lecture 5: hip lecture Flashcards
what is the order of progression
mobility , control and load
what do u need before strengthening
stability
what are the 2 waves to produce stability
static and dynamic
what is the neuromuscular control
body’s ability ri react and control movement
what is the goal for neuromuscular control
goal is to provide dynamic stability
the goal for neuromuscular control is to provide dynamical stability … to do this you need good ___ and ___
proprioception and
kinesthesia
if a pt doesn’t have good neuromuscular control they body will take the ….
path of least resistance
when restoring and building isolated strength and the integrating it into ____ and ___ training then leads to big results in impact from recovery vs.. ____ in isolations the focus is more towards ___ and ____
stability and functional
strengthening , hypertrophy and aaesthetics
how is the acetabulum oriented ?
anteriorly , laterally and inferiorly
how is the femur oriented
anteriorly , medially and superiorly
what is the frontal plane: angle of inclination
normal
coxa vara
coxa valga
Normal: 125°
Coxa Vara: <110°
Coxa Valga: >140°
in the hip the strong articular spatula is reinforced by what 3 ligaments
iliofemoral , pubofemoral and ischiofemoral ligaments
the acetabular labrum
___ ____ acetablum
___ absorber , joint ____ and pressure distributor
adds a partial vacuum that adds abtliity
depends concave
shock and lubricator
what is the most congruent positions of the hip
flex/abd/ ER
what is hip flexion and what is hip flexion w knee extedned
120°
90° if knee extended n (limited in hamstrings)
what is hip extension
10-30° and less with knee flexion (RF and TFL)
what is hip abduction adn adduction and what is limited
Abduction = 45-50°; limited by gracilis
Adduction = 20-30°; limited by TFL & ITB
what is the hip ROM for IR and ER
42-50° in 90° flexion
what is the closed pack positon of the hip
extension with some abduction and IR
what is the loose packed position for hip ROM
flexion / abduction . ER ( hooklying)
30°-30°-30°
what fucntional ROM is needed for gait in the hip
30° flexion, 10° ext, 5° of abd/add & MR/LR
how much average ROM is needed from shoe tying , sitting ,stooping and squatting
shoe tying: 120° flex
sitting : 112° flex
stooping: 125° flex
squatting : 115° , 20° and 20° IR
what is hip ORM needed for ascending stairs , descending stairs
ascending stairs: 67°
descending stairs: 36°
putting foot on opposite thigh: 120° , 20° abd 20° ER
putting on pants : 90° flex
during closed chain motions what kind of pelvic tilt does hip flexion casue?
anterior pelvic tilt
during closed chain motions what kind of pelvic tilt does hip extension casue?
posterior pelvic tilt
in closed chain , lateral pelvic tilt produces ___ or ___
abd or add
in a closed chain position if the opposite side of pelvis hikes then the stance hip is in ___
abduction
in a closed chain positon if the opposite side of pelvic DROPS , then the stance hips ___
adduct
lateral pelvic shift in bilateral stance , ____ on shift side ___ on opposite
adduction and abduction
anteiror (foward) pelvic rotation produces ____ ____ of the stance hip
medial rotation
posterior rotation produces hip ___ rotation
lateral
for the hip joint in stance the line of gravity creates an ___ ____ counterbalance by ligaments/iliopasa tension
extensor movement
what is the hip flexors fucntion in open chain and closed chain
open chain- leg swing in gait
closed chain: control WB ext forces
what is the fucntion of the TFL
flex , abd and IR hip rotation
what are teh secondary hip flexors
pectineus , add longus , add magnus , gracilis
adductors can flex the hip from an ___ position
extended
what is the function of the sartorius
flex , abd , LR of hip
FLex/ IR of knee
what is the fucntion of the hip adductors
stabilizes hip in standing , can help flex hip from extension and extend from flexed positon
what is the 5 mm for hip adductors
pectineus
adductor brevis
adductor longus
adductor magnus
gracilis
what are secondary movers of the hip adductors
Biceps femoris long head, glute max, quadratus
femoris, obturator externus
what are the 2 mm for hip extensors
glute max and hamstrings
what is hip extension assisted by what 3 mms
post glut med
add magnus
piriformis
what are the 3 mm that do hip abductors
glute medius
glute minimus
TFL
what is the hip abductors assisted by ? (3 mm)
piriformis
sartorius
RF
what do the anterior and posterior fibers of the glute medius do
ant fibers MR and post fibers LR
what are the 5 hip lateral rotators
Glute Max
Obturator internus & externus
Gemellus superior and inferior
Quadratus femoris
Piriformis
when does the piriformis do IR of the hip
when it is flexed > 90°
what 3 mm is the hip ER assisted by
Post glut med & min
