Ch18: Hip Joint Flashcards
The lower extremity includes the
Pelvis, Thigh, Leg, and Foot
Bones of the Pelvis
The two innominate bones (hip bones), the sacrum, and the coccyx.
The innominate bone consists of…
Three bones (ilium, ischium, and pubis) fused together.
The thigh contains the…
Femur and the Patella.
The leg includes the…
Tibia and Fibula, and the foot includes seven tarsal bones, five metatarsals, and 14 phalanges.
The Hip Joint
The most proximal of the lower extremity joints. It is very important in weight-bearing and walking activities
-Ball-and-Socket Joint
The rounded, or convex-shaped, femoral head fits into and articulates with the concave-shaped acetabulum
Action of the Hip Joint
Convex-on-Concave
The convex femoral head slides in the direction opposite the movement of the thigh.
-Very stable joint and therefore sacrifices some range of motion. Conversely, the shoulder, which allows a great deal of motion, is not as stable.
Flexion, extension, and hyperextension of the Hip
Occur in the sagittal plane, with approximately 120 degrees of flexion and 15 degrees of hyperextension. (Extension is the return from flexion)
Abduction and Adduction of the Hip
Occur in the frontal plane, with about 45 degrees of abduction. Adduction is usually thought of as the return to anatomical position, although there is approximately an additional 25 degrees of motion possible beyond the anatomical position.
Medial and Lateral Rotations of the Hip
Occur in the transverse plane, (sometimes referred to as internal and external rotation, respectively) There are approximately 45 degrees of rotation possible in each direction from the anatomical position.
Bones of the Lower Extremities
Anterior View
Region: Pelvis (Bones of the Lower. Extremity)
Bones:
- Innominate (ilium, ischium, pubis)
- Sacrum
- Coccyx
Region: Thigh (Bones of the Lower. Extremity)
Bones:
Femur
Individual Bones:
Patella
Region: Leg (Bones of the Lower. Extremity)
Bones:
- Tibia
- Fibula
Region: Foot (Bones of the Lower. Extremity)
Bones:
- Tarsals (7): Calcaneus, Talus, Cubooid, Navicular cuneiform (3)
- Metatarsals (5): First through fifth
- Phalanges (14): Proximal (5), Middle (4), Distal (5)
Motions of the Hip
.
Hip Joint Motions End Feel
The end feel of all hip joint motions, except flexion, is firm because of tension in the capsule, ligaments, and muscles. For hip flexion, the end feel is soft because of contact between the anterior thigh and the abdomen.
Open-Packed Position of the Hip
When it is in 30 degrees of flexion, 30 degrees of abduction, and a small degree of lateral rotation. This is the position where maximal joint surface movement is possible.
When the accessory motions of the femoral head are limited…
A mobilizing force that moves the head of the femur into the direction of restriction can help restore motion. (ex. a posterior glide of the head of the femur will promote stretching of the posterior capsule and increased flexion and medial rotation, whereas an anterior glide will stretch the anterior capsule and increase extension and lateral rotation)
Connection of the Pelvic Girdle
The two innominate bones are connected to each other anteriorly and to the sacrum posteriorly. The sacrum is also connected distally to the coccyx. These four bones (the two innominate bones, the sacrum, and the coccyx)
The hip joint is made up of the…
Innominate Bone and Femur
Arthrokinematic motion at hip joint
Convex joint surface moves in opposite direction of the femur during hip abduction/adduction.
Bones of the Pelvis
Anterior View
Ilium
Fan-shaped and makes up the superior portion of the innominate bone
Iliac Fossa of the Ilium
Large, smooth, concave area on the internal surface to which the iliac portion of the iliopsoas muscle attaches
Right Innominate Bone (medial view)
Consists of the ilium, ischium, and pubis. The greater sciatic notch, acetabulum, and obturator foramen are formed by different combinations of these bones
Iliac Crest of the Ilium
Bony part that your hands rest on when you put your hands on your hips. Its borders are the anterior superior iliac spine and the posterior superior iliac spine.
Right Innominate Bone
Lateral View.
Anterior Superior Iliac Spine (asis) of the Ilium
The projection on the anterior end of the iliac crest. The tensor fascia lata and sartorius muscles and the inguinal ligament attach here.
Anterior Inferior Iliac Spine (aiis) of the Ilium
The projection to which the rectus femoris attaches is on the AIIS.
Posterior Superior Iliac Spine (psis) of the Ilium
It is the posterior projection on the iliac crest.
Posterior Inferior Iliac Spine (piis) of the Ilium
Located just below the PSIS.
Ischial Body of the Ischium
Makes up about two-fifths of the acetabulum
Ischial Ramus of the Ischium
Extends medially from the body to connect with the inferior ramus of the pubis. The adductor magnus, obturator externus, and obturator internus muscles attach here.
Ischial Tuberosity of the Ischium
Rough, blunt projection of the inferior part of the body, which is weight-bearing when you are sitting. It provides attachment for the hamstring and adductor magnus muscles.
