HIP NOTES

MUSCLES OF THE HIP JOINT AND PELVIC GIRDLE sartorius

-ORIGIN - ASIS -INSERTION - anterior medial aspect of the tibial just below the condyle (pes anserine) -ACTION - flexion of the hip and knee, external rotation of the femus as it flexes the hip and knee, abduction of the hip and anterior pelvis rotation -the sartorius muscle was given this name because it is used to cross the legs in a tailor's position. when only one action is taking place (knee or hip flexion) it is effectively stronger. it is greatly weakened when both actions take place simultaneously. it is the longest muscle in the body. -strengthened with knee flexion and hip flexion exercises. stretching can be accomplished by passively taking the hip into extreme extension, adduction, and internally rotated with the knee extended, utilizing a stretching partner

MUSCLES OF THE HIP JOINT AND PELVIC GIRDLE gracilis

-ORIGIN - anteriomedial aspect of the inferior ramus of the pubis -INSERTION - anteriomedial aspect of the medial tibial condyle (pes anserine) -ACTION - adduction, flexion, and medial rotation of the hip and knee flexion -latin for strap like -similar to the hamstrings, sartorius, and rectus femoris in that is crosses the hip and knee joint -it participates in hip flexion only when the knee is extended and that it is most active during the early stages of hip flexion

MUSCLES OF THE HIP JOINT AND PELVIC GIRDLE adductor magnus

-ORIGIN - anterior head - entire inferior ramus of the pubis ------------posterior head - ischium and ischial tuberosity -INSERTION - entire length of the linea aspera (anterior), medial condyloid ridge (posterior) and adductor tubercle (posterior) -ACTION - both sections adduct the hip ------------anterior fibers - hip flexion and medial rotation of the femur as it adducts the hip ------------posterior fibers - hip extension and lateral rotation of the femur as it adducts

MUSCLES OF THE HIP JOINT AND PELVIC GIRDLE tensor fasciae latae

-ORIGIN - anterior iliac crest and surface just below the crest -INSERTION - superior anterior one-quarter of the iliotibial tract (IT band) -ACTION - abduction and flexion of the hip - internal femoral rotation during hip flexion -ACTION - anterior pelvic rotation - tightening of the fascia lata

MUSCLES OF THE HIP JOINT AND PELVIC GIRDLE adductor brevis

-ORIGIN - anterior inferior pubic ramus -INSERTION - inferior pectineal line of the femur and superior 1/2 of the medial lip of the linea aspera -ACTION - hip adduction, hip flexion, and external rotation of the hip when adducting -lies just above the adductor longus with ribers that are almost horizontal with the thigh in a resting or standing position -from this position, it both adducts and flexes the thigh. -if the hip is extended to a marked degree, it will extend and adduct the hip joint against resistance -squeezing the legs together toward each other against resistance is an effective strengthening exercise -abduction, extending, and internally rotation the hips provides stretching of the adductor brevis

MUSCLES OF THE HIP JOINT AND PELVIC GIRDLE adductor longus

-ORIGIN - anterior pubis just below the crest -INSERTION - middle 1/2 of the linea aspera -ACTION - adduction and flexion of the hip (past 70 ) degrees of flexion -always active during adduction of the hip due to its relationship to the hip joint -the additional flexion shifts the relationship between the muscles line of pull and the joints center of motion (axis). therefore it will aid in hip flexion. -the most anterior adductor -strengthened with hip flexion and hip adduction movements against resistance -stretching movements include hip extension, abduction, and external rotation

MUSCLES OF THE HIP JOINT AND PELVIC GIRDLE iliopsoas

-ORIGIN - illacus - inner surface of the ilium -INSERTION - lesser trochanter of the femur and shaft inferior -ORIGIN - psoas major & moinor - transverse processes of L1-5, sides of vertebral bodies T12 & L1-5, vertebral disks of T12 & L1-5 & base of sacrum -INSERTION - lesser trochanter of the femur and shaft inferior -ACTION - flexion of of the hip and external rotation of the femur. Depending on which body part is stabilized dictates the iliopsoas's movement. EXAMPLE: in a supine position, the hips are stabilized by the floor, therefore the iliopsoas will raise the legs. If the legs are stabilized, the iliopsoas will contract to cause flexion of the trunk as a unit on the thigh. The psoas major's origin on the lumbar vertebrae can cause problems in activities such as six inch leg raises. As the legs are raised the psoas major can cause excessive lumbar curvature bringing about low back pain.

