Hip

Question 1

Things that add to the overall stability of the hip joint are the structures of the (active/passive) subsystem.

Answer 1

passive

Question 2

The hip capsule is reinforced by the iliofemoral, pubofemoral, and the ischiofemoral ligaments. All three of these ligaments are partially taught in full hip (flexion/extension).

Answer 2

extension

Question 3

Because of how strong the iliofemoral ligament tendon is, it is a very important stabilizing force. It runs from the AIIS to the intertrochanteric line. The passive tension that is formed by this ligament is an important stabilizing force that resists further hip (flexion/extension) of the pelvis on the femur.

Answer 3

extension

Question 4

Out of the iliofemoral, pubofemoral, and ischiofemoral ligament, the iliofemoral ligament is the (strongest/weakest) ligament.

Answer 4

strongest

Question 5

The pubofemoral ligament will resist (abduction/adduction) of the hip and also assists in limiting (flexion/extension) of the hip.

Answer 5

abduction; extension

Question 6

The ischiofemoral ligament is going to be posterior to the femoral head so it has a role in reinforcing the posterior capsule and preventing the femoral head from being pushed out posteriorly. It passes anterior, superior, and laterally as it spirals around the neck of the femur. It then attaches to the upper aspect of the intertrochanteric line. The motion this ligament primarily resists is hip (internal/external) rotation.

Answer 6

internal

Question 7

The closed pack position is simply (flexing/extending) the hip, (adducting/abducting) it, and (internally/externally) rotating it. This puts the iliofemoral ligament, pubofemoral ligament, and the ischiofemoral ligament under the most amount of tension (these are the motions they resist). The ligaments are so strong and taught that it is actually in its’ closed pack position when the ligaments are taught and then bony congruency isn’t max.

Answer 7

extending; abducting; internally

Question 8

The loose packed position is where the femoral head is under the most congruency, but the ligaments are the loosest. This position occurs at 90 degrees of (flexion/extension), moderate (adduction/abduction), and (internal/external) rotation. In this loose pack position all the ligaments are unraveled and are on slack.

Answer 8

flexion; adduction; external

Question 9

Let’s say I thought someone’s arthrokinematics of their hip were off and I wanted to do something like a lateral glide with a belt to improve accessory motion. So I wanted to do like a joint mobilization on them. What position, do you think I would be putting that patient in in order to do a joint mobilization on somebody who I thought had lessened arthrokinematics of their hip? I wouldn’t put them in a (loose/closed) pack position and then try to mobilize their hip. I would put them in a (loose/closed)-packed position to have the highest capability of getting the most optimal mobility of the joint.

Answer 9

closed; loose

Question 10

So, in a frontal plane view we have something called the angle of inclination. It’s the femoral head and it’s angle of inclination is its relative position to the shaft of the femur. The angle between the neck and the long axis of the shaft is normally 125 degrees. At birth we have 140 to 150 degrees. The primary forces that we experience throughout our life or as a child that are responsible for moving that angle of inclination from 140 to 125 is body ___ in general. So the body weight compression from above and the GRF from below will have its ability to kind of change the morphology of the joint. So people who have developmental delays that could be a big issue. They could end up with an orthopedic or bony issue because they didn’t walk on time, or they have something that prevents them from walking at all.

Answer 10

weight

Question 11

Coxa valga is the term for a hip with an (increased/decreased) angle of inclination (above 125 degrees). The distal portion is further (towards/away) from the midline of the body and that creates the increased angle.

Answer 11

increased; away

Question 12

Coxa vara is the term for a hip with a (increased/decreased) angle of inclination (less than 125 degrees). The distal portion is (closer/further away) to the midline of the body and that creates the decreased angle.

Answer 12

decreased; closer

Question 13

If we were looking in this situation, and you are thinking about a hip abductor muscle that went from the greater trochanter up to your pelvis.. You are standing on one leg. Between coxa valga and coxa vara, which one would have an increased amount of internal torque? Coxa (valga/vara) because as the weight shift is further away from the moment arm, you would have an increased torque through your muscle in order to compensate for that.