Ischial Spine of the Ischium
Located on the posterior portion of the body between the greater and lesser sciatic notches. It provides attachment for the sacrospinous ligament
Pubis
Forms the anterior inferior portion of the innominate bone
-Can be divided into three parts: the body and its two rami
Pubic Body of the Pubis
Externally forms about one-fifth of the acetabulum and internally provides attachment for the obturator internus muscle
Superior Ramus of the Pubis
Lies superiorly between the acetabulum and the body and provides attachment for the pectineus muscle
Superior Ramus of the Pubis
Lies superiorly between the acetabulum and the body and provides attachment for the pectineus muscle
Inferior Ramus of the Pubis
Lies posterior, inferior, and lateral to the body. Provides attachment for the adductor magnus and brevis and gracilis muscles
Symphysis Pubis of the Pubis
A cartilaginous joint connecting the bodies of the two pubic bones at the anterior midline
Pubic Tubercle of the Pubis
Projects anteriorly on the superior ramus near the symphysis pubis and provides attachment for the inguinal ligament
Acetabulum (combination of the innominate bones)
A deep, cup-shaped cavity that articulates with the femur. It is made up of nearly equal portions of the ilium, ischium, and pubis.
Obturator Foramen (combination of the innominate bones)
A large opening surrounded by the bodies and rami of the ischium and pubis and through which pass blood vessels and nerves
Greater Sciatic Notch (combination of the innominate bones)
Large notch just below the PIIS that is actually made into a foramen by the sacrospinous and sacrotuberous ligaments. The sciatic nerve, piriformis muscle, and other structures pass through this opening.
Greater Sciatic Notch (combination of the innominate bones)
Large notch just below the PIIS that is actually made into a foramen by the sacrospinous and sacrotuberous ligaments. The sciatic nerve, piriformis muscle, and other structures pass through this opening.
Femur
The longest, strongest, and heaviest bone in the body. A person’s height can roughly be estimated to be four times the length of the femur. Articulates with the innominate bone to form the hip joint and has significant landmarks
Femur
The longest, strongest, and heaviest bone in the body. A person’s height can roughly be estimated to be four times the length of the femur. Articulates with the innominate bone to form the hip joint and has significant landmarks
Head of the Femur
The rounded portion covered with articular cartilage articulating with the acetabulum
Neck of the Femur
The narrower portion located between the head and the trochanters
Neck of the Femur
The narrower portion located between the head and the trochanters
Greater Trochanter of the Femur
Large projection located laterally between the neck and the body of the femur, providing attachment for the gluteus medius and minimus and for most deep rotator muscles
Parts of the Femur
Right front and back
Lesser Trochanter of the Femur
A smaller projection located medially and posteriorly just distal to the greater trochanter, providing attachment for the iliopsoas muscle
Trochanteric Fossa of the Femur
Medial surface of the greater trochanter
Intertrochanteric Crest of the Femur
The smooth ridge between greater and lesser trochanters. Serves as attachment for quadratus femoris.
Body of the Femur
The long, cylindrical portion between the bone ends; also called the shaft. It is bowed slightly anteriorly.
Medial Condyle of the Femur
Distal medial end
Lateral Condyle of the Femur
Distal Lateral End
Lateral Epicondyle of the Femur
Projection proximal to the lateral condyle
Medial Epicondyle of the Femur
Projection proximal to the medial condyle
Adductor Tubercle of the Femur
Small projection proximal to the medial epicondyle to which a portion of the adductor magnus muscle attaches
Linea Aspera of the Femur
Prominent longitudinal ridge or crest running down the middle third of the posterior shaft of the femur to which many muscles attach
Pectineal Line of the Femur
Runs from below the lesser trochanter diagonally toward the linea aspera. It provides attachment for the adductor brevis.
Pectineal Line of the Femur
Runs from below the lesser trochanter diagonally toward the linea aspera. It provides attachment for the adductor brevis.
Patellar Surface of the Femur
Located between the medial and lateral condyle anteriorly. It articulates with the posterior surface of the patella.
Tibial Tuberosity of the Tibia
Large projection at the proximal end, in the midline. It provides attachment for the patellar tendon
Joint Capsule of the Hip
Like all synovial joints, the hip has a fibrous joint capsule.
It is strong and thick, and it covers the hip joint in a cylindrical fashion. It attaches proximally around the lip of the acetabulum and distally to the neck of the femur. It forms a cylindrical sleeve that encloses the joint and most of the femoral neck.
Three ligaments reinforce the capsule:
The iliofemoral, the pubofemoral, and the ischiofemoral ligaments
Iliofemoral Ligament
The most important of these ligaments. Reinforces the capsule anteriorly by attaching proximally to the AIIS and crossing the joint anteriorly. It splits into two parts distally to attach to the intertrochanteric line of the femur. Because it resembles an inverted Y, it is often referred to as the Y ligament. It is also known as the ligament of Bigelow. Its main function is to limit hyperextension.
Pubofemoral Ligament
Spans the hip joint medially and inferiorly. It attaches from the medial part of the acetabular rim and superior ramus of the pubis and runs down and back to attach on the neck of the femur. Like the iliofemoral ligament, it limits hyperextension. In addition, it limits abduction.
Ischiofemoral Ligament
Covers the capsule posteriorly. It attaches on the ischial portion of the acetabulum, crosses the joint in a lateral and superior direction, and attaches on the femoral neck. Its fibers limit hyperextension and medial rotation.
Where do the Iliofemoral, Pubofemoral, and Ishiofemoral Ligaments attach?
All 3 ligaments attach along the rim of the acetabulum and cross the hip joint in a spiral fashion to attach on the femoral neck. The combined effect of this spiral attachment is to limit motion in 1 direction (hyperextension) while allowing full motion (flexion) in the other direction. Therefore, these ligaments are slack in flexion and become taut as the hip joint moves into hyperextension.
What happens if you thrust your hips forward so the Iliofemoral, Pubofemoral, and Ischiofemoral Ligaments are in front of your shoulders and knees?
