hip

adductors

ALL ADDUCTIOR MUSCLES: longus, brevis and magnus • origins are on the pubis • innervated by Obturator nerve L3, L4 • they do everything pectinus is the only adductor innervated by the femoral nerves

ANGLE OF INCLINATION

ANGLE OF INCLINATION • Purpose: to ensure that the head of the femur sits in the acetabulum(fossa) and to facilitate appropriate WB. • The angle is formed between the shaft and the neck of the femur • Normal adult is 125 degrees o baby's angle of inclination can be as high as 150 degree o the angles changes as muscles activate • angle of inclination - in the frontal plane the angle formed by the neck and shaft of the femur is about 125° in adults. This is often termed the angle of inclination. And increase in degrees of the normal inclination is referred to coxa valga, a decrease in angle inclination called coxa varum. • With babibies or young child this angle is 150° o The angle of inclention is important because it ensures that the head of the femur is placed within the acetabulum for weight-bearing purposes

Another boy was noted to have a free moral angle of inclination of 135°. What major hip muscle is shortened. What is the functional movement consequence of the shortening?

Another boy was An angle of inclination greater than 125 degrees is called coxa valga. To compensate for the increased angle the femur angles outward or laterally. This femoral position shortens the gluteus medius muscle. The gluteus medius This muscle plays an important role in maintaining a level pelvis during single limb support. It contracts during gait when the contralateral limb is unsupported. This muscle may not contract as effectively because of its shortened state.

COXA VALGAs

COXA VALGAs: An increase in this angle of inclination: greater than 125 degrees the compensation is that the entire Femur is angled outward • b/c the angle is "straighter" it tends to make the limb longer • the compensation is that the entire Femur is angled outward • the outward angle will then move the head of the femur into a more optimal weight-bearing position in the acetabulum we refer to that as coxa valga's. Results in GENU VARUS • Commonly called bow-leggedness, , is a physical deformity marked by (outward) bowing of the lower leg in relation to the thigh • femur moves laterally in order to put everything back in place • tibia angle in • shortening of the abductors • lengthening of the adductors we will have to do the opposite to get everything back into place

COXA VARAs

COXA VARAs: A decrease in this angle of inclination: less than 125 degrees to compensate, the entire femur angles inward • b/c it is more "bent" it tends to make the limb shorter: dropping the pelvis on that side during weight-bearing • femur angles itself to bring head of the femur to the optimal point of weight-bearing. • to compensate, the entire femur angles inward in order to weightbare when the entire femur angles in it changes the position of the head of the femur and placed the head of the femur more optimally into the acetabulum • this compensation is know as coxa varus is the compensation for decrease angle inclination. • The entire femur angles inward this is referred to as coxa varus. The limb will tend towards adduction because the entire femur angles in in order to change the position of head of the femur results in GENU VALgas • commonly called "knock-knee", is a condition in which the knee angles in and touch one another when the legs are straightened • femur angles inward • tibia angles outwards • knees come together • shortening of the adductors • lengthening of the abductors you have to do the opposite together everything back into place in order to get the person to walk properly

SQUAT

Eccentric Movements in a Squat In a squat, as you eccentrically lower yourself, your hips are eccentrically flexing. The gluteus maximus and hamstring muscles eccentrically control that motion. Also, your knee is eccentrically flexing, and the quadriceps muscles eccentrically control this movement. And finally, the ankle joint is eccentrically dorsiflexing, as the calf muscles control your descent. Note that these are the movements in a standard squat; different movements may occur in variations of the squat or if your form is not correct. Concentric Defined Concentric muscle contractions are visually easier to understand that eccentric contractions. A concentric contraction is one in which the muscle length decreases to perform a movement. In a squat, this would be the lifting phase of the squat as you stand back up. Looking at the rope analogy again, a concentric movement would be similar to pulling a rope attached to a boulder. As you do the work to pull the rope, the boulder gets closer and closer, just as a muscle shortens in a concentric contraction. Concentric Movements in a Squat In the squat, as you concentrically stand back up, your hips are concentrically extending. The gluteus maximus and hamstring muscles concentrically contract to shorten the muscles to pull your hips forward. Also, your knee is concentrically extending, and the quadriceps muscles shorten to pull the knee back to a straight position. And finally, the ankle joint is concentrically plantar flexing, as the calf muscles shorten to bring your lower leg back to an upright position. Again, these are the movements in a standard squat; different movements may occur in variations of the squat or if your form is not correct.

