Therapeutic Exercise: The Hip

Therapeutic Exercise
Foundations and Techniques

Part IV
Exercise Intervention by Body Region
Chapter 20
The Hip
Lahore Medical and Dental College
Structure and Function f Hip
Designed for weight bearing and transmitting forces
 The pelvic girdle links the lower extremity to the
trunk
 The bones of the hip joint
1. proximal femur
2. pelvis
Pelvis
 Parts
1. Ileum
2. Ischium
3. Pubis
 Articulations
1. Anteriorly pubic symphysis
2. posteriorly with the sacrum
ANATOMY (Hip Bone)
ANATOMY (Hip Bone)
Femur
The Femur
 Head Neck
 Neck
 Long bone
Angle of inclination
(normally125 degree)
Between the axis of the femoral
neck and the shaft of the femur
.
Femur
The angle of torsion
(8 to 25 degree)
Between trans- verse axis of the
femoral condyles and
the axis of the
neck of the femur
ANATOMY(Femur)
ANATOMY(Femur)
Hip Capsule Ligaments
Hip Capsule Ligaments
Hip Joint Characteristics and
Arthrokinematics
The hip is a ball-and-socket triaxial joint
 Bones
1. Head of the femur
2. Acetabulum of
 Ligaments
1. Iliofemoral
2. pubofemoral
3. ischiofemoral
Arthrokinematics
FUNCTIONAL RELATIONSHIPS
OFTHE HIP AND PELVIS
Pelvic Motions and Muscle Function
 Anterior Pelvic Tilt

 Posterior Pelvic Tilt
 Pelvic Shifting
 Pelvic Rotation
FUNCTIONAL RELATIONSHIPS
OF THE HIP AND PELVIS
Arthrokinematics
1. Flexion and Extension in Sagittal Plane

Arthrokinematics
• Abduction and Adduction in the Frontal Plane

Arthrokinematics
• Internal and External Rotation in the Horizontal
Plane
Arthrokinematics
1. Flexion and Extension in Sagittal Plane
Anterior Pelvic Tilt
ASIS moves anteriorly and inferiorly
pelvis rotates forward

around the tranverseverse
axis of the hip joints
increased lumbar spine

extension
Muscle Used
hip flexors and
Back extensors.
Posterior Pelvic Tilt
PSIS moves posterior and Inferiorly
pelvis rotates backward

around the axis of the hip joints
Hip extension and lumbar

spine flexion
Muscle Work
• Hip extensors
• Trunk flexors.
Pelvic Shifting
During standing, a forward translatory shifting of the
Pelvis
Hip Extention & Lower Lumber extension
.
posterior shifting of the thorax
increased flexion of these spinal segments.
Muscle Work
Little muscle is required

Lateral Pelvic Tilt
Frontal plane pelvic motion
Opposite motions at each hip joint
Hip adduction at Elevated side

Hip abduction at Lowered side
Muscle Work
Quadratus lumborum (Elevated Pelvis)
Gluteus medius (lowered Pelvis)
Pelvic Rotation
 lower extremity that is fixed on the ground
 The unsupported lower extremity swings Forward or backward
along with the pelvis.
Forward Rotation
Unsupported side of pelvis moves forward
Backward Rotation
Unsupported side of
Pelvis moves
Backward
Lumbopelvic Rhythm
• During maximum forward bending of the trunk
• pelvis shifts posteriorly to maintain the center of
gravity over the base
• At the end Range of bending Pelvis shift anteriorly
• Return to the upright
position pelvis
shift posteriorly
Pathomechanics of Hip joint
Hip pathologies contribute to stress in the

spine or other joints of the lower extremities.
 Decreased Flexibility
 Asymmetrical Leg Length
 Coxa valga and coxa vara
 Anteversion and retroversion.
Hip Muscle Imbalances Related
to Postural Impairments
Anterior Pelvic Tilt Posture
• Short TFL and IT band
• Limited Hip External Rotation
• Week Gluteus medius and piriformis
• Excessive medial rotation of the femur during
Gait
• Associated lower extremity compensations
Hip Muscle Imbalances Related
Slouched Posture
• Shortened rectus femoris and hamstrings
• General limitation of hip rotators
• Weak, stretched iliopsoas
• Weak and shortened gluteus medius
• Weak, poorly developed gluteus maximus

Hip Muscle Imbalances
Related
Flat Back Posture
 A shortened
• Rectus femoris,
• IT band
• Gluteus maximus
 Variations of the above
two postures
THE HIPAND GAIT
Normal gait cycle
 40 degree of flexion and extension at Hip
 10 degree of Abduction at hip
 Lateral pelvic tilt
 15 degree of hip Ext/Int and Pelvic rotation
• Loss of any of these motions affects the

smoothness of the gait pattern
Hip Muscle Function During Gait
Hip Flexors
• control hip extension
• Initiate swing.
With loss of flexor function, a posterior lurch of the
trunk to initiate swing is seen.
Contractures in the
hip flexors Lumber lordosis
Hip Muscle Function During Gait
Hip Extensors
• Control the flexor moment at initial foot contact
• initiates hip extension
With loss of Extension function a posterior lurch of
the trunk occurs at foot contact
Contracture of Hip Extensor range in the terminal swing

Hip Abductors
• Control the lateral pelvic tilt during
swinging of the opposite leg
• With the loss of Abduction

lateral shifting of the
trunk occurs over the
weak side during stance
REFERRED PAINAND NERVE
•
INJURY
Hip is innervated primarily from the L3 spinal level
• Hip joint irritation is
usually felt along the
L3 dermatome from
the groin, down the front
of the thigh to Knee
Major Nerves Subject to Injury or
Entrapment
• Sciatic nerve
• Obturator nerve
• Femoral nerve
Common Sources of Referred
Pain
in the Hip and Buttock Region
• Nerve roots or tissues derived from spinal
• segments L1,L2, L3, S1, and S2
• Lumbar intervertebral and sacroiliac joints

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Therapeutic Exercise

Foundations and Techniques

Pelvic Motions and Muscle Function

 Anterior Pelvic Tilt

1. Flexion and Extension in Sagittal Plane

• Abduction and Adduction in the Frontal Plane

pelvis rotates forward

increased lumbar spine

pelvis rotates backward

Hip extension and lumbar

Hip Extention & Lower Lumber extension

Little muscle is required

Opposite motions at each hip joint

Hip adduction at Elevated side

Hip pathologies contribute to stress in the

• Shortened rectus femoris and hamstrings

• General limitation of hip rotators

• Weak, stretched iliopsoas

• Weak and shortened gluteus medius

• Weak, poorly developed gluteus maximus

• Loss of any of these motions affects the

Contracture of Hip Extensor range in the terminal swing

• With the loss of Abduction

• Nerve roots or tissues derived from spinal

• segments L1,L2, L3, S1, and S2

• Lumbar intervertebral and sacroiliac joints

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