You cause the line of gravity (LOG) to pass posterior to the axis of rotation for the hip joint. This allows you to stand in the upright position without using any muscles by essentially resting or hanging on the iliofemoral ligament. This is the basis for the standing posture of an individual with paralysis following spinal cord injury
Acetabular Labrum
Fibrocartilaginous
Increases the depth of the acetabulum which is located around the rim
The free end of the labrum surrounds the femoral head and helps to hold the head in the acetabulum.
Inguinal Ligament
Has no function at the hip joint, but should be identified because of its presence. It runs from the ASIS to the pubic tubercle and is the landmark that separates the anterior abdominal wall from the thigh. When the external iliac artery and vein pass under the inguinal ligament, their names change to the femoral artery and vein.
Iliotibial Band or Tract
The very long, tendinous portion of the tensor fascia lata muscle. Attaches to the anterior portion of the iliac crest and runs superficially down the lateral side of the thigh to attach to the tibia. Both the gluteus maximus and tensor fascia lata muscles have fibers attaching to the iliotibial band.
Hip joint capsule is reinforced by three ligaments:
The iliofemoral, the pubofemoral, and the ischiofemoral ligaments.
The spiral attachment of the hip ligaments tends to limit hyperextension.
Positioning the hips forward of the shoulders and knees causes the line of gravity to run posterior to the axis of rotation for the hip joint, creating a natural extension force at the hip. This is referred to as “hanging on the Y ligament.”
Inguinal Ligament
Anterior View
The end feel of all hip joint motions, except flexion, is…
Firm because of tension in the capsule, ligaments, and muscles
For hip flexion, the end feel is…
Soft because of contact between the anterior thigh and the abdomen.
Adductor Hiatus
The gap or opening in the distal attachment of the adductor magnus between the linea aspera and the adductor tubercle. It is significant because the femoral artery and vein pass through this opening to reach the posterior surface of the knee, where their name changes to popliteal artery and vein
One and Two Joint Muscles of the Hip
The hip has a group of one-joint muscles that provide most of the control, and it has a group of longer, two-joint muscles that provide the range of motion. Muscles can also be grouped according to their location and somewhat by their function. (ex. the anterior muscles with a vertical line of pull tend to be flexors, lateral muscles tend to be abductors, posterior muscles tend to be extensors, and medial muscles tend to be adductors)
Medial Rotators of the Hip
Muscles that have a more horizontal line of pull and cross the anterior side of the hip
Lateral Rotators of the Hip
Muscles that cross the posterior side of the hip
Several of the hip prime movers are two-joint muscles that also cross…
The knee.
Knee Extensors
Muscles that cross the anterior side of the knee
Knee Extensors
Muscles that cross the posterior side of the knee
Muscle Group: Anterior (muscles of the hip)
One-Joint Muscles: Iliopsoas
Two-Joint Muscles: Rectus Femoris and Sartorius
Muscle Group: Medial (muscles of the hip)
One-Joint Muscles: Pectineus, Adductor Magnus, Adductor Longus, Adductor Brevis
Two-Joint Muscles: Gracilis
Muscle Group: Posterior (muscles of the hip)
One-Joint Muscles: Gluteus Maximus, Deep Rotators (6)
Two-Joint Muscles: Semimembranous, Semitendinosus, Biceps femurs (long head)
Muscle Group: Lateral (muscles of the hip)
One-Joint Muscles: Gluteus medius, Gluteus minimus
Two-Joint Muscles: Tensor Fascia Lata
The iliopsoas muscle is made up of the psoas major and the iliacus
Anterior View (add pic)
Iliopsoas Muscle. (OIAN)
O: Iliac fossa, anterior and lateral surfaces of T12 through L5
I: Lesser Trochanter
A: Hip Flexion
N: Iliac Portion (femoral nerve L2, L3)
Psoas Major Portion: L2 and L3
Rectus Femoris Muscle (OIAN)
O: AIIS
I: Tibial Tuberosity
A: Hip flexion, Knee Extension
N: Femoral Nerve (L2, L3, L4)
Rectus Femoris Muscle
Anterior View (add pic)
Sartorius Muscle (OIAN)
O: ASIS
I: Proximal Medial Aspect of Tibia
A: Combination of hip flexion, abduction, lateral rotation, and knee flexion
N: Femoral Nerve (L2, L3)
Sartorius Muscle
Anterior View (add pic)
Pectineus Muscle
Anterior View (add pic)
Pectineus Muscle (OIAN)
O: Superior ramus of pubis
I: Pectineal line of. femur
A: Hip flexion and adduction
N: Femoral Nerve (L2, L3)
Adductor Longus Muscle (OIAN)
O: Pubis
I: Middle third of the Linea Aspera
A: Hip Adduction
N: Obturator Nerve (L2, L3, L4)
Adductor Brevis Muscle (OIAN)
O: Pubis Pectineal line and proximal linea aspera
A: Hip Adduction
N: Obturator Nerve. (L2, L3)
Three Adductor Muscles
Anterior View (add pic)
Adductor Magnus Muscle (OIAN)
O: Ischium and Pubis
I: Entire linea aspera and adductor
A: Hip Adduction