Gluteus Minimus Deep Rotator Muscles

Gluteus Minimus Reversal muscle action: • When you stand on one leg the distal segment (femur) becomes more stable than the proximal end (pelvis) therefore the orgin moves towards the insertion • If these muscles didn't contract when you stand on one leg the opposite side of you pelvis would drop • The gluteus minimus and Medius contract to keep pelvic level to prevent the opposite side of the pelvis for dropping too much when you stand on one leg o This occurs every time you pick up one leg...like in walking • Weakness of loss of these muscles results in 'TRENDELENBURG gait" o Ex: if you right hip abductors are weak the left side of your pelvis will drop when you stand on your right leg and lift your left leg off the ground. o Deep Rotator Muscles: external rotators • Origins: pubis, illume, ischium • Insertions: greater trochanter area Piriformis: best know b/c of its close relationship to the sciatic nerve Gemellus superior Gemellus inferior Quadratus femoris Quadratus internus Obturator externus Obturator intennus

Hamstrings Gracilis Muscle

Hamstrings: consist of the following muscles • Semimembranosus • Semitendinosus • Biceps femoris Hamstrings flex the knee and extend the hip Hamstrings flex the knee and extend the hip Gracilis Muscle • Only adductor that crosses two joints • Passes behind the knee but attaches anteriorly • Not a hip flexor b/c it crosses the knee joint laterally but attaches anteriorly. • Longus of the abductors • Assists in knee flexion • If you flex the knee you can get more hip abduction Stretch: abduct hip with knee extension if someone have tight adductors and I laid them down and they could only out a small distance I want to see if the gracilis is playing a signifant role in tightness if I bend the knee take the gracilas off stretch and put on slack and then I can move into more abduction that tells me that the gracilis is playing a role in the limitation of the range of motion

toe in and out

If I have 30° ° of anteversion because it is a combination of normal torsion angle and a normal angle of inclination that puts the head of the femur in the acetabulum at the ideal place for weight-bearing. How do I compensate. The entire femur rotate medially to put the head of the femur into the acetablum when someone have excessive anteversion you may see them toe in (piggentoe) If you have excessive retroversion 10° your torsion angle is 10° that means your retroversion it in order to get the head of the femur back into the acetabulum you have to do lateral rotation then you tend to toe out

Ilipsoas:

Ilipsoas: • dual innervation (femoral nerve & L2 L3), which means that you could have a problem with femoral nerve and still have hip flexion from the psoas major because they do not share innovators. • Reverse Muscle action: the psoas portiontrunk flexion • Reverse Muscle action for iliacus: anterior pelvic tilt • All anterior hip muscle are innervated by the femoral nerve • is considered a hip flexor • is a combination of two muscles soas major and illaics • the soas major is is the hip flexors that assist in setups

kids

In a closed chain if the femur is angled inward or outward the tibia does the opposite • we are born with coxa valga we may see this with kids that walk late and as they age the move towards the 125° of angle of inclination Due to the remodeling stage and because they added weight on to the bone. Sometimes we may see decrease or increase angle of inclination because these kids did not put weight on the bone 36

A Nassau mechanic has to once again repair a part in a narrow compartment of the space shuttle. He enters the compartment by lying on his back and then using his lower extremities to push himself along the passageway. The part he must fix is at the very end of the passageway in the corner between the wall and ceiling. To reach it he must flex his shoulders and use his lower extremity to lift his butt off the floor. What muscle does he used to lift his body off the floor?

In order to lift his butt off the floor the mechanic must extend his hips this requires a bilateral contraction of the gluteus maximus muscle.

A dancers performing a slow and graceful dance. At one point she lifts her extended leg high in the air in the sagittal plane and then slowly moves the leg into the mid frontal plane. She maintains disposition and gracefully lowers the limb to the floor. What muscles are required to lift the limb in the sagittal plane? Also discuss what muscles are required for her to lowered the limb while in the mid frontal plane

In order to lift the limb in the sagittal plane the dancer must flex the hip. The iliopsoas is the primary hip flexor assisted by the pectineus, and rectus femoris. The iliopsoas has it origin on the iliac fossa and anterior and lateral surfaces of T12 through L5. It inserts on the lesser trochanter and is innervated by the femoral nerve. The pectineus has its origin on the pubis and inserts on the pectineal line of the femur. The rectus femoris has its origin on the anterior inferior iliac spine and inserts onto the tibial tuberosity. The femoral nerve also innervates these muscles. To lower the limb while in the mid-frontal plane the dancer must eccentrically contract the gluteus medius and tensor fascia latae. These muscles are hip abductors. Eccentric contractions are required to resist the force of gravity while lowering the limb.

