KINE 3200 - Chp. 8

Muscles of the pelvis that act on hip joint may be divided into 2 regions

(1) iliac (2) gluteal regions

6 Deep lateral rotator muscles

(1) piriformis (2) gemellus superior (3) gemellus inferior (4) obturator externus (5) obturator internus (6) quadrates femoris Origin: - anterior sacrum, posterior portions of ischium & obturator foramen; ischial spine; ischial tuberosity margin of obturator foramen; inferior margin of obturator foramen; ischial tuberosity Insertion: - superior & posterior aspect of greater trochanter; posterior aspect of the greater trochanter immediately below performs; posterior aspect of greater trochanter with obturator interns; posterior aspect of greater trochanter with gemellus superior; posterior aspect of greater trochanter immediately below obturator interns; intertrochanteric ridge of femur Action: - external rotation of hip Innervation: - piriforms: 1st or 2nd sacral nerve - gemellus superior: sacral nerve - gemellus inferior: branches from sacral plexus - obturator externus: obturator nerve - obturator internus: branches from sacral plexus - quadrates femoris: branches from sacral plexus Application, Strengthening, & Flexibility: - 6 lateral rotators used powerfully in movements of external rotation of femur, as in sports -> individual takes off on one leg from preliminary internal rotation i.e.) throwing a baseball & swinging a baseball bat - standing on one leg & forcefully turning body away from that leg is accomplished by contraction of these muscle & repeated for strengthening - stretched by -> supine position with a partner passively internally rotating & slightly flexing the hip

Pelvic bones made of 3 bones

(1) the ilium (2) the ischium (3) the pubis

Muscles of the hip & pelvic girdle

- all innervated from the lumbar & sacral plexus -> lumbosacral plexus Lumbar plexus: - formed by anterior rami of spinal nerves L1-L4 & some fibers from T12 - lower abdomen & anterior & medial portions of lower extremity innervated by nerves arising from lumbar plexus Sacral plexus: - formed by anterior rami of L4, L5 & S1-S4 - lower back, pelvis perineum, posterior surface of high & leg & dorsal & plantar surfaces of foot innervated by nerves arising from sacral plexus

Anterior pelvis rotation

- anterior movement of upper pelvis; the iliac crest tilts forward in sagittal plane, anterior tilt; downward rotation; accomplished by hip flexion and/or lumbar extension

Teres ligament

- attaches from deep in acetabulum to a depression in femoral head - slightly limits adduction

Hip joint

- ball & socket joint (enarthrodial) - consists of head of femur connecting with acetabulum of pelvic girdle - provides a great deal of stability, resulting in relatively few joint (hip) subluxations & dislocation - hip is one of the most mobile joints of the body because multi-axial arrangement - formed by femoral head inserting into socket provided by acetabulum of pelvis - acetabular femoral joint - very mobile with excellent stability - strong ligamentous capsule, especially anteriorly - femoral head inserts into acetabulum - labrum for extra stability & cushioning

Right lateral pelvic rotation

- fontal plane - right pelvis moves inferiorly in relation to left pelvis, either right pelvis rotates downward/left pelvis rotates upward; right lateral tilt; accomplished by right hip abduction, left hip adduction, and/or left lumbar lateral flexion

Left lateral pelvic rotation

- frontal plane - left pelvis moves inferiorly in relation to right pelvis, either left pelvis rotates downward/right pelvis rotates upward; left lateral tilt; accomplished by left hip abduction, right hip adduction, and/or right lumbar lateral flexion

Right transverse pelvic rotation

- horizontal plane of motion - rotation of pelvis of body's right; left iliac crest moves anteriorly in relation to right iliac crest, which moves posteriorly; accomplished by left hip external rotation, right hip internal rotation and/or left lumbar rotation

Left transverse pelvic rotation

- horizontal plane of motion - rotation of pelvis to body's left, right iliac crest moves anteriorly in relation to left iliac crest, which moves posteriorly; accomplishes by right hip external rotation, left hip internal rotation and/or right lumbar rotation

Pelvic bones (Pelvic Girdle)

- joined to form symphysis pubis, an amphiarthrodial joint - pubic symphysis: (anteriorly) - pelvic bones (x2) join to form symphysis pubis - amphiarthrodial joint - sacroiliac joints (x2): (posteriorly) - sacrum is between the pelvic bones - strong ligaments with slight mobility - diarthrodial synovial joint - sacrococcygeal symphysis: (posterior inferiorly) - amphiarthodial joint between the sacrum & coccyx