N: Obturator and Sciatic Nerve (L2, L3, L4)
Gracilis Muscle (OIAN)
O: Pubis
I: Anteromedial Surface of Proximal end of Tibia
A: Hip Adduction
N: Obturator Nerve (L2, L3)
Gracilis Muscle
Anterior View (add pic)
Gluteus Maximus Muscle
O: Posterior Sacrum and Ilium
I: Posterior femur distal to greater trochanter and to iliotibial band
A: Hip extension, hyperextension, Lateral rotation
N: Inferior Gluteal Nerve (L5, S1, S2)
Gluteus Maximus Muscle
Posterior View (add pic)
Deep Rotator Muscles
Anterior (add pic)
Deep Rotator Muscles (Posterior)
add pic
Deep Rotator Muscles (OIAN)
O: Anterior Sacrum, Ishium, Pubis
I: Greater trochanter area
A: Hip Lateral Rotation
N: Numereous
Semimembranosus Muscle
O: Ischial Tuberosity
I: Posterior surface of medial condyle of tibia
A: Hip extension and knee flexion
N: Sciatic Nerve - Tibial Division (L5, S1, S2)
Obturator Externus (Deep Rotator Muscles)
Proximal Attachment: External surface of inferior two-thirds of obturator foramen
Distal Attachment: Trochanteric Fossa
Innervation: Obturator Nerve
Obturator Internus (Deep Rotator Muscles)
Proximal Attachment: Internal surface of most of obturator foramen
Distal Attachment: Medial surface of greater trochanter
Innervation: Nerve to obturator internus
Quadratus Femoris (Deep Rotator Muscles)
Proximal Attachment: Ischial Tuberosity
Distal Attachment: Intertrochanteric Crest
Innervation: Nerve to Quadratus Femoris
Piriformis (Deep Rotator Muscles)
Proximal Attachment: Anterior Sacrum
Distal Attachment: Medial surface of greater trochanter
Innervation: L5, S1, S2
Gamellus Superior (Deep Rotator Muscles)
Proximal Attachment: Ischial Spine
Distal Attachment: Medial surface of greater trochanter
Innervation: Nerve to obturator internus
Gamellus Inferior (Deep Rotator Muscles)
Proximal Attachment: Ischial Tuberosity
Distal Attachment: Medial surface of greater trochanter
Innervation: Nerve to quadrates
Piriformis Stretch Position
A prime mover in hip lateral rotation. However, when the hip is flexed to 90 degrees or more, its line of pull shifts anterior of the hip axis for rotation, causing it to contribute toward medial rotation instead. It is for this reason that the piriformis can be stretched by placing the hip in lateral rotation (while also flexed). The piriformis is the only deep lateral rotator that functions this way.
Hamstring Muscles (Posterior View)
.
Semitendinosus Muscle (OIAN)
O: Ischial Tuberosity
I: Anteromedial surface of proximal tibia
A: Hip extension and knee flexion
N: Sciatic Nerve - Tibial Division (L5, S1, S2)
Biceps Femoris Muscle (OIAN)
O: Long Head: Ischial Tuberosity
Short Head: Lateral lip of Linea Aspera
I: Fibular Head
A: Long Head: Hip extension and knee flexion
Short Head: Knee Flexion
N: Long Head: Sciatic Nerve- Tibial Division (L5, S1, S2)
Short Head: Common Fibular (peroneal) Nerve (L5, S1, S2)
Gluteus Medius Muscle (OIAN)
O: Outer Surface of the Ilium
I: Lateral Surface of the Greater Trochanter
A: Hip Adduction
N: Superior Gluteal Nerve (L4, L5, S1)
Positioning for a Straight Leg Raise
During a straight leg raise in the supine position, the hip flexors move the leg against gravity. For this to occur, the hip flexor origin (pelvis) must be stabilized to prevent a reverse muscle action that would create an anterior pelvic tilt. This stabilization is achieved primarily by: (1) abdominal muscle contraction and (2) bending the opposite hip and knee. Both actions help lock the pelvis in a posterior direction, which helps resist the anterior tilting force exerted by the hip flexor muscles.
Gluteus Medius Muscle (lateral view)
.
Gluteus Minimus Muscle (Lateral View)
.
Gluteus Minimus Muscle (OIAN)
O: Lateral Surface of the Ilium
I: Anterior Surface of the Greater Trochanter
A: Hip abduction, Medial Rotation
N: Superior Gluteal Nerve (L4, L5, S1)
When you stand on one leg, the gluteus medius and minimus muscles contract to keep the…
Pelvis fairly level and to prevent the opposite side of the pelvis from dropping too much (lateral tilt) when you stand on one leg. This occurs every time you pick up one leg, as when walking.
-Weakness or loss of these muscles results in a “Trendelenburg gait.”
Right Hip Abductors (anterior view)
(A) In reverse muscle action, the right hip abductors contract to keep the pelvis steady when the left leg is lifted. (B) When right hip abductors are weak, the left side of the pelvis drops.
Tensor Fascia Lata Muscle (lateral view)
The very long, tendinous portion of this muscle is known as the iliotibial band.
Tensor Fascia Lata Muscle (OIAN)
O: ASIS
I: Lateral Condyle of Tibia
A: Combined Hip Flexion and Abduction
N: Superior Gluteal Nerve (L4, L5, S1)
Anterior Superficial Muscles (right leg)
.
Anterior Deep Muscles (right leg)
.
Medial Muscles (right leg)
.
Congenital Hip Dislocation, or Dysplasia
Occurs when an unusually shallow acetabulum causes the femoral head to slide upward. The joint capsule remains intact, though stretched.