Sartorius
Biceps femoris long head
what mm are for hip IR
no primary one
Ant gluteus medius
Ant gluteus minimus
TFL
Adductors
what mm length test can u do to test abdominal length
prone press up
what test can be used to test the length of the iliopsoas , TFL and RF
modified thomas test
what is the 3 things that can cause pain for resistive testing
bursa
tendon
peritendon
when will they have bursa pain and how do u treat it
pain w compression
dont treat w compression o r manual
when will they have tendon pain and how do u treat it
w contraction or pull
treat w isometric then isotonic
when will they have peritendon pain and how do u treat it
pain w stretching of tendon
treat w cross friction massage
how do u mm strength the postieor glute medius and glute min and glute max
Posterior glut medius (PGM) –sidelying abd
with extension, LR
Glut min – sidelying abd with extension
Glut max – prone hip ext with knee flex
if the TFL is dominant what is weak
iliopsoas
if the hip adductors are dominant what is week
hip abductors
if the hamstrings as hip extensors are the dominant mm waht is the weak mm
glute max
if the hamstrings are dominant as knee extensors in closed chain what mm is weake
quads
if the biceps femoris is strong in ER what is mm is weak
piriformis and ER’s
what are the top 3 knee issues that hip mm weakness is linked too
Patellofemoral dysfunction
ACL injury
ITB syndrome (at hip and knee)
if you are doing a hip tendon palpation on the R hip with the patient sidelying what mm is at
12 o’clock
1 o’clock
6 o’clock
7-8 o’clock
10 o’clock
11 o’clock
12 o’clock: glute med and bursa
1 o’clock: glute min and bursa
6 o’clock: glute max
7-8 o’clock: quad fem
10 o’clock: gemelli and oburator internus
11 o’clock: piriformis
if you are doing a hip tendon palpation on the L hip with the patient sidelying what mm is at
12 o’clock
1 o clock
2 oclock
4-5 o’clock
6 o’clock
11 o’clock
12 o’clock: glute med and bursa
1 o’clock: piriformis
2o’clock: gemelli and oburator internus
4-5 o’clock: quadratus femoris
6 o’clock: glute max
11 o’clock: glute min and bursa
what is the difference between acetabular dysplasia and profunda
dysplasia is a shallow socket
profunda is a deep socket
what is the different of PAILS (progressive angular isometric loading) and RAILS (regressive angular isometric loading)
pails: isometric contraction of the mm in a lengthen positioned (
rails: isometric contraction of the tissue in a shortened position
what is the benefits to PAILS/RAILS
- bypass the stretch reflex
-creates cortical mapping - increase neural drive to the tissue
- casues a cellular adapatation in the tissue
- increased blood flow to both the PAILS and RAILS tissue
describe the PAILS/RAILS performance
1/ stretch for 1-2 mins
2. being to irradiate by slowing tensing ur mms
3. being PAILS ( SLOWLT begin to produce force with the tissue you are stretching ISOMETRICALLY and work up from 20% effect to 100%
4. hold this max effect of isometric for 10-15 secs
5. being RAILS by immediately reversing and maximally engaging the tissue that pulls you deeper into the stretch
6. hold for 5-10 secs
7. slowly relax but stay int his stretch or new range of motion
8. slow ur breathing
how do u really isolated the glute max for hip extension
abd hit 30° and bend the knee
how to test the deep rotators of the hip
side lye and just abduct and ER no hip extension
if you are performing a single knee to chest and u see your pt’s knee go out and foot go in what mm are they using
sartorius
if you are having ur pt do single knee to chest and you notice their foot going in what is happening
tibia IR and u want the foot to be neutral to just focus on iliopsoas
when does hip IR occur
when extending toward 0° from a flexed positon
flexed 60-100°
hip ___ ___ drives force into the ground
internal rotation
what happened at teh sacrum during hip IR in open cain
sacral nutation( flexion)
posterior rotation of innominates
how much flex, IR and abd does squatting refrigerate
115* of flex
20° of IR
20° of abd
what are the CPG for hip pain with mobility deficits (OA)
- pain is indiosus onset
- mornign stiffness less then 1 hour
- hip IR ROM less than 24° (highlighted in slide)
- IR and hip flexion 15° less than other side
hip OA CPR
- self reported squatting aggravates symptoms
- active hip flexion causes a later hip pain (highlighted in slide)
- the scour test with adduction causes lateral hip or groin pain
-active hip extension causes pain - passive internal rotation is less than or equal a to 25°
according to the CPG recommended interventions for hip OA what is considered level A evidence
working on flexibiltiy , strenghengin and endurance exercise is
manual therapy
what FAI is related to the femorla head/neck morphology?