MUSCLES OF THE HIP JOINT AND PELVIC GIRDLE semimembranosus

-ORIGIN - ischial tuberosity -INSERTION - posteromedial surface of the medial tibial condyle -ACTION - flexion and internal rotation of the knee, and internal rotation of the hip and extension of hip -the semimembranosus lies anterior to the semitendinosis and has a shorter deeper tendon that is difficult to palpate the semimembranosus is so called due to its membranous origin, which is long, wide, and thin and resembles a membrane which is defined as a thin pliable layer of tissue

MUSCLES OF THE HIP JOINT AND PELVIC GIRDLE semitendinosus

-ORIGIN - ischial tuberosity -INSERTION - superior anteriomedial aspect of the tibia -ACTION - internal rotation and extension of the hip, flexion and internal rotation of the knee -the semitendinosus tendon can be easily palpated on the medial of the posterior surface of the knee when the knee is flexed against resistance -the semitendinosus is so called due to the great length of its tendon

MUSCLES OF THE HIP JOINT AND PELVIC GIRDLE gluteus medius

-ORIGIN - lateral surface of the ilium just inferior to the crest -INSERTION - posterior and mid surface of the greater trochanter -ACTION - hip abduction, external rotation of the femur as the hip abducts and hip extension (posterior fibers), and internal rotation of the femur as the hip abducts and hip flexion (anterior fibers) -important in walking and standing in good posture -when the weight of the body is suspended on one leg as in walking, the gluteus medius, along with other hip abductors prevent the opposite hips from snagging. -weakness in the gluteus medius and other hip abductors can result in Trendelenburg gait. with this weakness, the individuals opposite hip will sag upon weight bearing because the hip abductors cannot maintain proper alignment -the lack of stabilization results in an exaggerated sideward thrust upon ground contact -external and internal rotation exercises and hip abduction exercises can provide strengthening for the gluteus medius. -it is best stretched by moving the hip into extreme adduction in front of the opposite extremity and then behind

MUSCLES OF THE HIP JOINT AND PELVIC GIRDLE biceps femoris - long head and short head

-ORIGIN - long head - ischial tuberosity ------------ short head - inferior 1/2 of the linea aspera and lateral condyloid ridge of the femur -INSERTION - lateral condyle of the tibia head and of the fibula -ACTION - long head - extension, external rotation of the femur and posterior pelvic rotation ------------short head - flexion, external rotation of the knee -the biceps femoris long head originates on the tuberosity of the ischium, and the short head originates on the linea aspera and the medial supracondylar ridge -the two joint at the distal tendon, close to the lateral condyle of the femur not far above from the tendon's attachment to the lateral tibial condyle and the fibular head -generally, the biceps femoris will cause femoral lateral rotation. when this motion is coupled with tibial external rotation, the biceps femoris will become stronger with hip extension and knee extension

MUSCLES OF THE HIP JOINT AND PELVIC GIRDLE gluteus minimus

-ORIGIN - mid lateral surface of the ilium of the pelvis -INSERTION - anterior surface of the greater trochanter of the femur -ACTION - hip abduction, internal rotation of the femur as it abducts, and hip flexion -both the gluteus minimus and gluteus medius are used forcefully in running to maintain proper hip abduction while running, hopping, and skipping in which weight is transferred forcefully from one foot to another -strengthening by hip abduction exercises and stretched by hip adduction with slight external rotation -the gluteus minimus is primarily an inward rotator and an abductor secondarily