Hip external rotation

- lateral rotary movement of femur in transverse plane around its longitudinal axis away from midline; lateral rotation

Iliofemoral (4) ligament

- located anteriorly - prevents hyperextension

Pubofemoral ligament

- located anteromedially & inferiorly - limits excessive extension & abduction

Ischiofemoral ligament

- located posteriorly limits internal rotation

Hip internal rotation

- medial rotary movement of femur in transverse plane around its longitudinal axis toward midline; medial rotation

Hip flexion

- movement of anterior femur from any point toward the anterior pelvis - sagittal plane

Hip diagonal abduction

- movement of femur in diagonal plane away from midline of body

Hip diagonal adduction

- movement of femur in diagonal plane toward midline of body

Hip abduction

- movement of femur in frontal plane laterally to the side away from midline

Hip adduction

- movement of femur in frontal plane medially toward midline

Hip horizontal abduction

- movement of femur in horizontal/transverse plane away from pelvis

Hip horizontal adduction

- movement of femur in horizontal/transverse plane toward pelvis

Hip extension

- movement of posterior femur from any point toward posterior pelvis - sagital plane

At birth & growth & development, 3 distinct bones at maturity, they are fused to form one pelvic bone

- os coax - coxal - innominate bone

Posterior pelvis rotation

- posterior movement of upper pelvis; the iliac crest tilts backwards in sagittal plane, posterior tilt; upward rotation; accomplished by hip extension and/or lumbar flexion

Pelvic bone can be divided roughly into 3 areas, starting from acetabulum

- upper 2/3 -> ilium - posterior & lower 2/3 -> ischium - anterior & lower 1/5 -> pubis

Tensor fasciae latae muscle

Origin: - anterior iliac crest & surface of ilium just below the crest Insertion: - one-fourth way down the thigh into iliotibial tract, which in turn inserts onto Gerry's tubercle of anterolateral tibial condyle Action: - abduction of hip - flexion of hip - lateral pelvic rotation to ipsilateral side - external rotation of knee - tendency to rotate hip internally as it flexes - anterior pelvic rotation Innervation: - superior gluteal nerve Application, Strengthening, & Flexibility: - aids in preventing external rotation of hip as it is flexed by other flexor muscles - tensor fasciae latae used when flexion & internal rotation take place - developed by -> performing hip abduction exercises against gravity & resistance while in a side-lying position - done by abducting hip that is up & slowly lowering it back to rest against other leg - stretched by -> remaining on side & having a partner passively move downside hip into full extension, adduction & external rotation

Rectus femoris muscle

Origin: - anterior inferior iliac spine of ilium & groove (posterior) above the acetabulum Insertion: - superior aspect of patella & patellar tendon to tibial tuberosity Action: - flexion of hip - extension of knee - anterior pelvic rotation Innervation: - femoral nerve Application, Strengthening, & Flexibility: - pulling from anterior inferior iliac spine of ilium, rectus femoris has the same tendency to anteriorly rotate pelvis - muscle's ability to exert force decr. as it shortens - rectus femoris -> powerful extensor of knee when hip is extended, but weaker when hip is flexed - exercised, along with vastus group, in running, jumping, hoping, etc. - developed by performing hip flexion exercises/knee extension exercises against manual resistance - best stretched by -> side-lying position by having partner take knee into full flexion & simultaneously take hip into extension

Adductor longus muscle

Origin: - anterior pubis just below its crest Insertion: - middle 3rd of linea aspera Action: - adduction of hip - external rotation as it adducts hip - assists in flexion of hip - assists in anterior pelvic rotation Innervation: - obturator nerve Application, Strengthening, & Flexibility: - strengthened by using scissors exercise, requires subject to sit on the floor with legs spread wide while partner puts his/her legs/arms inside each lower leg to provide resistance (exercise may be used for either one or both legs) - as subject attempts to adduct his/her legs together, partner provides manual resistance throughout range of motion - adductor longus stretched in same manner as adductor brevis

Sartorius muscle

Origin: - anterior superior iliac spine & notch just below the spine Insertion: - anterior medial surface of the tibia just below the condyle Action: - flexion of hip - flexion of knee - external rotation of thigh as it flexes the hip & knee - abduction Innervation: - femoral nerve Application, Strengthening, & Flexibility: - sartorius -> 2-joint muscle, effective as a hip/knee flexor - sometimes referred to as the tailor's muscle, active in all hip & knee movements - weak in both flexion movements take place at same time - with knees extended (held) -> sartorius becomes a more effective hip flexor - longest muscle in the body - strengthened when hop flexion activities are performed as described for developing iliopsoas - stretched by -> partner passively taking hop into extreme extension, adduction & internal rotation with knee extended

