus, all four heads of the quads extend the knee joint but only rectus femoris also flexes the hip joint. In addition, the quads are the only muscles that can extend the knee joints, so they are crucial for walking, running, jumping and squatting. The quads are also called anti-gravity muscles because they contract as we rise from a seated position and as we lower our bodies in reverse, holding our weight against gravity (think of the thighs in snow skiing).
Ye can test your own quads this way. Place your back against a wall. Drop your tush while walking your legs away from the wall until you assume a squat position (Photo I). Thighs and legs should be at 90° to each other (don’t drop lower even if you can – this is bad for your knee joints!). Now hold your torso in place for 30 seconds and then gradually straighten (extend) your knee joints. If you feel wobbly, then you probably need quad work as these muscles quickly lose mass and strength due to inactivity, sedentary jobs or aging. Quads can be strengthened by wall squats or any exercise that adds weight to the feet while extending the knee joint!
Now on to the knee joint, the largest joint of the human body (photo J – knee in partial flexion)! Here the medial and lateral femoral condyles (knuckles) ride atop a flat plateau formed by the medial and lateral tibial condyles – no stable joint here! Then the patella glides between the femoral condyles during flexion and extension. All bony surfaces of the joint are covered with articular cartilage, a bloodless, firm connective tissue that allows for smooth movement. This odd joint also has a medial and a lateral meniscus (made of a different type of cartilage) that create two shallow sockets atop the tibial plateau – one for each femoral condyle; these also act as shock absorbers.
There are also very strong ligaments (Photo K – right knee in full flexion – patella removed) designed to secure the tibia and femur: medial (tibial) and lateral (fibular) collateral ligaments and anterior and posterior cruciate ligaments (there are others too!). Overall, the knee joint is at risk due to our sports prone cultures and because supporting the body weight while in motion is a challenge on these relatively flat surfaces.
Now, for the fun stuff! I promised in Anatomy Lesson #3 that I would be returning to the scene where Jamie dismounts to grab Claire (Starz episode 1, Sassenach)! Yep, that’s the one! Let’s revisit that scene where we first git to see Jamie’s thighs – aye, readers, there’s a first time for everything!
Wait fer it…………….(Lost yer way?)
Wait fer it……….. (Jamie’s shifting his weight. He looks a wee bit annoyed!)
Wait fer it.…. (Wit’ a high kick Jamie’s right thigh clears the steed’s neck).
Worth the wait? Jamie’s dropping to the ground. Gad, this man has really loooooong legs!!!! Thank gawd that the kilt wasna doing its job here!
A firm landing and further evidence of those thighs and knees!
This just keeps gettin’ better and better! Geez, Jamie’s a perfect anatomical model! I can clearly see three of the four heads of the quads. The red arrow points to the head of the rectus femoris! I dinna ken why Claire isna splayed out on the leaf-strewn ground in a dead swoon wit’ that breath-taking sight advancing toward her!
OK, Claire, now yer in fer it! Ye’re gonna get what ye deserve! Oops, sorry, wrong Starz episode. Heh!
Hey, now, in the above images, what happened to the belt o’er Jamie’s left shoulder? Remember, when Claire reduced Jamie’s dislocated shoulder and after he dumps her off the saddle (head-first BTW!)? Weel, Angus’ belt was o’re his left shoulder. Here there is only a belt o’er his right shoulder – apparently for his scabbard. Mayhap he gave the belt back so Angus could keep up his kilt? Just sayin’……………………
Now, let’s identify more of Jamie’s quads in the next image (Starz episode 7, The Wedding – just in case ye forgot). Do you see the major bulge (no, not that one!) on the inside of his thigh (blue arrow)? That is the head of his right vastus medialis muscle! Whew!
I know the light is dim but in the next image the blue arrow marks the bulging head of his left vastus lateralis muscle just peeking out from under his wedding shirt. He is sooo modest!
Now fer the knees! I ken that gazillions of ye have been awaiting fer another glimpse of Jamie’s knees so feel free ta take yer time! Sorry to mess up his gorgeous knees with a quiver of arrows, but just so ye ken: the blue arrow is his lateral femoral condyle, the red arrow is his medial femoral condyle, the green arrow marks his patella and the orange arrow is his tibial tuberosity. So now ye ken the names of all the knuckles and knobs o’ his knees! Claire, lift your eyes girl! He squatted down ta show ye his knees and git in yer face! He knows he is one damn fine looking Scot – grubby shirt or no!
Moving on, darn it! Next, ye should know that all of the thigh muscles are wrapped in a very strong, inelastic sheet of connective tissue, the fascia lata which is reinforced at the side as the iliotibial tract (see Anatomy Lesson #1, Jamie’s Tush) or IT band (Photo L). The fascia lata continues over the leg as the crural fascia (more about that in a later post).
Now, fer more applied anatomy! Ye see the thick band of tissue running vertically just under the skin of Jamie’s right thigh (Starz, episode 1, Sassenach)? That is his right IT band! Ye can see it plain as the nose on yer face! The tissue just behind the IT band belongs to muscles that flex the knee joint – we’ll puzzle those out later!
You all should ken that the fascia lata is verra important: it’s a long way for the heart to move venous blood from the foot back to the chest especially working against gravity. Contraction of thigh and leg muscles helps milk venous blood back towards the heart. The fascia lata aids this process by compressing contracting muscles against the deep thigh veins. But if the thigh muscles get seriously injured they swell and the inelastic fascia lata willna stretch to accommodate such swelling. When this happens, it is a medical emergency because the swollen muscles not only retard the return of venous blood but also diminish the flow of oxygen-rich arterial blood to the lower limb – and, as ye ken, tissue dies if deprived of oxygen!
This condition is known as compartment syndrome and the next photo (Photo M) shows the result of medical intervention. This is the right thigh of one of my former students (aye, I have his permission). After injuring his thigh muscles, the swelling threaten necrosis (death) of his lower limb so surgeons slit his fascia lata (at the margin of the IT band) to relieve the pressure and reestablish blood flow. Now, when he contracts his right thigh muscles, they bulge through the slit in the fascia lata! Gives ye a pretty good idea of just how strong and tight the fascia lata truly is!
OK, wit’ that, we have come to the end of our thigh and knee anatomy lesson! But, I’m no gonna leave ye bereft. Here is one last image designed to increase yer admiration and respect for Jamie’s anti-gravity quads! In this modest scene from Starz episode 7, The Wedding, Jamie bears Claire’s entire weight (9 stone or 126 lb – Herself wrote in Outlander). Then he slowly lowers their combined weight (I am guessing around 16 stone, 100 kg or 220 lb) to the bed afore he flips her over (BIG grin)! That takes a whole lot of quad strength! I am duly impressed and I’m a guessing ye are too!
Ok, mukkers, that’s it fer now. Please stay tuned for my next post. There is still a lot of anatomy to cover as I work my way through the first eight episodes of Starz! I am deliberately taking a slow pace to keep us occupied until we see what Jamie’s going do to about BJR’s (or was it Claire’s?) knife at Claire’s breast! It won’t be very pretty fer BJR, of that I am reasonably sure. Signing off! Happy Thanksgiving to those who celebrate it!
Oh, almost forgot. You can now follow me on Facebook and Twitter.
A deeply grateful,
Image credits: Starz, Grant’s Atlas of Anatomy, 10th ed., Netter’s Atlas of Human Anatomy, 4th ed., Clinically Oriented Anatomy, 5th ed, www.AuthenticFX.com, Wikipedia, OA archival photos, AAOC Website, Tumblr.com