Answer 13

vara

Question 14

The angle of torsion is the angle between the axis of the femoral neck and the femoral condyles. It is rotation in the (sagittal/transverse) plane.

Answer 14

transverse

Question 15

The angle of torsion is normally 15 degrees of anteversion and we are born with about 30 degrees. Most likely as we start to develop and crawl and then sit and then walk our anteversion changes. So if you take a model of the femur and you lay it flat on the table, if the condyles are flat on the table the femoral head should be 15 degrees off of the table rotated (anteriorly/posteriorly).

Answer 15

anteriorly

Question 16

So if we have abnormal torsion we can end up with excessive anteversion over, where you can be up as high as 35 degrees, or you can have retro version, where we have a much lower number. Both retroversion and anteversion are going to alter the mechanics of the LE. If you look at the major weight bearing portions of the hip you can kind of see how they’re slightly off of optimal.

Answer 16

Got it

Question 17

The acetabulum is going to face (medial/lateral) with varying amounts of anterior and inferior tilt.

Answer 17

lateral

Question 18

The center-edge angle (angle of wyberg) is the center of the femoral head and we draw a perpendicular line straight in the air and it goes to the edge of the acetabulum. This measures how well the acetabulum surrounds the femoral head in the frontal plane. So optimally we want about 35 degrees and in this frontal plane, we see how far or how well the acetabulum provides coverage to the femoral head. If we had an angle that was smaller than this you would have (more/less) coverage of the femoral head. Overall, the acetabulum provides a protective shelf over the top of the femur and so, if you have this 35 degree angle, we can assume that you have a good amount of coverage, a good amount of containment.

Answer 18

less

Question 19

If the center-edge angle is off you are (increasing/decreasing) stability. Less containment of the head equals (more/less) joint stability.

Answer 19

decreasing; less

Question 20

Because the acetabulum faces a little anterior, the posterior part of the hip joint has more coverage than the anterior part of the hip joint. The normal amount of acetabular anteversion angle is about 20 degrees. And so, that means that the anterior aspect of the femur or the femoral head is exposed to the capsule and the iliopsoas tendon. So we have some soft tissue that is present in front of the hip joint in this area, which provides stability to the hip normally. If you’re taking this angle from the posterior edge of the acetabulum to the front of acetabulum and it is bigger than 20 degrees more of the femur is exposed and not covered anteriorly. So now there is going to be more need for the passive and active subsystem structures to provide anterior stability. So overall, when these angles are off there’s (more/less) joint stability.

Answer 20

less

Question 21

The iliopsoas and the rectus femoris are hip (flexors/extensors).

Answer 21

flexors

Question 22

The sartorius muscle has the ability to (flex/extend) the hip.

Answer 22

flex

Question 23

Let’s say somebody comes to your clinic and they’re having a lot of pain in their sartorius tendon and they are a runner. So you are looking at this person and trying to figure out why do you have so much pain in your sartorius muscle. Could it possibly be because they are not utilizing other muscle groups which should be the primary hip flexors? Running is a lot of hip flexion over and over and over again. So the sartorius might have pain in it, but it might not be the problem right, you might have to adjust form, you might have to get them more activated through other muscles and then by that process, the sartorius will start working (more/less) and start being (more/less) worked and overused and uncomfortable and painful. We want our most efficient muscles doing our tasks for us.

Answer 23

less; less

Question 24

The gluteus maximus is a major hip (flexor/extensor). Other muscles that can help in hip extension are the long head of the biceps femoris, the semitendinosus, and the semimembranosus.

Answer 24

extensor

Question 25

The gluteus medius is a (primary/secondary) hip abductor and the minimus is a (primary/secondary) hip abductor. The TFL is a (massive/minimal) hip abductor.

Answer 25

primary; secondary; minimal

Question 26

Sometimes the TFL is very painful because we rely on the TFL which is a small muscle to do a big muscles job. Same kind of concept as the sartorius in hip flexion.

Answer 26

Got it

Question 27

The adductor magnus, longus, brevis, and gracilis (adduct/abduct) the hip.