MUSCLES OF THE HIP JOINT AND PELVIC GIRDLE gluteus maximus

-ORIGIN - posterior 1/4 of the crest of the ilium, posterior sacrum, posterior coccyx, and fascia of the lumbar -INSERTION - oblique ridge of the greater trochanter and superior posterior 1/2 of the IT band -ACTION - hip extension (main ext.), external rotation of the femur, lower fibers adduct the femur, upper fibers abduct the femur, and posterior pelvic rotation -largest and most superficial of the 3 butt muscles -powerful hip extensor and outward rotator of the femur -the lower portion assists in adduction from an abducted position against resistance -the upper portion abducts against strong resistance -these contradictory movements take place due to the relation of the muscle to the hip joint's center of motion as seen posteriorly -about 1/3 of the muscle lies above the center of motion, and 2/3 below. this puts the upper fibers in a position to abduct the thigh and the lower fibers in a position to adduct the thigh. -the fibers lying directly behind the femoral head are only in the position to extend the hip. -because of its size prominence, the gluteus maximus has been shown to be active only when moderate to heavy resistance exists. -during normal walking, hip extension is accomplished by the hamstrings -the gluteus maximus was also found to be very active in hyperextension (> than 60 degrees) movements against resistance from the erect standing position. -in the deadlift, the gluteus maximus was found to be active during the last 15-20 degrees of the movement. -tensing of the gluteus maximus frequently advocated as a corrective postural exercise. if an individual stands erect with parallel, voluntary contraction of the gluteus maximus produces two postural effects. -the pull on the femur causes a slight outward rotation at the hip joint, but since friction between the soles of the feet and the floor prevent the feet from turning laterally, the rotary force is transmitted from the femur to the talus and to the other tarsal bones, resulting in supination of the foot and lifting of the medial aspect of the longitudinal arch. -at the same time, the pull at the muscle's proximal attachment decreases the lumbar lordosis. -hip extension exercises from a forward leaning or prone position may be used to develop the gluteus maximus. it is not emphasized when the hip starts from a flexed position and moves to full extension with the knee flexed 30 degrees or more to reduce the hamstring's involvement in the action

MUSCLES OF THE HIP JOINT AND PELVIC GIRDLE pectineus

-ORIGIN - superior anterior ramus of the pubis -INSERTION - roughened line of bone from the lesser trochanter to the linea aspera (pectineal line) -ACTION - flexion, adduction, and internal rotation of the hip -a short, thick, quadrilateral muscle situated lateral, superior, and parallel to the adductor longus -as a flexor, it has a good angle of pull. this angle of pull along with its structure makes it a strong hip flexor -can be palpated near the anterior pubis -as the pectineus contracts, it tends to rotate the pelvis anteriolateral. however, the rectus abdominus pulling in the opposite direction prevent this tilting action. -hip flexion and adduction exercise can be used for strengthening -can be stretched by abducting, extending, and externally rotating the hip

pectineal line

-a ridge of bone that runs from the lesser trochanter to the medial superior lip of the linea aspera

glenoid labrium

-a rim of fibrocartilage that encircles the acetabulum -serves to deepen the socket to increase the stability

linea aspera

-a rough line of the bone located on the mid-posterior aspect of the femur

ANGULATION OF HIPS AND KNEES angle of anteversion

-angle of femoral neck in the transverse plane -normally, the femoral neck is rotated anteriorly 12-14 degrees with respect to the femur -if there is excessive anteversion in the hip joint in which it rotates BEYOND 14 degrees to the anterior side, this produces a toeing in -produces an increase in the Q angle, patellar tracking problems, increase in leg length which could start the scoliosis process, and increase lumbar curvature

PARTS OF THE PELVIS pubis

-anterior aspect of the pelvis -forms the anterior aspect of the acetabulum and completes the obturator foramen -the two pubic bones are joined together anteriorly at the pubic symphysis -each bone has a superior ramus, which extends laterally to articulate with the ilium and a inferior ramus, which articulates with the ischium

pubic crest

-anterior aspect of the pubis

MOVEMENTS OF THE PELVIS

-anterior pelvis rotation -posterior pelvis rotation -right lateral pelvis rotation -left lateral pelvis rotation -right transverse rotation -left transverse pelvis

sacroiliac joint (SI joint)

-articulation of the sacrum and two pelvic bone -movements of the pelvis involve the entire pelvis, not a lot of movement at the SI joint

IT band friction syndrome

-as the IT band crosses over the head of the fibula and the lateral tibial condyle, the anterior posterior movement of the IT band produced by knee flexion and extension can cause tendonitis type pain symptoms

hip

-ball and socket joint that consists of the head of the femur articulating with the acetabulum of the pelvis -approx. 70% of the head of the femur articulates with the acetabulum

medial and lateral femoral condyles

-broadens the distal end of the femur -articulate with the condyles of the tibia to form the knee

leg-length discrepancy

-can be caused by anatomical factors such as unequal leg growth or functional discrepancies such as a pelvis tilt or anteversion -anatomical leg length is measured from the ASIS to the lateral malleolus -functional leg length is measured from the ASIS to the medial malleolus -bilateral discrepancies of greater than 0.393 to 0.780 ins. are considered significant

LABRUM TEARS

-can occur from hypertrophy of the femoral neck, which would impinge and come in contact with the labrum and cause tears of the labrum and wears over a period of tears, which would cause the labrum to tear away from the bone

What forms the neck of the femur?

