The Hip Complex

Why is the hip stable during bilateral stance?

1. line of gravity sits posterior to axis of the hip joint 2. causes a posterior tilt of the pelvis 3. leads to hip extension (moment torque) 4. closed-packed position when hip is extended 5. causes ilio, pubo, & ischio ligt to become taut 6. support body weight & increase stability

How much of the body weight is distributed in each hip joint?

1/3

bilateral stance: weight distribution

1/3 of body weight is distributed to each hip joint

what is the angle of torsion of the femur in adults?

10 - 15 degrees

what is the angle of inclination of the femur in adults?

125 degrees

what is the normal anterversion of the femur?

15 degrees

quiet standing: compressive forces

2.5 or 3

standing phase of gait: compressive forces

3-4

unilateral stance

5/6 of body weight 2/3 from head and trunk 1/6 from opp. leg

climbing stairs compressive forces

7

what events take place during anterior pelvic tilt?

ASIS moves anterior and inferior

what events take place during posterior pelvic tilt?

ASIS moves posterior and superior

The PT is analyzing a patient's gait cycle with descending stairs. During left single-limb stance, the patient demonstrates a right pelvic drop with left trunk lean. What is the physical therapy hypothesis in this case? A. weak right gluteus medius with left trunk lean to move center of mass toward stronger side B. weak left gluteus with left trunk lean to move center of mass toward weaker side C. weak right gluteus medius with left trunk lean to move center of mass to balance weight distributed

Answer B: weak left gluteus medius with left trunk lean is to move center of mass towards the weaker side A pelvic drop in a single limb midstance is a classic positive Trendelenberg sign of gluteus medius weakness. The compensatory trunk lateral lean is to bring the center of mass closer to the weaker side to decrease the external moment arm on the weak muscle

Evaluation is conducted on a patient who recently resumed full weight bearing after an injury. On assessment, a drop of the pelvis is noted toward the swing leg with visible movement of the hip toward the stance leg. The patient moves the trunk laterally over the stance-phase leg. The patient's gait indicates: A. Quadriceps weakness B. Hip abductor weakness C. Hip extensor weakness D. Hip flexion contracture

B. Hip abductor weakness

Which of the following describes anterior pelvic tilt? A. upward movement of the ASIS, downward movement of the PSIS, lumbar extension B. downward movement of the ASIS, upward movement of the PSIS, lumbar extension C. upward movement of the ASIS, downward movement of the PSIS, lumbar flexion D. downward movement of the ASIS, downward movement of the PSIS, lumbar flexion

B. downward movement of the ASIS, upward movement of the PSIS, lumbar extension

If the line of gravity is posterior to the hip joint in standing, on what does the body first rely to keep the trunk from moving into excessive lumbar extension? A. iliopsoas muscle activity B. abdominal muscle activity C. anterior pelvic ligt of the hip joint capsule D. posterior pelvic ligt of the hip joint capsule

C. anterior pelvic ligt of the hip joint capsule

Which of the following describes posterior pelvic tilt? A. upward movement of the ASIS, downward movement of the PSIS, lumbar extension B. downward movement of the ASIS, upward movement of the PSIS, lumbar extension C. upward movement of the ASIS, downward movement of the PSIS, lumbar flexion D. downward movement of the ASIS, downward movement of the PSIS, lumbar flexion

C. upward movement of the ASIS, downward movement of the PSIS, lumbar flexion

Nadine assess her patient's hamstring ROM in the sitting and standing position. The therapist finds that the patient's ROM is significantly better in the standing position. Which of the following is MOST likely reason for the diminished end range of the knee EXTENSION ROM in sEATING? A. active insufficiency of the quads B. active insufficiency of the hamstrings C. passive insufficiency of the quads D. PASSIVE insufficiency of the hamstrings

D. passive insufficiency of the HAMSTRINGS During standing the hip is slightly extended, if patient flexes knee it will lead to passive inufficiency of the quads

what is the function of the labrum of the hip?

Deepen the socket of the hip maintain contact with the head of the femur

True or False, The pubofemoral ligt's superior band is the strongest in the hip?