Answer 27

adduct

Question 28

The gluteus maximus is the (primary/secondary) hip lateral rotator. The piriformis, the rest of the deep rotators, and the sartorius, are (primary/secondary) hip lateral rotators.

Answer 28

primary; secondary

Question 29

There are no primary (medial/lateral) rotators of the hip, but we have some muscles that kind of secondarily assist internal rotation of the hip. The anterior fibers of the gluteus medius and minimus, the TFL, the adductor longus and brevis, pectineus, semitendinosus, and semimembranosus are all examples of muscles that secondarily assist in internal rotation of the hip.

Answer 29

medial

Question 30

Most of the time, all of these muscles that contribute to hip motion kind of operate in co contraction in order to (mobilize/stabilize) the hip joint during functional activities which usually require high levels of forces. It’s usually more complicated than just breaking it down into individual movements and osteokinematic motions. A lot of things are going on at the same time, usually.

Answer 30

stabilize

Question 31

Right foot is in front, left foot is behind and you drop down into a lunge: (right/left) hip (flexors/extensors) are working (concentrically/eccentrically) to lower the individual to the ground.
Your hamstrings are working right your hip abductors are also working because they have to stabilize the trunk they have to make sure that, as you lower down into a lunge position that the trunk doesn’t drop in the pelvis doesn’t drop in one direction so actually the right hip abductor is turned on, the left hip abductor is probably turned on as well to control the pelvis on that side. Your core muscles are turned on in order to keep this positioning your hip abductors are also turned on to keep your knee from drifting towards midline right

Answer 31

right; extensors; eccentrically

Question 32

As an individual is sprinting towards the soccer ball to make a save. What hip muscle, would you say is preventing her from falling forward? So the person is sprinting up to the ball and then slowing down to decelerate. What hip muscle is preventing this momentum from going forward and falling down? As she sprints forwards and then decelerates the (rectus femoris/hamstring) muscle (hip flexors and knee extensors) would be activated and turned on to keep her momentum from going forward. The gluteus maximus would be working to keep the individual from falling over and it will be working (concentrically/eccentrically). The hip (adductor/abductor) would also probably be turned on to prevent the individual’s knee from going inward.

Answer 32

rectus femoris; eccentrically; abductor

Question 33

Hip (flexion/extension) in the sagittal plane during bilateral stance is the moment that is created and the main tissue that restricts that motion is the iliofemoral ligament which prevents you from falling into hip extension.

Answer 33

extension

Question 34

In the sagittal plane, (very little/ a lot of) muscular energy is required to keep you in quiet standing.

Answer 34

very little

Question 35

In this frontal plane on both legs, the moment overall would be a potential for a hip (adduction/abduction) torque. The pelvis would fall towards the line of gravity creating an overall adduction torque. However, because we have equally spaced feet and each one counteracts each other it ends up being very balanced. So the ground reaction force between both legs, is what offsets that adduction torque. There’s no muscle energy needed if you’re standing still in a centered position in quiet standing.

Answer 35

adduction

Question 36

If we were to have a flexion contracture of the hip meaning, you were never able to get to fully neutral here, the femur stays flexed relative to the pelvis. So the line of gravity moves anterior to the axis of rotation, the proximal segment falls towards the line of gravity and now there is a hip (flexion/extension) moment that is created in this aspect. If there is a hip flexion moment, the hip (flexors/extensors) have to turn on and have to work with a counterclockwise torque keep the individual upright. This is going to create an increased metabolic cost of standing because increased muscle activity is needed.

Answer 36

flexion; extensors

Question 37

In a person with a hip flexion contracture there will be a (dorsiflexion/plantarflexion) moment so the (dorsi flexors/plantar flexors) have to work a lot harder.

Answer 37

dorsiflexion; plantar flexors

Question 38

When you stand on your right foot, you would feel that you have to kind of shift over that right foot, so you have to take your center of mass and move it to the (right/left), in order for it to line up with your base of support. The amount that you have to do this is kind of individual right some people it’ll go further other people it won’t go as far but it always happens there’s some little shift over your base of support.