-cancellous bone with a thin corticol layer for strength -the corticol layer is reinforced on the lateral surface of the neck where great strength is required in response to the high tension force

Q angle

-defined as the angle formed between the imaginary line of the quadriceps pull and the imaginary line connecting the center of the patella to the center of tibial tuberosity -has significant influence on the mechanical axis of a bone

hip joint

-defined as the articulation of the head of the femur with the acetabulum of pelvis -it is mobile due to its multiaxial movement, stable due to its bony structure, strong musculature surrounding joint, and the pressure difference created by the capsule

MOVEMENTS OF THE HIP

-flexion -extension -adduction -abduction -internal rotation -external rotation

ANGULATION OF HIPS AND KNEES coxa valga

-if the angle of the femoral neck is GREATER THAN 125 degrees -this positions lengthens the limb, reduces the effectiveness of the abductors, increases the load on the femoral head and decreases the load on the femoral neck

ANGULATION OF HIP AND KNEES coxa vara

-if the angle of the femoral neck is LESS THAN 125 degrees -this means that the limb will be shortened, the abductors are more effective, there is less load on the femoral head, but more load on the femoral neck

ANGULATION OF HIP AND KNEES tibia valgus

-increases compression forces on the lateral aspect of the talus and calcaneous

ANGULATION OF HIPS AND KNEES tibial varus

-increases the compression forces on the medial aspect of the talus and calcaneous

pes anserine

-insertion point for the sartorius -it is latin for crows foot. this area was given this name because two other muscles besides the sartorius insert here. therefore it resembles a crows foot.

PARTS OF THE PELVIS right and left ilium

-joined together posteriorly by the sacrum -forms the projection of the hip -its smooth, concaved surface serves for attachments for muscles -forms the superior aspect of the acetabulum -on the posterior aspect of the ilium is a passageway for the largest nerve in the body, the sciatic notch

iliotibial band

-lateral aspect of the fascia lata -stronger and thicker than the rest of fascia lata -functions as a reinforcement of the fascia lata and as an insertion location for muscles -when it contracts, it tenses the fascia lata, enabling the gluteus maximus to produce greater power due to the tighter insertion structure -also involved in IT band friction syndrome. -attachment site is Gerdy's tubercle, located on the anterolateral aspect of the proximal tibia, just lateral to the superior tibial tuberosity (Pierre Gerdy)

sacrum

-located between the two pelvis bones to join the two -this connecting of the two flat bones is one of the major differences between the shoulder and pelvic girdle -this connection brings great stability to the structure

LIGAMENTS OF THE HIP JOINT ischiofemoral

-located on the lateral aspect of the hip where it resists adduction and internal rotation

femur (thigh bone)

-longest, strongest, and heaviest bone in the body

DEEP LATERAL ROTATORS OF THE FEMUR

-piriformis (pear shaped) -gemellus superior (twin) -gemellus inferior -obturator internus (stop up) -obturator externus -quadratus femoris (four) -ORIGIN - anterior sacrum, posterior ischium, and obturator foramen -INSERTION - superior posterior aspect of the greater trochanter -ACTION - external rotation of the hip and femoral head stabilization

LIGAMENTS OF THE HIP JOINT iliofemoral

-referred to as the Y ligament -supports the anterior aspect of the hip joint in the standing position

ANGULATION OF HIP AND KNEES genu recurvatum

-refers to a hyperextension at the knees in a standing position -caused by genetic placement of the ACL and PCL -this condition would increase the tension force on structures of the knee (ACL, PCL, hamstring tendons) -increases compressive forces on the anterior aspect of the tibiofemoral joint