Legg-Calvé-Perthes Disease, or Coxa Plana
A condition in which the femoral head undergoes necrosis. It is usually seen in children between the ages of 5 and 10 years. During the course of the disease, it may take about 2 to 4 years for the head to die, revascularize, and then remodel
Slipped Capital Femoral Epiphysisis
Seen in children during the growth-spurt years. The proximal epiphysis slips from its normal position on the femoral head.
Posterior superficial muscles (right leg)
.
Angle of Inclination
The angle between the shaft and the neck of the femur in the frontal plane. It is normally is 125 degrees. This angle varies from birth to adulthood. At birth, the angle may be as great as 170 degrees, but by adulthood the angle decreases significantly. However, factors such as congenital deformity, trauma, or disease may affect the angle.
Coxa Valga
Characterized by a neck-shaft angle greater than 125 degrees. Because this angle is “straighter,” it tends to make the limb longer, thus placing the hip in an adducted position during weight-bearing.
Coxa Vara
A deformity in which the neck-shaft angle is less than the normal 125 degrees. Because it is “more bent,” it tends to make the involved limb shorter, dropping the pelvis on that side during weight-bearing.
Posterior Deep Muscles (right leg)
.
Posterior Deep Muscles (right leg)
.
Angle of Torsion
The angle between the shaft and the neck of the femur in the transverse plane. which normally has the head and neck rotated outward from the shaft approximately 15 to 25 degrees. Looking down on the femur, you can see the femoral head and neck superimposed on the shaft. The shaft is best shown here by a line through the femoral condyles, which attach to the shaft distally. As the shaft rotates, so do the condyles.
Anteversion
An increase in the angle of torsion which forces the hip joint into a more medially rotated position. This causes a person to walk more “toed in.”
Retroversion
A decrease in the angle of torsion which forces the hip joint into a more laterally rotated position, causing the person to walk more “toed out”
Lateral Muscles (right leg)
.
Osteoarthritis
A degeneration of the articular cartilage of the joint. It may result from trauma or wear and tear and is typically seen later in life. It is commonly treated with a total joint replacement.
Hip Fractures
Tend to be of two types: intertrochanteric and femoral neck. These are very common among elderly people, usually resulting from falls. High-impact trauma such as motor vehicle accidents may cause hip fractures in younger individuals.
Assistive Device Use on Opposite Side
An assistive device, such as a cane, is often used to relieve hip pain and/or compensate for weakness in the hip abductors. While it may seem logical to use the cane on the same side as the painful hip, it should be placed in the opposite hand. A wider base of support is created between the cane and the involved leg. This allows the cane to share in the weight-bearing demand, directly reducing the weight that the involved hip needs to bear.
The upward force from the cane prevents lateral tilt of the pelvis on the non-weight-bearing side, thus reducing the contraction force needed from the hip abductors on the weak/painful side. As a result, the hip abductors do not have to contract as hard and therefore do not produce as much compressive force on the involved hip. Holding the cane in the opposite hand also promotes a normal arm swing during gait.
Iliotibial Band Syndrome
An overuse injury causing lateral knee pain. It is commonly seen in runners and bicyclists. This syndrome is believed to result from repeated friction of the band that slides over the lateral femoral epicondyle during knee motion. It is caused by such factors as muscle tightness, worn-down shoes, and running on uneven surfaces. Because many muscles insert at the greater trochanter, there are many bursae providing a friction-reducing cushion between the muscles and bone.
Trochanteric Bursitis
The result of either acute trauma or overuse. It can be seen in runners or bicyclists or in someone with a leg length discrepancy, or it can be caused by other factors that put repeated stress on the greater trochanter.
Hamstring Strain
Also called pulled hamstring, is probably the most common muscle problem in the body. Unfortunately, it is often recurrent. It may result from an overload of the muscle or trying to move the muscle too fast. Therefore, this is a common injury among sprinters and in sports that require bursts of speed or rapid acceleration, such as soccer, track and field, football, baseball, and rugby. Hamstring strains can occur at one of the attachment sites or at any point along the length of the muscle.
Angle of Inclination Diagram
Angle of inclination is normally about 125 degrees. Coxa valga is an angle greater than 125 degrees, and coxa vara is an angle less than 125 degrees.
Hip Pointer
A misnomer because it occurs at the pelvis, not the hip joint. It is a severe bruise caused by direct trauma to the iliac crest of the pelvis. It is most commonly associated with football but can be seen in almost any contact sport. Spearing the hip/pelvis with a helmet while tackling may be the most common cause.
Angle of Torsion (superior view)
A) Angle of torsion normally has the head and neck rotated outward from the shaft approximately 15 to 25 degrees. An increase in this angle is called anteversion (B), and a decrease in this angle is called retroversion (C).
