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Neuromusculoskeletal > PT3 - Hip In Sitting > Flashcards

PT3 - Hip In Sitting Flashcards

1
Q

What are the key functions of the spine and hip for sitting?

A
  • muscular strength + control + ROM to transition from standing to sitting
  • muscular endurance + coordination + control + ROM to maintain + adapt to sitting postures
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2
Q

What it’s the structure of the hip?

A
  • deep ball and socket joint
  • multi-axial (moves in combined planes) + combines movements e.g. flexion, extension, abduction, adduction, internal + external rotation, circumduction
  • stable joint (ligaments + labrum + depth)
  • labrum deepens socket + vacuum suction
  • good for weight bearing => neck of femur angled
  • thick hyaline cartilage on lunate surface
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3
Q

What are the specialisations of the femur and how can this lead to maladaptation?

A
  • shape of femur relative to ground => valgus of knee making force disicipate through body
  • superior surface well adapted for weight bearing, however, can end up maladaption due to changes in anterior/posterior/side bend/rotation
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4
Q

What are the articular specialisations of the hip?

A
  • synovial ball and socket => lubrication, nutrition, waste removal, multi-axial
  • femoral head + acetabulum => all motion between the 2 is rotational, no detectable translation due to congruency of articulating surfaces => smooth movement
  • labrum + vacuum effect => provides congruency + deep socket for stability + provides absolute limits of motion + hydrostatic fluid pressure to facilitate synovial lubrication and resistance to joint distraction
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5
Q

What are the absolute limits of the hip before bony impingement occurs?

A
  • flexion = 120 degrees
  • extension = 10 degrees
  • abduction = 45 degrees
  • adduction = 25 degrees
  • internal rotation = 15 degrees
  • external rotation = 35 degrees
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6
Q

What is the function of the ligaments of the hip?

A
  • strong => maintains articular congruity in all movements
  • blend seamlessly with capsule of hip
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7
Q

What are the 3 main ligaments of the hip?

A
  • iliofemoral = y shaped + blends with capsule + rectus femoris
  • pubofemoral = rectangular + blends with capsule + obturator fascia
  • ischiofemoral = spiral => maintains integrity during hip movement
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8
Q

What is femoroacetabular impingement syndrome?

A
  • abdnormal contact between bone of proximal femur + acetabulum’s
  • result of alteration in osteo us morphology of hip
  • creates force on labrum => injury + pain + tearing => chondral injury + degenerative changes
  • impingement = reduced area => between femur + acetabular rim
  • thickening of labrum => inflammatory cascade
  • impingement happens anteriorly, but can be felt into extension => inflammation + aggregated in multiple directions
  • acute => can lead to chronic
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9
Q

What are the symptoms of FAI?

A
  • hip pain
  • clicking
  • catching
  • stiffness
  • giving way
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10
Q

What are the signs of FAI?

A
  • restricted ROM
  • positive impingement test
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11
Q

What would you find in radiological findings?

A
  • cam
  • pincer
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12
Q

What are the tests for FAI?

A
  • hip injections to confirm hip as source of pain
  • FAI orthopedic test
  • MRI/CT scan
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13
Q

What is a CAM morphology?

A
  • boney growth on head of femur
  • caused by off-centre rotation => non-spherical spinning => compression of labrum => more prominent in repetitive actions e.g. kicking
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14
Q

What is the morphology of a PINCER?

A
  • development from child femur => pushed into acetabulum
  • results in deeper socket
  • change to ilium + pubis + ischium surface (deeper)
  • can lead to OA
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15
Q

What interventions are available for PINCER/CAMs morphologies?

A
  • surgical = bumpectomy or arthroscopy
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16
Q

What are the maladaptations of PINCER/CAMs?

A
  • can lead to FAIS => accelerated changes => OA
  • OA weight bearing may be painful
  • OA neutral position may not be as stable
17
Q

How might FAI present in a patient?