Gracilis muscle

Origin: - anteromedial edge of descending ramps of pubis Insertion: - anterior medial surface of tibia just below the condyle Action: - adduction of hip - weak flexion of knee - internal rotation of hip - assists with flexion of hip - weak internal rotation of knee Innervation: - obturator nerve Application, Strengthening, & Flexibility: - also known adductor gracilis, -> performs same functions as other adductors, but adds some weak assistance to knee flexion - adductor muscles as a group called into action in horseback riding & doing breaststroke kick in swimming - proper development of adductor group prevents soreness after participation in these sports - strengthened by -> same exercises described for other hip adductors - stretched by -> similar manner to adductors, except that the knee must be fully extended

Adductor Magnus muscle

Origin: - edge of entire ramps of pubis & ischium & ischial Insertion: - whole length of linea aspera, medial condyloid ridge & adductor tubercle Action: - adduction of hip - external rotation as hip adducts - extension of hip Innervation: - anterior: obturator nerve - posterior: sciatic nerve Application, Strengthening, & Flexibility: - adductor magnus used in breaststroke kick in swimming & horseback riding - strengthened by -> hip adduction exercises described for adductor brevis & adductor longus - stretched by -> same manner as adductor brevis & adductor longus

Adductor brevis muscle

Origin: - front of infereior pubic ramps just below the origin of the adductor longus Insertion: - lower two-third of pectineal line of femur & upper half of the medial lip of the linea aspera Action: - adduction of hip - external rotation as it adducts the hip - assists in flexion of hip - assists in anterior pelvic rotation Innervation: - obturator nerve Application, Strengthening, & Flexibility: - adductor brevis, along with other adductor muscles, provides powerful movement of the thighs toward each other - squeezing thighs together toward each other against resistance is effective in strengthening the adductor brevis - stretched by -> abducting the extended & internally rotated hip with knee in flexion

Iliopsoas muscle

Origin: - iliac: inner surface of ilium - posts major & minor: lower borders of transverse processes, sides of the bodies of the last thoracic vertebra, lumbar vertebrae, intervertebral fibrocartilage & base of sacrum Insertion: - iliac & psoas major -> lesser trochanter of femur & shaft just below - psoas minor -> pectineal line (of pubis) & iliopectineal eminence Action: - flexion of hip - external rotation of hip - anterior pelvis rotation - flexion of lumbar spine (psoas minor & major) - transverse pelvic rotation contralaterally when ipsilateral femur is stabilized - lateral flexion of lumbar spine (psoas minor & major) - lateral pelvic rotation to contralateral side (psoas minor & major) Innervation: - lumbar nerve & peroneal nerve Application, Strengthening, & Flexibility: - iliopsoas commonly referred as 1 muscle, but composed of the iliacus & psoas major - iliopsoas powerful in action i.e.) raising lower extremity from floor while in supine position - psoas major origin in lower back tends to move the lower back anteriorly or in supine position, pulls up the lower back as raises thighs - exercised by supporting arms in dip bar/parallel bars & then flexing hips to lift legs - stretched by -> hip must be extended so femur is behind plane of body - isolate iliopsoas -> full knee flexion (avoid)

Semimembranosus muscle

Origin: - ischial tuberosity Insertion: - posteromedial surface of the medial tibial condyle Action: - flexion of knee - extension of hip - internal rotation of hip - internal rotation of flexed knee - posterior pelvic rotation Innervation: - sciatic nerve - tibial division Application, Strengthening, & Flexibility: - both semitendinosus & semimembranosus -> responsible for internal rotation of knee, along with popliteus muscle - best developed by performing leg curls - internal rotation of knee throughout range accentuates activity of muscle - semimembranosus stretched same manner as semitendinosus

Semitendinosus muscle

Origin: - ischial tuberosity Insertion: - anterior medial surface of tibia just below condyle Action: - flexion of knee - extension of hip - internal rotation of hip - internal rotation of flexed knee - posterior pelvic rotation Innervation: - sciatic nerve - tibial division Application, Strengthening, & Flexibility: - 2-joint muscle -> most effective when contracting to wither extend the hip & flexion of knee - extension of hip & flexion of knee at same time -> both movement are weak - trunk flexed forward with knee straight, hamstring muscles have a powerful pull on rear pelvis & tilt it down in back by full contraction - knees flexed when movement takes place -> gluteus maximus - muscles used in powerful flexion of knees, hanging by knees from a bar, flexors of hip come into play to raise origin & more effective as knees flexors - best developed through knee flexion exercises against resistance (hamstring curl/leg curls) - performed in prone position on knee table/standing with ankle weights - emphasized performing hamstring curls while attempting to maintain knee joint in internal rotation - internal rotation brings insertion in alignment with origin - stretched by -> maximally extending the knee while flexing externally rotated & slightly abducted hip