Combination of Flexion and Abduction (Action of Hip Prime Movers)
Tensor Fascia Lata
Combination of Flexion, Abduction, and Lateral Rotation (Action of Hip Prime Movers)
Sartorius
Flexion (Action of Hip Prime Movers)
Rectus Femoris, Iliopsoas, Pectineus
Extension (Action of Hip Prime Movers)
Gluteus Maximus, Semitendinosus, Semimembranosus, Biceps Femoris (long head)
Hyperextension (Action of Hip Prime Movers)
Gluteus Maximus
Adduction (Action of Hip Prime Movers)
Pectineus, Adductor Longus, Adductor Brevis, Adductor Magnus, Gracilis
Medial Rotation (Action of Hip Prime Movers)
Gluteus Minimus
Lateral Rotation (Action of Hip Prime Movers)
Gluteus Maximus, Deep Rotators
Iliopsoas (Innervation of the Muscle of the Hip)
Psoas Part: Anterior Rami (L1,L2)
Iliacus Part: Femoral (L2, L3)
Rectus Femoris (Innervation of the Muscle of the Hip)
Femoral (L2, L3, L4)
Sartorius (Innervation of the Muscle of the Hip)
Femoral (L2, L3)
Pectineus (Innervation of the Muscle of the Hip)
Femoral (L2, L3)
Gracilis (Innervation of the Muscle of the Hip)
Obturator (L2, L3)
Adductor Longus (Innervation of the Muscle of the Hip)
Obturator (L2, L3, L4)
Adductor Brevis (Innervation of the Muscle of the Hip)
Obturator (L2, L3)
Adductor Magnus (Innervation of the Muscle of the Hip)
Obturator/Sciatic- Tibial Division (L2, L3, L4)
Gluteus Maximus (Innervation of the Muscles of the Hip)
Inferior Gluteal (L5, S1, S2)
Gluteus Medius (Innervation of the Muscles of the Hip)
Superior Gluteal (L4, L5, S1)
Gluteus Minimus (Innervation of the Muscles of the Hip)
Superior Gluteal (L4, L5, S1)
Tensor Fascia Lata (Innervation of the Muscles of the Hip)
Superior Gluteal (L4, L5, S1)
Semitendinosus (Innervation of the Muscles of the Hip)
Sciatic- Tibial Division (L5, S1, S2)
Semimembranosus (Innervation of the Muscles of the Hip)
Sciatic- Tibial Division (L5, S1, S2)
Biceps Femoris, Long Head (Innervation of the Muscles of the Hip)
Sciatic- Tibial Division (L5, S1, S2)
Obturator Externus (Innervation of the Muscles of the Hip)
Obturator (L3, L4)
Obturator Internus (Innervation of the Muscles of the Hip)
Nerve to Obturator Internus (L5, S1)
Gamellus Superior (Innervation of the Muscles of the Hip)
Nerve to Obturator Internus (L5, S1, S2)
Quadratus Femoris (Innervation of the Muscles of the Hip)
Nerve to Quadratus Femoris (L5, S1)
Gamellus Interior (Innervation of the Muscles of the Hip)
Nerve to Quadratus Femoris (L4, L5, S1)
Piriformis (Innervation of the Muscles of the Hip)
Anterior Rami (L5, S1, S2)
How do you determine the leverage?
the muscle’s point of attachment to the bone is used.
With a second-class lever, resistance is…
Between the axis and the force.
With a third-class lever, force is…
In the middle.
What is end feel?
Tthe quality of the feel when applying slight pressure at the end of the joint’s passive range
What is end feel?
Tthe quality of the feel when applying slight pressure at the end of the joint’s passive range
What does a closed kinetic chain require?
That the distal segment is fixed and the proximal segment(s) move.
To stretch a one-joint muscle, it is necessary to…
Put any two-joint muscles on a slack over the joint not crossed by the one-joint muscle.
To contract a two-joint muscle most effectively, start with it being…
Stretched over both joints.
When determining whether a concentric or eccentric contraction is occurring, decide…
- If the activity is accelerating against gravity or slowing down gravity, or
- If a weight greater than the pull of gravity is affecting the activity.
List the bones that make up the Pelvis
Two innominate bones, the sacrum, and the coccyx
List the bones that make up the Innominate
The fused bones of the ilium, ischium, and pubis
List the bones that make up the Hip Joint
Acetabulum of the innominate and head of the femur
List the bones that make up the Acetabulum
x
List the bones that make up the Obturator Foramen
The ilium, ischium, and pubis
List the bones that make up the Greater Sciatic Notch
The ilium and ischium
If you were handed an unattached innominate bone, what landmarks would you use to determine whether it was a right or left bone?
With the greater sciatic notch posterior and the body of the pubis anterior, the acetabulum faces laterally. Therefore, if the acetabular opening is facing to the right in this position, it is a right innominate bone.
How would you determine whether an unattached femur is a right or left one?
With the femur in the vertical position, the linea aspera and lesser trochanter are posterior, and the head faces medially. Therefore, in this position the head of the right femur faces toward the left.
Describe the hip joint: Number of Axis
x
Describe the hip joint: Shape of Joint
Shape of joint: ball and socket
Describe the hip joint: Type of Motion allowed
Type of motion allowed: flexion/extension, abduction/adduction, and rotation
What hip motions occur in: the transverse plane around the vertical axis?
Medial and Lateral Rotation
What hip motions occur in: The sagittal plane around the frontal axis?
Flexion/Extension
What hip motions occur in: The Frontal plane around the Sagittal axis
Abduction/adduction
What is referred to as the Y ligament? Why?
The distal attachment of the iliofemoral ligament; because it splits into two parts, forming an upside-down Y
Regarding the statement “hanging on the Y ligaments”: What position are the hips in relative to the shoulders?
Anterior/ hips are in extension
Regarding the statement “hanging on the Y ligaments”: Where does the line of gravity fall relative to the hip joint axis of rotation?
Posterior
Regarding the statement “hanging on the Y ligaments”: Gravity exerts a force that wants to move the hip into ____________.
Extension
Regarding the statement “hanging on the Y ligaments”: This strategy is most helpful when the hip ____ muscles group is weak.
Extensor
Why is the hip joint not prone to dislocation?
The acetabulum forms a deep socket holding most of the femoral head, and the joint is surrounded by three very strong ligaments.