False, superior band makes up the iliofemoral ligt

what is the closed packed position of the hip complex?

HIP extension slight abduction internal rotation

what motions lead to the greatest joint congruency?

Hip flexion abduction external rotation

During pelvic drop what motions does the hip and lumbar preform? Regarding R leg weight bearing

Hip R adduction Lumbar R lateral flexion

During hip hike what motions does the hip and lumbar preform? Regarding R leg weight bearing

Hip abduction Lumbar L lateral flexion

During forward rotation what motions does the hip and lumbar preform? Regarding R leg weight bearing

Hip internal rotation Lumbar L rotation

what three bones and fractions make up the acetabulum?

Ilium- 2/5th Ischium- 2/5th Pubis- 1/5th

During forward rotation what motions does the hip and lumbar preform? Regarding L leg weight bearing

LEFT leg is weight bearing - LEFT LEG IS BEHIND Right PELVIS is infront leg I. Rotates NEED RIGHT lumbar rotation to stay forward

The acetabulum faces in what orientation?

Laterally Inferiorly Aanteriorly

A physical therapist is examining a patient and finds that when the patient's feet are together in standing position, the left iliac crest appears lower than the right. However, when the feet are spread apart, the iliac crests are level. This discrepancy is MOST likely caused by tightness of which of the following muscle groups? 1. Right hip abductors 2. Left hip adductors 3. Right hip adductors 4. Left hip abductors

Left hip abductors The iliac crests are level with the hips abducted (feet spread apart), but the right iliac crest is higher when the hips are adducted (feet together). Tightness in the left hip abductors would be the most likely cause, because the tight left hip abductors would be pulling the left hip downward.

During backward rotation what motions does the hip and lumbar preform? Regarding L leg weight bearing

Left leg is weight bearing - LEFT LEG IS FORWARD Right Pelvis is behind leg and E. Rotates NEED LEFT lumbar Rotation to stay forward

The head (proximal end) of the femur faces in what orientation?

Medial Anteriorly Superiorly

Nadine assess her patient's hamstring strength in the sitting and standing position. The therapist finds that the patient's strength is significantly better in the standing position. Which of the following is MOST likely reason for the diminished end range of the knee flexion strength in standing? A. active insufficiency of the quads B. active insufficiency of the hamstrings C. passive insufficiency of the quads D. active insufficiency of the hamstrings

Note: length-tension relationship a two joint muscle works better when it is stretched across another joint active insufficiency when a two-joint muscle is shorten across all joints and can no longer shorten or produce force Hamstrings: flex the knee and extend the hip Standing: hip is extended, if patient does knee flexion that muscle will reach active insufficiency therefore end range of the knee flexion strength

Length- tension relationship of two joint muscles

a two joint muscle acts better across on joint when its stretched across another

While lying prone with your left knee flexed, raise your left leg straight up, keeping your pelvis flat on the table. a. Are the hamstrings contracting at their strongest? b. Why or why not?

a. No b. By having the knee flexed, the hamstrings are already shortened. As the hip goes into more hyperextension, the hamstrings will quickly become actively insufficient. A two-joint muscle acts better across on joint when its stretched across another

Starting in a supine position with the knees flexed, patient moves into pelvic lift in supine with shoulders and feet on floor. a. What type of kinetic chain activity is this? b. What hip motion is occurring? c. What type of contraction is occurring? d. What hip muscle group is the agonist? e. If this motion could not be completed because a muscle was passively insufficient, what muscle would that be?

a. closed chain b. posterior pelvic tilt or hip extension c. concentric d. hip extensors. e. hip flexors

Patient is lying on their back and the PT instructs them to extend or straighten hips and knees. Then to raise their right leg toward the ceiling. .a. Is a concentric or eccentric contraction occurring at the hip? b. The hip flexors are demonstrating what class of lever? c. What force do the hip flexors want to exert at the pelvis? d. What muscle group needs to contract to prevent the motion in (c)?

a. concentric b. third class c. anterior tilt d. trunk flexors and hip extensors

What motions does the hip complex preform in the frontal plane?

abduction and adduction

Specifically, at what degrees does the piriformis preform Hip IR?