ANGULATION OF HIP AND KNEES talipes

-refers to a talipes that is turned inward toward the midline of the body -brought on by a congenital misalignment of the tibia with the talus, increasing compression forces to the medial aspect of the tibia, talus, and calcaneous -tension forces to the lateral aspect

ANGULATION OF HIP AND KNEES varus (bent inward)

-refers to an angulation inward of a structure from the proximal to distal aspect toward the midline of the body -an individual is referred to as being knocked-kneed or genu varus -causes the weight bearing line to pass to the lateral side of the center of the knee -causes a majority of the body weight to be borne on the lateral aspect of the articulating surfaces, therefore subjecting the lateral articulating surfaces to an increased compression force, increasing the chances of developing osteoarthritis -medial collateral ligament will be subjected to an increased tension force, which could cause stretching of the medial collateral ligament, bringing instability

ANGULATION OF HIP AND KNEES valgus (bowlegged)

-refers to angulation outward from proximal to the distal aspect of a structure or away from the midline of the body -an individual is referred to as being bowlegged or genu valgus -causes the weight bearing line to pass to the medial side of the center of the knee -this causes a majority of body weight to be borne on the medial aspect of the articulating surfaces, therefore subjecting the medial articulating surfaces to an increased compression force, increasing the chances of developing osteoarthritis -lateral collateral ligament will be subjected to an increased tension force, which could cause stretching of the lateral collateral ligament, bringing instability

psoas loin

-refers to the lower back and sides between the ribs and pelvis

LIGAMENTS OF THE HIP JOINT pubofemoral

-resists abduction and some resistance to external rotation

ischial bursae

-separates the gluteus maximus from the ischial tuberosity

trochanteric bursae

-separates the gluteus maximus from the lateral aspect of the greater trochanger

glutealfemoral bursae

-separates the proximal aspect of the gluteus maximus from the lateral aspect of the vastus lateralis

intercondylar notch

-space between medial and lateral femoral condyles

fascia lata

-strong dense broad tissue sheath that invests the muscles of the thigh like an elastic stocking -it functions to prevent the thigh muscles from bulging excessively to contract, which improve their effectiveness

iliac crest

-superior aspect of the ilium -ends in a projection known as the anterior superior iliac spine (ASIS) -inferior to the ASIS is a smaller projection known as the anterior inferior iliac spine (AIIS)

femoral epicondyles

-superior to the femoral condyles -serve as attachment points for the medial (tibial) collateral ligament and the lateral (fibula) collateral ligament

ANGULATION OF HIP AND KNEES talipes valgus

-talipes that is turned outward away from the midline of the body -brought on by congenital misalignment of the tibia and talus, increasing compression forces to the lateral aspect of the tibia, talus, and calcaneous -tension forces to the medial aspect

ANGULATION OF HIP AND KNEES angle of retroversion

-the angle of anteversion is reversed so that it moves posteriorly -creates an externally rotated gait, supinated foot, and a decrease in the Q angle, patellar tracking problem, and begins the scoliosis process

HAMSTRINGS pt 2

-the bicep femoris long head, semimembranosus and semitendinosus are fusiform in arrangement while the biceps femoris short head is unipenneform in arrangement -the hamstrings, along with the rectus abdominus are responsible for posterior pelvic tilt to counteract the weight of the trunk (30 kg) which lies anterior to the vertebrae -however, very tight hamstrings can produce an excessive posterior curvature which can produce excess pressure on the posterior aspect of the lumbar disks, causing lower back pain -in level walking or in low output hip extension activities, the hamstrings are the predominant muscles creating hip extension. -if the resistance in the extension movement is increased, or if a more vigorous hip extension is needed, the gluteus maximus is recruited as a joint action. this occurs in running up hills, climbing stairs, sprinting, or rising from a chair

INFORMATION ON FEMORAL NECK pt 1

-the femoral neck is positioned at a specific angle in both the frontal and transverse planes -in order to facilitate a congruent articulation within the hip joint and to hold the femur away from the body -the angle of inclination is the angel of the femoral neck in the frontal plane, which is approx. 125 degrees with respect to the femoral shaft -the angle is larger at birth by almost 20-25 degrees -it lowers as the person matures and assumes a weight baring position -it is also believed that the angle continues to lower into later life by about 5 degrees. this would further enhance the tension force on the superior aspect of the femoral neck. therefore this angle is important in determining which individuals may have a greater chance for having a fractured hip -the range of the angle of inclination is usually within 90-135 degrees -holds the femur away from the acetabulum and pelvis

