PT3 - Hip In Locomotion Flashcards
What are the functions of the hip during locomotion?
- stability for weight baring in single leg
- stability + ROM to transmit and increase forces from spine and pelvis to lower limb
- stability + ROM to dissipate + transmit forces from ground contact to spine
What is the trendelenberg test?
- hip on contralateral side drops when one leg is lifted
- glute medius/minimus/tfl and trunk on contralateral side not strong enough to hold side up
What is reverse trendelenberg?
- contralateral hip hike
- might see a trunk lean to opposite side during gait
- seen in OA => lean towards painful hip to avoid trendellenberg in hip that’s not very comfortable
Where does force initiation of the hip movement come from?
- trunk and spine
- step forwards with right leg results in contralateral side rotation towards hip and thigh
What happens to the pelvis and hip as the trunk accelerates?
- pelvis and hip lengthen out
What happens when the pace of walking slows down?
- trunk and pelvis go together
Which age group do you see trunk and pelvis movements happening together?
- older people + coordination movement issues e.g. parkinsons
- thorax and spine looses mobility
- shift to sync gait
What generates energy in the gait sequence and what effect can this have on the head?
- trunk and spine
- force comes down from trunk + spine
- ground reaction force comes up from foot
- need to dissipate forces to stop head nodding during gait
What movements happen to the hip at heel strike?
- hip flexion
- hip abduction
- hip internal rotation
What happens to the hip in stance phase?
- hip flexion
- hip adduction
- hip internal rotation
What happens to the hip in swing phase?
- hip extension
- hip adduction
- hip external rotation
What is the q-angle of the hip?
- line between ASIS + patella
What are the key factors around q-angle?
- shape and size of pelvis
What happens to the q-angle in women?
- increased angle in women
- increased load through hip => requires stronger adductor force
- lateral hip structures work harder to stop knee coming in (trendelenberg action) => more difficult to control hip
- results in increased loading of lateral hip and medial knee
What is anteversion/retroversion?
- measures the shape/direction of rotation in the femur compared to the shape/direction of the femoral condyles
Describe how the increased q angle in women affects the pelvis, femur and knee
- increased q angle due to wider pelvis
- increased femoral anteversion
- relative knee valgus angle
What happens to femoral version/torsion in a baby?
- femur is anteverted
What happens to version/torsion as we grown into an adult?
- lateral hip muscles work, twisting femoral neck outwards compared to femoral condyles
- normal femoral neck anteversion
- hip hasn’t come out of baby stage of anteversion
What happens to the femoral neck in retroversion and what impact does this have on the leg?
- femoral neck becomes parallel with femoral condyles
- results in bowed knees when femur is in neutral
Anteversion and which disease of the hip have a high correlation?
- OA
Which test do you perform to identify femoral version/torsion?
- Craig’s test
- find greater trochanter in neutral and then look at foot
- foot internal rotation => anteversion
- foot pointing up => neutral anteversion
- foot pointing out => retroversion
What happens with an aging hip?
- aging is a natural process that occurs in all people to some degree
- acceleration => pathological OA of hip => inappropriate degeneration
- hip common joint for OA
How do you assess the aging hip?
- individual agency => social, sport, occupation => requirements and effect on structure/function
- local tissue changes => how has NMS changed?
- global effect of changes on NMS
Give examples of how individual agency can be affected by an aging hip (how does this impact life?)
- sit to stand => prolonged sitting => difficult to get going after long sedentary period of time
- weight baring e.g. walking issues
- cannot put socks/trousers on easily as have to take hip through EROM => painful
- loss of hip extension early on
- weight baring with impact e.g. stepping off of curb