Hip Joint and Pelvic Girdle

Hip Joint and Pelvic Girdle

Bones Involved
A. Pelvic bone - made up of three fused bones: the ilium, ischium and pubis. B. Sacrum - articulates with the pelvic bone, and is made up of five fused bones. C. Femur - the longest bone in the body.

Sacro-iliac (SI) Joint

Hip Joint and Pelvic Girdle

Joints Involved
A. Symphysis pubis - an amphiarthrodial joint in which the two pelvic bones are connected. Found in the anterior portion of the pelvis. B. Sacroiliac joint - a mixed diarthrotic/amphiarthrotic joint that is formed by the two pelvic bones and the sacrum. This joint is in the posterior portion of the pelvis. C. Hip joint - an enarthrodial joint formed by the head of the femur inserting into the socket provided by the acetabulum of the pelvis.

Pelvic Girdle Movements

 There

are no joints within pelvis where movement is normal.  SI joint and joints between ilium, ischium and pubis essentially fused.  Combination of movements of spinal column and hip joint result in pelvic motion.

Pelvic Girdle Motions

A. Anterior rotation - Movement of the upper
pelvis in anterior fashion; the iliac crest tilts forward (anterior tilt). Trunk extension, hip flexion.

B. Posterior rotation - Movement of the upper

pelvis in posterior fashion; the iliac crest tilts backward (posterior tilt). Trunk flexion, hip extension

C. Right lateral tilt - the right ilium moves downward

in the frontal plane in relation to the left ilium. Combination of right lateral flexion of trunk, adduction of left hip and abduction of right hip.

Pelvic Girdle Movements

Anterior pelvic rotation Posterior pelvic rotation

Pelvic Girdle Motions

D. Left lateral tilt - The left ilium moves downward in
the frontal plane in relation to the right ilium. A combination of left lateral flexion of the trunk, adduction of the right hip and abduction of left hip.

E. Left transverse rotation - The pelvis rotates left

in the transverse plane. The right iliac crest moves anteriorly in relation to the left iliac crest.

F. Right transverse rotation - The pelvis rotates right

in the transverse plane. The left iliac crest moves anteriorly in relation to the right iliac crest.

Pelvic Girdle Movements

Left lateral pelvic tilt Right transverse pelvic rotation

Hip Ligaments

Anteriorly, the iliofemoral or Y, ligament prevents hip hyperextension. Pubofemoral ligament is anteromedial and inferior and limits hyperextension and excessive abduction.

Movements
The pelvic girdle is a highly moveable, relatively stable joint. The hip joint, although freely moveable, is not as stable as the pelvic girdle because it does not contain as many stable, bony joints.

Hip joint movements

A. Flexion - movement of the femur straight anteriorly toward the pelvis. B. Extension - Movement of the femur straight posteriorly away from the pelvis.

Hip Flexion

Hip Extension

Hip Joint Movements

C. D.

E.

F.

Abduction movement of the femur laterally to the side away from midline. Adduction movement of the femur medially toward the midline. External rotation rotary movement of the femur around its long axis anterior surface moves away from midline (laterally). Internal rotation rotary movement of the femur around its long axis toward midline.

Hip Adduction

Hip Abduction

Lateral Rotation = External Rotation

Medial Rotation = Internal Rotation

Pelvis and Hip Motions

Pelvic rotation Anterior rotation Posterior rotation Right lateral tilt Left lateral tilt Right transverse rotation Left transverse rotation Lumbar spine motion Right hip motion Extension Flexion Left lateral flexion Right lateral flexion Left lateral rotation Right lateral rotation Flexion Extension Abduction Adduction Internal rotation External rotation Left hip motion Flexion Extension Adduction Abduction External rotation Internal rotation

Muscles
There are 16 muscles in this section. Six of these muscles also play a role in the knee joint. In order to facilitate learning, we will divide the muscles into four groups. What are the four primary hip flexors, found on the anterior portion of the hip joint/pelvic girdle? 1. Iliopsoas 2. Pectineus 3. Rectus femoris* 4. Sartorius*

Muscles
What are the five primary hip extensors, found in the posterior portion of the hip joint/pelvic girdle? 1. Gluteus maximus 2. Biceps femoris* 3. Semitendinosus* 4. Semimembransosus*

5. External rotators What are the four primary abductors, found on the lateral side of the hip joint/pelvic girdle. 1. Gluteus medius 3. Tensor fasciae latae* 2. Gluteus minimus 4. External rotators

Muscles
What are the four primary adductors, found on the medial side of the hip joint/pelvic girdle? 1. Adductor brevis 2. Adductor longus 3. Adductor magnus 4. Gracilis*

Primary hip flexors

A. Iliopsoas - this muscle is actually a combination of two muscles, the psoas major and the iliacus. This muscle is the strongest hip flexor. What are the actions of the iliopsoas? Hip flexion and external rotation What exercises can be used to strengthen the iliopsoas? Supine leg raises Leg lifts from parallel bar Multi-hip machine

Pectineus

Iliopsoas

Primary hip flexors

B. Pectineus muscle - this muscle is sometimes considered an extension of the iliopsoas. It is the uppermost muscle of the medial thigh muscles, and is grouped with the hip flexors because its primary action is hip flexion. What are the actions of the pectineus? Hip flexion Hip adduction

Equivocal hip external rotation

Primary hip flexors

What are exercises used to strengthen the pectineus?