Joint Structure and Motion distinguish between the pelvis, pelvic girdle, hip joint

Joint Structure and Motion distinguish between the pelvis, pelvic girdle, hip hip joint • head of the femur and the acetabulum(socket) of the pelvis pelvic bone • bones of the pelvis are the two hip bones the sacrum and the coccyx • the pelvis is made up of three bones ilium, issum an pubis fused together Pelvis girdle • right and left pelvis bone • joined together by the sacral iliac joint as well as the pubis's emphasis

a six-year-old child have surgery where they repaired there anteversion where they put the head of the femur in anatomical position and pivot their pelvis in place. The child now requires physical therapy • he has excessive anteversion.

Normal anteversion you look at the neck in relationship to the shaft and the femur is twisted on the chef between 15 to 20° anteriorly. When the doctor fix the head of the femur, he moved the head of the femur posteriorly (posterior torsion) to bring it back to normal.(if the child was at 20 degres he prob moved it at 15 degrees) he will still be Antivert but not as excessive Now that the child is postsurgical what would the physical therapist have to concentrate on. Prior to the surgery how would this child be compensated for the excessive anteversion. • They will have medial rotation of the femur causing the child to toe in when they internally rotate their moving the head of the femur posteriorly • they will have shorten medial rotators and lengthening external rotators • the rom consequence would be that the external rotators will be limited • you would have to stretch the medial rotators because you still don't have the capabilities of positioning the hip because your external rotators are limited their building tension and are able to contract forcefully but because the internal rotators are shortened which keeps the external rotators from contracting forcefully . therefore you have to lengthen your internal rotators in order to move to a neutral rotation at the hip. And you'll have to strengthen your external rotators in order to build up the contractile properties of the external rotators I want to strengths my internal rotators and try to do things that will strengthen my external rotators

anteversion and retroversion

Normally the head of the femur should be in anteversion • 12°-15° of anteversion is NORMAL. • when someone has greater than 12°-15° the person has excessive anteversion o Excessive anteversion = medially rotated hips results in toeing In • when someone has less than 12°-15° the person has retroversion. o Retroversion = laterally rotated hips, results in toeing out

A runner experienced severe pain at the left anteior thigh.She felt the pain while her left hip was extended and her knee flexed. What is the probable cause of her pain.

Passive insufficiency of the rectus femoris muscle may have played a role in this runner's injury. The rectus femoris is a two joint muscle. It originates on the anterior inferior iliac spine and inserts on the tibial tuberosity. It performs hip flexion and knee extension. This muscle becomes passively insufficient when stretched across both joints simultaneously. The muscle moves toward passive insufficiency when the knee is flexed and hip extended. The rectus femoris is innervated by the femoral nerve.

Rectus Femoris: Sartorius Muscle Pectineus Muscle:

S Rectus Femoris: • The only muscles in quadriceps that cross the knee and hip • It is a 2 joint muscle • hip flexion and knee extension • it is susceptible to be moved towards passive insufficiency Stretch: Hip extension and knee flexion Sartorius Muscle: • longest muscle in the body • most efficient when doing all four motions: flexion, abduction, lateral rotation and knee flexion • is most efficient when doing all four motions at the same time an example of this is when you cross your legs by putting forth on the opposite knee Pectineus Muscle: • Most proximal muscle • Hip flexion and adduction why do we need 5 adductors? It keeps the femur on the acetabulum evertime you lift your femur up gravity tries pull the femur out of the acetabulum the adductor muscles keep the femur in the acetabulum so gravity doesn't pull you out

THE ANGLE OF TORSION

THE ANGLE OF TORSION • angle between the neck of the femur and the shaft in the transverse plane • the torsion angle of the femur refers to the twists that exist between the shaft and neck of the femur. In normal development femur projects between 12 to 15° anterior to the femoral shaft. This degree of torsion is called normal antiversion. This torsion contributes to the alignment and congruently of the joint surfaces. A torsion angle less than 12 to 15° is called retro version which forced the hip joint into lateral rotation. A torsion angle greater than 12 to 15° is called excessive anti-version which forced the hip joint into medial rotation position

The 10-year-old boy is noted to have a femoral angle of inclination of 100°. This angle has resulted in maladapted shortening and lengthening of specific muscles around the hip. Please discuss why the muscular shortening and lengthening has occurred. Please identify one muscle that is shortened and that is stretched as a result of angle of inclination.