What is the direction of the line of attachment of the hip ligaments—vertical, horizontal, or spiral? What does this line of attachment allow for?
The line of attachment of the ligaments is a spiral. This arrangement causes the ligaments to become taut as the joint moves into extension and to slacken with flexion, thus limiting hyperextension without impeding flexion.
Which two-joint hip muscles attach below the knee?
The rectus femoris, sartorius, gracilis, semitendinosus, semimembranosus, biceps femoris (long head), and tensor fascia latae muscles
Which hip joint muscles are not prime movers in any single action but are effective in a combination of movements? List the movements.
The sartorius muscle is involved in hip flexion, abduction, and lateral rotation; the tensor fasciae latae muscle is involved in flexion and abduction.
What muscles keep your pelvis from dropping on one side when you lift one foot off the floor? Describe what happens.
When you lift your right foot off the floor, the left hip abductors and right trunk extensors contract to keep the right side of the pelvis from dropping. A force couple exists when the hip abductors are pulling down while the trunk extensors are pulling up.
What muscles keep your pelvis from dropping on one side when you lift one foot off the floor? Describe what happens.
x
Does the femoral head surface glide in the same or opposite direction as the thigh during hip flexion/extension?
Opposite
If hip lateral rotation was limited, the femoral head is restricted from gliding in the _____ direction.
Anterior
What is the end feel of hip flexion? Hip extension?
Hip Flexion: Soft
Hip Extension: Firm
A right-handed tennis player strikes a ball with a forehand swing and follows through. The left hip is moving into what positions?
Hip extension and medial rotation, and maybe some adduction
How is hip flexion affected by sitting on a low surface versus a higher one (e.g., a regular versus a raised toilet seat)?
Greater hip flexion is required with a low surface
What accompanying hip motions or positions may occur if a person has her feet apart, knees together, and hands on her knees, and she pushes down to assist when standing?
Medial rotation and adduction may accompany the increased flexion.
Standing in anatomical position and keeping your pelvis fairly level, shift your weight to your right foot. What hip joint motion has occurred at your right hip?
Adduction
Standing in anatomical position and keeping your pelvis fairly level, shift your weight to your right foot. What muscle group initiates this action?
Right Hip Adductors
Standing in anatomical position and keeping your pelvis fairly level, shift your weight to your right foot. Is this an open- or closed-chain activity?
Closed
While weight-bearing on the left leg, note the motions of your right hip as you swing your right leg in the following activities: Walking
Swing phase includes hip flexion, extension, and hyperextension.
While weight-bearing on the left leg, note the motions of your right hip as you swing your right leg in the following activities: Stepping up onto a curb
Greater hip flexion than walking
While weight-bearing on the left leg, note the motions of your right hip as you swing your right leg in the following activities: Getting into a car
Hip flexion and abduction
While weight-bearing on the left leg, note the motions of your right hip as you swing your right leg in the following activities: Getting on what is commonly called a boy’s bicycle (bar between handlebars and seat)
Combination of hip hyperextension, abduction, flexion, adduction as you swing your leg over the bike, and may also include some rotation
When an assistive device is used as a result of hip pain, which hand should the cane be held in, and why?
Opposite so the cane can bear body weight and help prevent lateral tilt on the non-weight-bearing side
Lie supine on a table with your knees bent and feet flat. Note the position of your pelvis and determine whether you can put your hand on the small of your back. If you cannot, what is the position of your pelvis?
Posterior Tilt
Lie supine on a table with your knees bent and feet flat. Note the position of your pelvis and determine whether you can put your hand on the small of your back. If you can, what is the position of your pelvis and lumbar spine?
Anterior tilt with increased lumbar lordosis
Lie supine on a table with your knees bent and feet flat. slowly slide your feet down the table until your hips and knees are extended. Again, note the position of your pelvis and determine whether you can put your hand on the small of your back. Repeat this again, keeping your right knee and hip flexed with your foot flat while you move your left foot down until your left hip and knee are extended.
What is accomplished at the pelvis by keeping your right hip and knee flexed?
x
Lie supine on a table with your knees bent and feet flat. slowly slide your feet down the table until your hips and knees are extended. Again, note the position of your pelvis and determine whether you can put your hand on the small of your back. Repeat this again, keeping your right knee and hip flexed with your foot flat while you move your left foot down until your left hip and knee are extended.
What can be said about left hip muscle length if you cannot rest your left thigh completely on the table? In other words, why would you not be able to extend your left hip?
x
Lie supine on a table with your knees bent and feet flat. slowly slide your feet down the table until your hips and knees are extended. Again, note the position of your pelvis and determine whether you can put your hand on the small of your back. Repeat this again, keeping your right knee and hip flexed with your foot flat while you move your left foot down until your left hip and knee are extended.
What is the one-joint hip muscle attaching on the pelvis and lumbar spine that may be responsible for this limitation?
Iliopsoas
Lie supine on a table with your knees bent and feet flat. slowly slide your feet down the table until your hips and knees are extended. Again, note the position of your pelvis and determine whether you can put your hand on the small of your back. Repeat this again, keeping your right knee and hip flexed with your foot flat while you move your left foot down until your left hip and knee are extended.
What difference does the position of the pelvis have on anterior hip muscle length?
The anterior hip muscles must be elongated more when the pelvis is in a posterior tilt position versus an anterior tilt position.
Pretend that you cannot completely extend your hip due to tight hip flexors. How might you compensate for this when standing?