cam pingment
the cam impingment is seen often in patients with history of what
SCFE or legg calve or present with femorla head anteversion or coxa cara
is cam impingment more common in men or females
men
what is the pincer impingement related to
acetabular morphology
what else is pincer impingment associated with
acetabular retroversion, coxa profunda,
acetabular protrusions
who is th epincer impingment more common in
middle ages , active women
what may make us think a pt has a FAI
Moderate+ hip or groin pain
Stiffness
Decreased ROM
Click/catching
Giving way
during ur examination what may we deiscorver of we think the pt has an FAI
Passive hip MR- painful and limited
Passive hip flexion-painful and limited
Trendelenburg gait or abductor lurch
what are the 6 functions of the labrum
- deepends the socket
- decreases forces
- negative intra articular pressure
- may okay a role in proprioception
- may be. a potential source of pian
labral tears may be a precursor to hip ___
OA
what traumatic mechanism could causes a acetabular labral teat
rapid twisting
pivoting
falling
forceful rotation with hip hyperextended
labral tears increase with ___
AGE
what are s/s for labral tears
Complain of anterior hip or groin pain.
Clicking/locking/popping
Giving way
Catching Stiffness
Dull ache with running/stairs
Limited ability with sitting, twisting, walking, stairs
May have audible pop
what are 4 special test for assessing for labral involvement
- fadir
- quadrant
- scour test
- fitzgeralds
what are the related factors for structural instability
shallow acetabulum )dysplasia
excessive femoral anteversion
inferior acetabulum insufficiency
neck shaft angle > 140° (coxa valga)
____ ____ may play a role in stabilization, resist subluxation forces,
especially with hip in ER/flexion and IR/extension
ligamentum teres
what hip path are we thinking if the kid is between 4-8 , shorter and there is a deformity of the femorla head
Legg-Calve-Perthes
Disease (LCPD
what may ur examination tell u if a patient has Legg-Calve-Perthes Disease (LCPD
- decreased hip IR and abduction
- trendelenburg sign
- may have tenderness to palpat
- affected leg may be short
- may have anterior tight atrophy
for slipped capital femoral epiphysis
they are usually between ___ ___ y/o
child tends to be ___
displacement of the femorla ____
usually treated with waht
10-15
over weight
neck
sx - internal fixation
if a patient has SCFE what may be found during ur exMinaiton
Decreased hip MR, abduction, and flexion
LE goes into LR with passive hip flexion
May have hip tenderness to palpation
if there is too much movemtn what is the intervention
stabilize (motor control)
if there is not enough movemtn what is the intervention
mobs , manipulation , stretches
what should u ALWAYS include during ur interventions to patients
EDUCATION
what takes linger to heal ?
THA
labral repair
microfracture
hardware .. plate or nail
plate
what is the posterior hip precautions after a THA
- no hip flexion > 90°
- no hip IR
- no adduction
what is the anterior hip precautions after a THA
- no hip extension or hip ER
- no birding. no prone lying
for a hip labral repair what are things u shoudl avoid in the first month (0-4 weeks)
- active hip flexion
- ER past 20°
- ROM outside of 0-90°
- walking w more or less than 20 lbs of pressure
- tip top or tow touch WB (should be flat foot WB)
- hip extension past 0°
- hip abduction pst 20°
when can u full WB after a hip microfracture
8 weeks