Ten year old boy • The angle of inclination is the angle between the femoral neck and shaft in the frontal plane. The normal angle of inclination is about 125 degrees. This angle is important because it contributes to maintenance of the head of the femur in a proper weight bearing position within the acetabulum. When the angle is less than 125 degrees, such as in this case, the femur compensates by angling medially so that the position of the head is maintained as close to optimum as possible. An angle of less than 125 degrees is called coxa vara. • Because the femur is angled in the muscles that cross the hip laterally will be stretched while those that cross medially will be shortened. Therefore the gluteus medius may be stretched and the adductor longus may be shortened. • femur angles inward • tibia angles outwards • knees come together • shortening of the adductors • lengthening of the abductors you have to do the opposite together everything back into place in order to get the person to walk properly

Tensor Fascia Late glutus medius

Tensor Fascia Late • Inserts in ITB (Iliotibial band) -"Builds tension in ITB" • Purpose is for lateral stability for hip and knee;; and hold muscles in place • Reverse muscle actions: anterior pelvic tilt and lateral pelvic tilt tensorfasa lata • it's a 2 joint muscle bc it inserts into the IT band, the IT B attaches to the lateral epicondyle of the tibia when it contracts it tightens the fascia that provides support to the lateral aspect of the thigh, it provides a little flexion on the knee because it crosses the knee posteriorly glutus medius o Ex: if you right hip abductors are weak the left side of your pelvis will drop when you stand on your right leg and lift your left leg off the ground. o Ex o every time I pick up one leg the opposite/contralateral glutes medias contracts in order to keep the pelvis up (in a reverse muscle action) o the ipsilateral quadratus lumborum contracts to keep my hip up o they both do it in a reverse muscle action

The Hip Joint

The Hip Joint • Important for weight bearing and walking • The femur articulates with the acetabulum • Very stable joint: therefore it sacrifices some range of motion • Tri-axial joint: moves in all three planes o Flexion / extension (sagittal plane / frontal axis) o Abduction / adduction (frontal plane / sagittal axis) o Internal / external rotation (transverse plane / vertical axis)

pelvic girdle

The two hip bones are connected to each other anteriorly and the sacrum posteriorly • The sacrum is connected distally to the coccyx • These four bones: two hip bones, the sacrum and coccyx make up the pelvic girdle

Iliofermoral Ligament

Three Ligaments the combined actions of these three ligaments is to prevent the hyperextension 4. Iliofermoral Ligament • Most important • Reinforces the capsule anteriorly by attaching proximally to the anterior inferior iliac spine • Splits into two parts distally to attach to the femur • Called the Y ligament or ligament of bigelow • LIMITS HYPEREXTENSION , ADDUCTION AND MEDIAL ROTATION 5. Pubofemoral Ligament • crosses the hip joint medially and inferiorly • it Attaches on the proximately on the medial part of the acetabulum rim and the superior ramus and runs down to attach on the neck of the femur • LIMITS HYPEREXTENSION AND ABDUCTION AND LATERAL ROTATION 6. Ishhiofemoral Ligament • crosses the hip posteriorly • Attaches proximally on the Ischial portion of the acetabulum and attaches distally on the femoral neck • LIMITS HYPEREXTENSION AND MEDIAL ROTATION TOGETHER ALL THESE LIGAMENTS • Attach along the rim of the acetabulum and cross hip joint in a spiral fashion to attach to the femoral neck. • COMBINED EFFORT: LIMIT HYPEREXTENSION • Ligaments become tight during extension Acetabular Labrum • Increases depth of the acetabulum • Fibrocartilage • Located around the rim of acetabulum Iliotibial band IT Band • Very long tendinous portion of the tensor fascia latae muscle • Attaches to the anterior portion of the iliac crest and runs superiorly down the lateral side of the thigh to attach to the tibia

Gracilis Muscle • Only adductor that crosses two joints • Passes behind the knee but attaches anteriorly • Not a hip flexor b/c it crosses the knee joint laterally but attaches anteriorly. • Longus of the abductors • Assists in knee flexion

• If you flex the knee you can get more hip adduction Stretch: abduct hip with knee extension if someone have tight adductors and I laid them down and they could only out a small distance I want to see if the gracilis is playing a signifant role in tightness if I bend the knee take the gracilas off stretch and put on slack and then I can move into more adduction that tells me that the gracilis is playing a role in the limitation of the range of motion