Answer 38

right

Question 39

In a unilateral stance the line of gravity is still posterior to the hip like it normally would be, and it is now just medial to the foot. An (adduction/abduction) (a clockwise torque that is being performed on the axis of rotation on the hip) moment of the hip is created in this position by gravity. The hip (adductors/abductors) will resist the adduction moment and this is by far the most functional way that our hip abductors work. We hardly ever in real life stand up and take our leg and swing it out to the air, it hardly ever works open chain. It’s always in this closed chain position where that is working in order to stabilize and level out your pelvis.

Answer 39

adduction; abductors

Question 40

The hip abductor moment arm is half the size of the external force of gravity. Let’s just say it’s half the size of the external force of gravity. So the hip abductors internal force has to be (half/twice) as big, which creates a larger, but equal JRF. The take home point here is because of situations like this where we’re on one leg a lot, even with walking, that hip joint is going to experience a lot of joint reaction forces because of all of the activation that goes on across the joint.

Answer 40

twice

Question 41

If the left hip abductor is not functioning, as an individual is walking, the Trendelenberg sign is where the pelvis drops to the (weight/non weight) bearing side. The reason why it’s going to drop to this side is because the hip abductor is not performing its duty and providing a stabilization effect to the pelvis. It’s allowing that pelvis to drop to the non weight bearing side. That is the Trendelenberg sign. So the hip abductor is not performing its job and because of that, the Center of mass is now dropping the pelvis into this (adduction/abduction) torque. And so now the hip is falling into adduction, because the abductor on the left side is not working.

Answer 41

non weight; adduction

Question 42

So there is something called a compensated Trendelenberg. It is a compensatory motion and it is where a person may walk and as they land on the left side (side with the abductor that is not working) you’ll see their shoulder go to the (right/left). They’ll stand on their left side and their shoulder will go to the left every time they stand on that left leg. If you put the LOG through the AOR then there is no torque generated. So if this individual leans far enough to the left and their Center of mass goes far enough over that way there is going to be less external torque because it is going to try and get the COM through the AOR. So as you are walking, the individual is leaning their upper body towards the side of (strength/weakness).

Answer 42

left; weakness

Question 43

In Compensated Trendelenberg, they know they have a hip abductor which is weaker, so they shift their weight over to that side, so that their hip abductor can function a little bit more normally or not have to function at all if there’s no torque generated.

Answer 43

Got it

Question 44

Having a cane in the (same/opposite) hand is really the hand that is needed to provide the balance by taking pressure off of the hip abductor to reduce the external load that is felt by the hip abductors.

Answer 44

opposite

Question 45

Hip flexion with the knee extended has a much (larger/smaller) normal range of motion than with the knee flexed because your hip extensors would be taught because they cross the hip and the knee, so by flexing the knee you’re putting them more on slack so that you can FLEX your hip more. So if you put your leg out straight and you lift it up in the air pretty soon you’re going to feel a big hamstring pull. The hamstrings are a hip extensor so if you are flexing your hip and your knee is extended those hip extensors (the hamstrings) are already elongated at the knee level. So now they’re not able to move through the full range, so your leg can’t move as high. If you FLEX your knee now they are loosened, they’re on slack a little bit so now you’re able to move your knee to your chest a little bit more.

Answer 45

smaller

Question 46

During flexion and extension of the hip the arthrokinematics are a (roll and slide/spin).

Answer 46

spin

Question 47

There’s a very little amount of hip (flexion/extension) available at the ball and socket joint – 10 degrees. So a lot of times when you see people doing rehab exercises and they’re swinging their leg way back behind them way past 10 degrees, the idea would be that they’re getting that movement from somewhere else, not the hip joint so you are no longer doing a glute Max exercise you’re doing a lumbar extension exercise right because you’re making the pelvis tilt anteriorly. And so, those are all the compensations that as a therapist you’re going to have to look for.