You may compensate by standing with the lumbar spine in lordosis and the pelvis in anterior tilt or by leaning forward in a slightly flexed hip position.
You are seated at a table. Stand up while turning to the right. Stop halfway through this motion (before you move your feet). The right hip is in what positions? (1) flexed/extended, (2) abducted/adducted, or (3) medially rotated/laterally rotated
x
You are seated at a table. Stand up while turning to the right. Stop halfway through this motion (before you move your feet). The left hip is in what positions? (1) flexed/extended, (2) abducted/adducted, or (3) medially rotated/laterally rotated
The left hip is extended, abducted, and laterally rotated.
- When a tennis player hits the ball, what type of kinetic chain activity is occurring at the hip? At the shoulder?
Hip: Closed Chain
Shoulder: Open Chain
While lying prone with your right knee flexed, raise your right leg straight up, keeping your pelvis flat on the table. Describe what has occurred in terms of: Hip Joint Motion
Hip Hyperextension
While lying prone with your right knee flexed, raise your right leg straight up, keeping your pelvis flat on the table. Describe what has occurred in terms of: Whether stretching or strengthening is occurring
Strengthening
While lying prone with your right knee flexed, raise your right leg straight up, keeping your pelvis flat on the table. Describe what has occurred in terms of: Muscle(s) involved
Gluteus Maximus
In the position shown in, move your right leg forward until your right knee is directly over your right ankle. Your left hip is hyperextended and your left knee is flexed and resting on the floor. Rock your weight forward onto the front (right) leg without moving your right foot. Describe what has occurred at the left hip in terms of: Joint Motion
x
In the position shown in, move your right leg forward until your right knee is directly over your right ankle. Your left hip is hyperextended and your left knee is flexed and resting on the floor. Rock your weight forward onto the front (right) leg without moving your right foot. Describe what has occurred at the left hip in terms of: Whether Stretching or Strengthening is occurring
x
In the position shown in, move your right leg forward until your right knee is directly over your right ankle. Your left hip is hyperextended and your left knee is flexed and resting on the floor. Rock your weight forward onto the front (right) leg without moving your right foot. Describe what has occurred at the left hip in terms of: Muscle(s) Involved
x
If the position was changed by holding the left knee in more flexion (difficult to achieve comfortably, but pretend), do you think this is a good position in which to stretch the rectus femoris? Why?
x
Lying on your right side with your left hip and knee in extension, raise your left leg toward the ceiling about 2 feet. Describe what has occurred in terms of: Joint Motion
x
Lying on your right side with your left hip and knee in extension, raise your left leg toward the ceiling about 2 feet. Describe what has occurred in terms of: Whether stretching or strengthening is occurring
x
Lying on your right side with your left hip and knee in extension, raise your left leg toward the ceiling about 2 feet. Describe what has occurred in terms of: Muscle(s) Involved
x
Lying on your right side with your left hip in approximately 30 degrees of flexion, raise your left leg toward the ceiling about 2 feet. Describe what has occurred in terms of: Joint Motion
x
Lying on your right side with your left hip in approximately 30 degrees of flexion, raise your left leg toward the ceiling about 2 feet. Describe what has occurred in terms of: Whether stretching or strengthening is occurring
x
Lying on your right side with your left hip in approximately 30 degrees of flexion, raise your left leg toward the ceiling about 2 feet. Describe what has occurred in terms of: Muscles Involved
x
Lie on your back with your hips and knees in extension. Raise your right leg toward the ceiling. Is a concentric or eccentric contraction occurring at the hip?
x
Lie on your back with your hips and knees in extension. Raise your right leg toward the ceiling. The hip flexors are demonstrating what class of lever?
x
Lie on your back with your hips and knees in extension. Raise your right leg toward the ceiling. What force do the hip flexors want to exert at the pelvis?
x
Lie on your back with your hips and knees in extension. Raise your right leg toward the ceiling. What muscle group needs to contract to prevent the motion in (c)? (What force do the hip flexors want to exert at the pelvis?)
x
While lying prone with your left knee flexed, raise your left leg straight up, keeping your pelvis flat on the table. Are the hamstrings contracting at their strongest? Why or why not?
x
Sitting on the floor with your legs far apart, lean forward from the hips while keeping your back straight. Describe what has occurred in terms of: Hip Joint Motion
x
Sitting on the floor with your legs far apart, lean forward from the hips while keeping your back straight. Describe what has occurred in terms of: Whether stretching or strengthening is occurring
x
Sitting on the floor with your legs far apart, lean forward from the hips while keeping your back straight. Describe what has occurred in terms of:
Muscle(s) Involved
x
Shows an individual doing hip flexion exercises two different ways. The starting position in both exercises is hip extension and knee extension. In exercise A, the person flexes the hips with the knees flexed. In exercise B, the person performs the same hip flexion motion but with the knees extended. Which exercise is more difficult? Why? In which exercise is an anterior pelvic tilt more likely to occur, and why?
x
Starting in a supine position with the knees flexed, move into the position shown in figure. What type of kinetic chain activity is this?
x
Starting in a supine position with the knees flexed, move into the position shown in figure. What hip motion is occurring?
x
Starting in a supine position with the knees flexed, move into the position shown in figure: What type of contraction is occurring?
x
Starting in a supine position with the knees flexed, move into the position shown in figure: What hip muscle group is the agonist?
x
Starting in a supine position with the knees flexed, move into the position shown in figure: If this motion could not be completed because a muscle was passively insufficient, what muscle would that be?
x