PARTS OF THE PELVIS ischium

-the inferior aspect of the pelvis -forms the inferior posterior aspect of the acetabulum -serves as the origin for the hamstring muscles -forms most of the obturator foramen

pelvis

-the region where the trunk and lower limbs meet -the female pelvis is lighter, thinner, and wider than that of a male -excess width of a pelvis will alter the joint mechanics of the hip, knee, and ankle

deep lateral rotators of the femur

-these 6 muscles for a compact group posterior to the hip joint -runs horizontally -the piriformis, the most superior of the group, is slightly above the joint -the quadratus femoris, the most inferior, is slightly below the joint -they are used powerfully in movements of external rotation of the femur as in sports in which the individual take off on one leg from a preliminary internal rotation. -throwing a baseball or swinging a bat are examples -standing on one leg and forcefully turning will strengthen these muscles

ligamentum teres

-triangular band implanted by its apex into a depression in the superior aspect of the femoral head, just below the center, known as fovea capitus, and by its broad base into the margins of the acetabulum -surrounded by synovial lining -this ligament is made tense when the hip is flexed and abducted and/or laterally rotated -not a strong ligament, but contributes to hip stability internally

ADDUCTORS AND ABDUCTORS OF PLEVIS

-work together to balance pelvis -abductors on one side of the pelvis will work with adductors on the opposite side to maintain proper pelvis positioning and prevent tilting -therefore the adductors and abductors must be balanced in strength and flexibility so that the pelvis can be balanced from side to side -if the abductors overpower the adductors, the plevis will tilt to the side of the strong or tight abductor -if the adductors overpower the abductors, the pelvis will tilt to the side of the strong or tight adductor -this imbalance will alter the position of the disks, therefore causing the nucleus pulposus to be pushed into the disks wall with additional force which can bring about back pain due to the increased pressure on the pain receptors in the wall of the disks, and/or a bulging or herniated disk

HAMSTRINGS pt 1

biceps femoris semimembranosus semitendinosus -located on the posterior aspect of the thigh, extending from the tuberosity of the ischium to just inferior to the knee -biceps femoris is located on the lateral aspect of the posterior aspect of the thigh, and the two semi muscles on the medial aspect of the thigh -only the long head portion of the biceps femoris crosses the hip joint -the short head of the biceps femoris, the only one joint muscle belonging to the hamstring group, therefore it has no part in hip joint movements -together the semitendinosus and semimembranosus constitute the medial component of the hamstring group -the semimembranosus and semitendinosus will show maximal activity during hip extension and knee flexion due to the internal rotation of the tibia during knee flexion -in addition, all three hamstrings help stabilize the pelvis -the hamstrings are best stretched by lying supine and having a partner perform hip flexion with the knee in full extension

HIP EXTENSORS

gluteus maximus biceps femoris semitendinosus semimembranosus adductor magnus gluteus medius gluteus minimus

HIP ABDUCTORS

gluteus medius gluteus minimus gluteus maximus sartorius tensor fascia latae psoas iliacus rectus femoris

HIP FLEXORS

iliacus psoas major rectus femoris pectineus sartorius tenor fascia latae gracilia adductor longus adductor brevis adductor magnus gluteus medius gluteus minimus

3 ligaments of the hip joint

iliofemoral pubofemoral ischiofemoral -forms a loose but strong capsule surrounding the hip joint -this capsule is more sense anterior and superior where the stresses are the greatest and quite thin on the posterior and inferior aspects -NONE of these ligaments resist the movement of flexion; they are loose during flexion -therefore, hip flexion is the movement with the greatest range of motion in the hip joint

The pelvis consists of 3 parts:

ilium ischium pubis

Q angle degrees

males - 10 to 14 degrees females - 15 to 17 degrees

HIP ADDUCTORS

pectineus gracilia adductor longus adductor magnus adductor brevis gluteus maximus semimembranous semitendinosus biceps femoris

3 bursae associated with the gluteus maximus

trochanteric bursae glutealfemoral bursae ischial brusae