above 60 degrees

what makes up the coxofemoral joint?

acetabulum of pelvis head of femur

angle of torsion of femur

angle between an axis of the head/neck of femur and axis through the femoral condyles

angle of inclination of the femur

angle between the axis through head/neck and longitudinal axis of the shaft

what events take place during forward pelvic rotation?

anterior rotation of the contralateral innominate

In what orientation does the iliofemoral ligt stabilize the hip complex?

anteriorly

what orientation of the hip joint capsule is the thickest?

anteriorly

After a long-term history of bilateral lower extremity vascular insufficiency, an otherwise healthy patient had a right femoral amputation. As far as weight bearing for this patient, which of the following factors is MOST correct? a. The unilateral leg must support 2/5 of the body weight b. The unilateral leg must support 5/6 of the body weight c. The unilateral leg must support 4/6 of the body weight

b. The unilateral leg must support 5/6 of the body weight

Specifically, at what degrees does the piriformis preform Hip ER?

below 60 degrees

what does the head of the femur and acetabulum have in common regarding orientation?

both face anterior can cause complications

what two functions lead to joint stability?

congruency + ligament tautness

what abnormalities can the angle of inclination cause?

coxa vara coxa valgum

what joint makes up the hip complex?

coxofemoral joint

what is retroversion and results?

decrease in angle of inclination lower extremity external rotation

coxa vara

decreased angle of inclination 105 degrees

what events take place during pelvic drop?

depression of the contralateral iliac crest

what events take place during hip hiking?

elevation of the contralateral iliac crest

what are some abnormalities in the angle of torsion?

excessive anteversion retroversion

True or False. the ligamentum teres helps stabilize the acetabulum to the fovea of the femur?

false, NOT A STABILIZER provides secondary source of blood for the femoral head/neck

What motions does the hip complex preform in the sagittal plane?

flexion and extension

what are the effects of unilateral stance?

frontal plane disruption of hip and pelvis must support 5/6 of body weight

what are the arthrokinematics of the coxofemoral joint?

head of femur: convex acetabulum of pelvis: concave convex on concave - move in opposite direction

During posterior tilt what motions does the hip and lumbar preform?

hip extension lumbar flexion

During therapy, PT places the patient from 90 degrees of flexion into 120 degrees of flexion. What muscles are being stretched?

hip extensors

During anterior tilt what motions does the hip and lumbar preform?

hip flexion lumbar extension

During therapy, PT places the patient from 20 degrees of extension into 45 degrees of extension. What muscles are being stretched?

hip flexors

what two ligaments stabilize the hip complex anteriorly?

iliofemoral ligt pubofemoral ligt

what two ligts in the hip complex form a Z and stabilize the anterior portion?

iliofemoral ligt pubofemoral ligt

what ligaments stabilize the hip complex?

iliofemoral ligt pubofemoral ligt ischiofemoral ligt

what is excessive anterversion and results?

increase in the angle of inclination lower extremity internal rotation

The pelvis or ox coxae is also known as?

innominate

What motions does the hip complex preform in the transverse plane?

internal and external rotation

what structures of the joint capsule are intracapsular or extracapsular?

intracapsular femoral neck extracapsular trochanters

what ligts stabilize the hip complex posteriorly?

ischiofemoral ligt

coxa valgum

large angle of inclination 140 degrees

What motions does the pelvis preform in the transverse plane?

pelvic rotation forward rotation backward rotation

What motions does the pelvis preform in the frontal plane?

pelvic tilt hip hiking pelvic drop

What motions does the pelvis preform in the sagittal plane?

pelvic tilt anterior and posterior

what events take place during backward pelvic rotation?

posterior rotation of the contralateral innominate

In bilateral stance, where does the line of gravity fall?

posterior to the axis of the hip joint

In what plane is the hip muscle torque the greatest?

sagittal plane: EXTENSORS, flexors

What important structures increase the congruency of the hip complex?

the tautness of the hip ligaments

gluteus medius gait

trunk lean over the stance leg

Trendelenburg gait

weakness in gluteus medius pelvic drop the swing leg

labrum of the hip

wedge shaped fibrocartilage that rings the acetabulum