Answer 47

extension

Question 48

As you go into hip extension and the femur extends backwards, you’re going to reach the anatomic limit because of all that taught tissue anteriorly. If this person keeps extending their hip they keep moving their leg backwards, an (anterior/posterior) pelvic tilt will occur. So we know that hip motions can also affect lumbar spine motions through the pelvis tilting anteriorly or posteriorly.

Answer 48

anterior

Question 49

As you go into hip flexion there is going to be a pelvic substitution into (anterior/posterior) pelvic tilting.

Answer 49

posterior

Question 50

As we abduct the hip, the (ischiofemoral/pubofemoral) ligament comes under tension and the (abductor/adductor) and (quadriceps/hamstring) muscles are also under tension.

Answer 50

pubofemoral; adductor; hamstring

Question 51

As we adduct the hip and you bring your leg across your body, the (same/opposite) leg plays a role in limiting further movement into adduction. So for example, your right leg can only adduct so far until it runs into your left leg. Other structures that limit adduction are the (adductors/abductors), your IT band, and the superior fibers of the (pubofemoral/ischiofemoral) ligament.

Answer 51

opposite; abductors; ischiofemoral

Question 52

External rotation of the hip is limited by the tensor fasciae lata, the IT band, and the lateral portion of the (pubofemoral/iliofemoral) ligament.

Answer 52

iliofemoral

Question 53

Internal rotation of the hip is limited by your (internal/external) rotators and parts of the (pubofemoral/ischiofemoral) ligament.

Answer 53

external; ischiofemoral

Question 54

Hip flexion (is/ is not) equal to anterior pelvic tilting.

Answer 54

is not

Question 55

In the sagittal plane, anterior rotation of the pelvis on the femur becomes hip (flexion/extension). So think of bringing your trunk to your knee.

Answer 55

flexion

Question 56

In the transverse plane, anterior rotation of the pelvis on the femur becomes (internal/external) rotation on the stance side. So if I step forward with my left leg my right hip will be in internal rotation.

Answer 56

internal

Question 57

During lateral tilts of the pelvis on the weightbearing femur, the iliac crest on the nonweight bearing side elevates causing hip (adduction/abduction) on the weight bearing side. As the iliac crest on the nonweight bearing side lowers, the hip will be in hip (adduction/abduction).

Answer 57

abduction; adduction

Question 58

In coxa valga you are going to have a (increased/decreased) hip abductor moment arm. The distance is now smaller than it would have been before and you are going to have (increased/decreased) joint reaction forces and (increased/decreased) risk of degenerative joint disease. It is also possible to have a superior dislocation. It’s just slowly over time, going to like wear and kind of ride a little high in the hip. Those are implications for coxa valga.

Answer 58

decreased; increased; increased

Question 59

When it comes to coxa vara you’re going to have an (increased/decreased) bending moment on the femoral neck. The load is coming straight and it’s going to create a bend moment through the femoral neck. You have an (increased/decreased) hip abduction moment arm because of this distance, however, because you have this increased pull medially you can still have DJD occur because the pull is directly into the hip from that hip abductor so the joint may also suffer in this condition.

Answer 59

increased; increased

Question 60

Sometimes, when you have excessive anteversion as an individual, it’s almost as if your body recognizes the fact that things aren’t in alignment and then what the body does to compensate, is rotate the entire lower leg to make the femur sit more naturally within the acetabulum. So in this situation if someone were to have excessive anteversion one thing you might see is in-toeing. You sense that there is a lack of anterior joint stability up here and so, then the person’s natural compensation is to take their whole foot and turn it (in/out) so that you get more centered congruency of the joint. Excessive anteversion is associated with congenital dislocation. Sometimes, when you have these issues you do increase that idea of wear and tear. You may visualize someone with an interesting gait pattern, this could be a reason why it could be happening at any level of that joint on the way down, but if you see someone who’s in-toeing one of the possible reasons is this hip excessive anteversion.

Answer 60

in

Question 61

If you were in excessive anteversion (internal rotation) for a long time the hip (internal/external) rotators would be stretched out and over worked.

Answer 61

external

Question 62

In retroversion, to be in proper alignment the foot would (internally/externally) rotate in order to keep your hip properly aligned.

Answer 62

externally