Pathological Hip Deviations

Question 1

what are the possible causes / effects of limited hip flexion - IC/LR (stance)

Answer 1

Causes:
- Weak hip flexors
- Purposeful to decrease demand on hip extensors
- Limited hip flexion ROM in TSw

Effect:
- Abnormal LR by limiting knee flexion & ankle plantarflexion to neutral
- Decreased step length

Question 2

what are the possible causes of limited hip flexion - swing

Answer 2

Causes:
- Impaired motor control w/inability to flex hip
- Weak hip flexors
- Hip extensor hypertonicity
- decreased hip flexion ROM (< 40° SLR)
- 2° foot drag (also an effect)
- Hip pain
- Intentional to decrease demand on hip extensors @ LR

Question 3

what are the possible effects of limited hip flexion - swing

Answer 3

Effects:
- decreased step length of ref. limb
- Pelvis may compensate (PPT, circumduction)
- Vaulting or contralateral trunk lean
- Interferes w/ability to clear foot (toe drag), advance thigh and create forward momentum

Question 4

what are the possible causes of increased hip flexion / decreased hip extension

Answer 4

• Flexion contracture
• Anterior IT band contracture
• Flexor spasticity
• Pain (intra-articular pressure)
• Hip joint arthrodesis (surgical arthrodesis or spontaneous ankylosis) – fixed ~20-45°
• Voluntary posturing (pass-retract, steppage)

Question 5

what are the possible effects of increased hip flexion / decreased hip extension

Answer 5

introduces 3 postual errors: forward trunk lean, lumbar spine lordosis, flexed knee

• 15° hip flexion easily compensated in normal lumbar lordosis
• 40° contracture
• Adult: Lack of spinal mobility
• Child: spinal growth absorbs stresses & develops necessary lordosis

Question 6

what are possible causes / effects of increased hip flexion - IC/LR and stance

Answer 6

Causes:
- Hip flexion contracture
- increased DF, knee flexion
- Hip pain
- Lacking heel-off

Effects:
- decreases limb stability
- decreases opposite step length
- Increases energy cost
- increases APT & lordotic curve which may result in LBP

Question 7

what are possible causes / effects of increased hip flexion - swing

Answer 7

Causes:
- increased PF ROM or longer swing limb
- decreased knee flexion
- Purposeful to clear foot

Effects:
- increased energy cost
- helps with limb clearance

Question 8

what is hip: pass retract?

Answer 8

• Technique used due to inability to selectively extend knee while flexing hip during swing –> initial contact.
• Dynamic retraction of tibia/knee joint by soleus & Glut. maximus.
  Intentional to help achieve stable knee in LR.
• decreases step length of reference limb

Question 9

why do some patients walk with a pass-retract pattern?

Answer 9

• Purposeful to decrease demand on quads & hip ext’s @ LR
• Paralyzed quadriceps
• decreased proprioception
• Hamstring hypertonicity

Question 10

what does internal tibial / femoral torsion cause?

Answer 10

toeing in

Question 11

what does external tibial / femoral torsion cause?

Answer 11

toeing out

Question 12

what are possible causes / effects of hip internal rotation for gait?

Answer 12

Causes:
- IR contracture/hypertonicity
- Femoral anteversion
- Intentional to increase knee stability in stance due to quad weakness
- Medial hamstring hypertonicity

Effects:
- increased knee stability
- Results in “toe-in” position –> increases relative length of foot.
- May interfere w/limb clearance
- increased lateral joint stress – lateral aspects of ankle, knee, hip

Question 13

what are possible causes / effects of hip external rotation for gait?

Answer 13

Causes:
WA/SLS/SLA: Femoral Retroversion
WA/SLS:
- ER contracture
- Gluteus maximus hypertonicity
- Purposeful to progress over stance limb when ankle DF is limited

SLA:
- Intentional to substitute for weak hip flexors
- Intentional to functionally shorten limb

Effects:
- “toe-out” position which increases BOS & decreases forefoot lever
- increased medial joint stress
- May help w/limb clearance

Question 14

what muscles are involved with an ER contracture for hip external rotation?

Answer 14

piriformis, obturator externus, obturator internus, superior and inferior gemellus, and quadratus femoris

Question 15

what are possible causes / effects of hip aDduction rotation for gait?

Answer 15

Causes:
- adductor hypertonicity or contracture
- gluteus medius weakness

Effects:
- decreased BOS
- decreased limb stability
- causes scissoring in swing
- may increase relative limb length and interfere w/ clearance

Question 16

what are possible causes / effects of hip aBduction rotation for gait?

Answer 16

Causes:
- Abductor contracture
- Abductor weakness (stance)
- Adductor Contracture (reference
- Compensation to clear leg
- Reference limb functionally longer

Effects:
- increased BOS
- decreases relative leg length
- 2° effect –> pelvic drop

Question 17

What are the mass (Primitive patterns affect lower limb control) flexion patterns to influence the knee & hip?

Answer 17

(flexion synergy): activation of hip flexors, knee flexors and ankle dorsiflexors

Question 18

What are the mass (Primitive patterns affect lower limb control) extension patterns to influence the knee & hip?

Answer 18

(extension synergy): activation of hip extensor (gluteus maximus), knee extensor (quadriceps), ankle plantar flexors (soleus)