Gluteus medius muscle

Origin: - lateral surface of ilium just below the crest Insertion: - posterior & middle surfaces of the greater trochanter of femur Action: - abduction of hip - lateral pelvic rotation to ipsilateral side - anterior fibers: internal rotation, flexion of hip & anterior pelvic rotation - posterior fibers: external rotation, extension of hip & posterior pelvic rotation Innervation: - superior gluteal nerve Application, Strengthening, & Flexibility: - typical action of gluteus medius & minimus -> walking - weakness in gluteus medius & minimus -> trendelenburg gait - hip external rotation exercises performed against resistance can provide some strengthening of gluteus medius - strengthened by -> performing side-lying leg raises/hip abduction exercises described for tensor fasciae latae - stretched by -> moving hip into extreme adduction in front of opposite extremity & then behind it

Gluteus minimus muscle

Origin: - lateral surface of ilium just below the origin of gluteus medius Insertion: - anterior surface of greater trochanter of femur Action: - abduction of hip - lateral pelvic rotation to ipsilateral sife - internal rotation as femur abducts - flexion of hips - anterior pelvic rotation Innervation: - superior gluteal nerve Application, Strengthening, & Flexibility: - gluteus minimus & medius used powerfully in maintaining proper hip abduction while running - exercised effectively in running, hopping, etc. - best strengthened by -> performing hip abduction exercises similar to tensor fasciae latae & gluteus medius - developed by -> performing hip internal rotation exercises against manual resistance - stretched by -> extreme hip adduction with slight external rotation

Biceps femoris muscle

Origin: - long head: ischial tuberosity - short head: lower half of linea aspera & lateral condyloid ridge Insertion: - lateral condyle of tibia & head of fibula Action: - flexion of knee - extension of hip - external rotation of hip - external rotation of flexed knee - posterior pelvic rotation Innervation: - long head: sciatic nerve - tibial division - short head: sciatic nerve - perineal division Application, Strengthening, & Flexibility: - semitendinosus, semimembranosus, & biceps femoris -> hamstrings - these muscles & gluteus maximus are used in extension of hip when knees are straight/nearly so i.e.) running, jumping, hopping, etc. - biceps femoris best developed through hamstring curls as described for semitendinosus - emphasized more is knee is maintained in external rotation throughout range of motion, which brings origin & insertion more in line with each other - stretched by -> maximally extending knee while flexing the internally rotated & slightly adducted hip

Gluteus maximus muscle

Origin: - posterior one-fourth of crest of ilium, posterior surface of sacrum & coccyx near ilium & fascia of lumbar area Insertion: - oblique ridge (gluteal tuberosity) on lateral surface of greater trochanter & iliotibial band of fasciate latae Action: - extension of hip - external rotation of hip - upper fibers: assist in hip abduction - lower fibers: assist in hip adduction - posterior pelvic rotation Innervation: - inferior gluteal nerve Application, Strengthening, & Flexibility: - comes into action when movement between pelvis & femur approaches & goes beyond 15 deg. of extension - not used extensively in ordinary walking - important in extension of thigh with external rotation - strong action of gluteus maximus in running, hopping, skipping, etc. - hip extension exercises from forward-leaning/prone position used to develop - most emphasized when hip start from a flexed position & moves to full extension & abduction with knee flexed 30 deg. or more to reduce hamstring involvement in action - stretched by -> supine position with full hip flexion to ipsilateral axilla & then to contralateral axilla with knee in flexion - simultaneous internal hip rotation accentuates this stretch

Pectineus muscle

Origin: - space 1-inch wide on the front of the pubis just above the crest Insertion: - rough line leading from the lesser trochanter down to the line aspera (pectineal line of femur) Action: - flexion of hip - external rotation of hip - adduction of hip - anterior pelvic rotation Innervation: - femoral nerve Application, Strengthening, & Flexibility: - as pectinous contracts, it also tends to rotate the pelvis anteriorly - abdominal muscles pulling up on pelvis in front to prevent this tilting action - pectineus muscle exercised together with iliopsoas muscle in leg raising & lowering - strengthened by -> hip flexion & hip adduction exercises against resistance - stretched by -> fully abducting the extended & internally rotated hip with knee in flexion