A
  • sitting with leg externally rotated, abducted + dropping pelvis => flexed lumbar spine
  • no weight bearing through hip in sitting => primary complaint of head + neck
  • driving + getting out car + sit to stand difficult
  • sit to stand => COG moves further forwards as needs to be with BOS
  • leaning to side, rotate away to open up angle
  • use arms of chair to stand up
  • flex through thoracic spine without rotating pelvis (lumbar + thoracic + mechanical stress through areas load increase)
18
Q

What are the muscular specialisations of the hip?

A
  • diverse muscles cross hip joint
  • bi-articular (muscles cross 2 joints) => transfer of tension in sit to stand between different points (slow down, speed up, lengthening + shortening)
  • uni-articular (muscles cross 1 joint)
  • diverse ROM architecture

NB - if PT is doing isolated based exercises => compound movement coordination difficulties

19
Q

What are the bi-articular muscles of the hip?

A
  • iliacus
  • psoas major
  • psoas minor
  • semimembranosus
  • bicep femoris
  • semitendionsus
  • sartorius
  • gracillis
20
Q

What are the uni-articular muscles of the hip?

A
  • tensor fascia lata
  • rectus femoris
  • vastus lateralis
  • vastus medialis
  • piriformis
  • gluteus maximus
  • gluteus minimus
  • gluteus medius
  • pectineus
  • adductor brevis
  • adductor longus
  • adductor magnus
21
Q

What is a concentric action?

A
  • loading + shortening of muscle
22
Q

What is an eccentric action?

A
  • lengthening under load
23
Q

What is an isometric action?

A
  • maintaining muscle length (Biarticular are best described as isometric)
24
Q

How does stand to sit work using Biarticular muscles?

A
  • hip flexors aren’t going to contract
  • hip extensors => eccentrically contract to slow down movement (gravity always wins)
25
Q

What is non-contractile soft tissue?

A
  • tendons
  • ligaments
  • fascia
  • other tissue between cells e.g. extracellular matrix
26
Q

Explain sit to standing occurs

A
  • gravity wins by leaning forwards
  • creation of tension in non-contractile tissues
  • storage of potential/elastic energy => take advantage of gravity
27
Q

What is the function of muscles?

A
  • maximum performance for minimum cost (energy efficiency)
  • potential energy <- transferred to become -> kinetic energy
  • using structures to mechanical advantage
28
Q

What are the sit to stand kinematic?

A
  • phase 1: flexion phase
  • phase 2: extension phase
29
Q

What happens during sit to stand kinematic?

A
  • phase 1: flexion = first 35% of movement cycle
  • phase 2: extension = begin at head and knee
  • phase 2: reversal of head movement + rapid increase in knee extension
  • phase 2: reversal movement spreads inferiorly from head => trunk => pelvis
  • phase 2: reversal from flexion to extension => correspond with buttocks lifting off chair
30
Q

What maladaptations might create challenges for someone to stand from sitting successfully?

A
  • fixed flexion deformity => patient has flexion in hip and unable to get from flexion into extension
  • FAI/OA => patient moves away from painful hip to push off non-FAI/OA leg (rotation through lumbar spine + pelvis + knee + ankle)
  • posterior tilt of pelvis due to extended seated position => cannot get into flexion and uses trunk and head flexion to assist with movement
  • uses hands to push off arms of chair as weakness in legs
31
Q

How can frontal and transverse plan movements of the hip contribute to sit to stand efficiency?

A
  • hip extensors generate force in frontal + transverse plane => may result in knees + feet coming inwards/outwards
  • might rotate towards a specific direction
32
Q

What influences the way we sit?

A
  • enrivonment
  • task
  • organism
  • centre = coordination + control
33
Q

Discuss the potential effects of changes in hip mobility on the sitting posture of the pelvis and lumbar spine

A
  • pelvis may be raised on affected side and anteriorly rotated to assist with flexion of the hip, contralateral side might be anteriorly rotated
  • might observe muscle mass differences on each side where non-affected side has larger muscle definition due to more use for support; affected side might have atrophy of the muscles
34
Q

What effect might FAI have on a person’s ability to sit and their sitting posture?

A
  • FIA/OA => lumbar comes into a more side bent and rotated position to allow for less pressure onto the hip socket + leg more externally rotated + flexed + abducted on affected side

Neuromusculoskeletal (23 decks)

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