Leg raises as for iliopsoas Flexion and adduction against resistance [External rotation against resistance]
Note: The pectineus tends to rotate the pelvis anteriorly by pulling the symphysis pubis downward as it contracts. The abdominals, which also are attached to the symphysis pubis, prevent this action. The pectineus is sometimes considered part of the adductor muscle group.

Primary hip flexors

C. Rectus femoris - the rectus femoris is part of the quadriceps group. It is the only muscle in the quads that cross the knee and hip joints. Its combined actions are seen as the leg is swung forward in walking. What are the actions of the rectus femoris? Hip flexion and knee extension What exercises strengthen the rectus femoris? Leg raises, leg lifts, multi-hip machine Leg extensions, leg presses, squats

Rectus Femoris

Primary hip flexors

Note: Like the pectineus, the rectus femoris tends to rotate the pelvis forward as it contracts. Again, the abdominal muscles keep the pelvis fixed. Weak abdominals can cause the pelvis to rotate, creating lordosis of the lumbar spine. When doing sit-ups or crunches, why is it important to do the exercise with the knees bent? To shorten thus neutralize the hip flexors and concentrate on the abdominal flexors.

D. Sartorius muscle - the longest muscle in the body, it is the most superficial thigh muscle and forms the lateral border of the femoral triangle. Its name is derived from
Sartorius

the Latin word for tailor, sartor, to indicate its action of bringing the leg into a cross legged sitting position. Not a powerful muscle, it only assists in its actions.

Primary hip flexors

What are the actions of the sartorius muscle? Hip flexion Knee flexion External rotation of thigh as it flexes knee and hip Exercises to strengthen the sartorius include leg lifts, leg raises, etc. as for the iliopsoas. Note: the sartorius is another muscle that tends to move the pelvis as it contracts. This muscle is most known for its ability to help cross the leg.

Primary hip extensors

A. Gluteus maximus - Gluteus is Greek for rump. It is used mostly for power, as in going upstairs, rising from a sitting position, climbing, or running rather than walking. What are the actions of the gluteus maximus? Hip extension External rotation

Upper fibers abduction, Lower fibers adduction

Gluteus Maximus

Primary hip extensors

Name some exercises used to strengthen the gluteus maximus? Extension on multi-hip machine Squats Lunges Leg press
Notes: To emphasize this muscle, do hip extension with the knee flexed. This will remove the action of the hamstrings. Used more in running than walking, because the hip must be extended beyond 15 degrees to involve the gluteus maximus.

Primary hip extensors

B. Biceps femoris - This muscle is one of the three muscles that form the hamstring group. What are the four actions of the biceps femoris? Hip extension Knee flexion External rotation of hip External rotation of knee when flexed Name some exercises to strengthen the biceps femoris? Hamstring curls prone or standing Hip extension with knee extended

Biceps Femoris Long Head

Biceps Femoris Short Head

Primary hip extensors

C. Semitendinosus - this muscle is the middle of the hamstring group. The inability to touch the toes while keeping the knees extended is largely due to shortened, inflexible hamstring muscles. What are the four actions of the semitendinosus? Hip extension Knee flexion Internal rotation of hip Internal rotation of knee

Strengthening exercises include leg curls and hip extension. Isolated more if knee is internally rotated during motion.

Primary hip extensors

D. Semimembranosus - The third muscle in the hamstring group. Order from lateral to medial, their initials, BTM, indicates their arrangement at the bottom of the thigh. Name the actions of the semimembranosus. Hip extension Knee flexion Internal rotation of hip Internal rotation of knee

Exercises to strengthen the semimembranosus are the same as the semitendinosus, as they have similar actions.

Primary hip extensors

E. External rotators - this group of six muscles will be considered as one in our studies. What are the actions of the external rotators? External rotation of the hip ??Hip extension?? Exercises to strengthen the external rotators would include anything that externally rotates against resistance.
Note: Used greatly in activities that require taking off one leg. Long jump, high jump, swinging bat, throwing a ball.

Primary hip abductors

A. Gluteus medius - when standing on one foot, this muscle contracts on that side to keep the pelvis from tilting to the unsupported side. Alternate contraction of these muscles occurs in walking. Paralysis of this muscle on one side results in the gluteus medius limp: the pelvis tilts toward the unsupported side in walking.

Gluteus Medius

Primary hip abductors

What are the actions of the gluteus medius? Abduction of the hip Posterior fibers -External rotation, extension Anterior fibers -Internal rotation, flexion What are some exercises to strengthen the gluteus medius? Side lying leg raises Multi-hip machine

Primary hip abductors

B. Gluteus minimus muscle - The gluteus minimus works with the gluteus medius. What are the actions of the gluteus minimus? Abduction Internal rotation with abduction Exercises to strengthen the gluteus minimus are similar to those used to strengthen the gluteus medius.

Gluteus Minimus
Deepest of 3 gluteal muscles

Primary hip abductors

C. Tensor fasciae latae combines with gluteus maximus to unite with fasciae latae which inserts on lateral condyle of tibia.
What are the actions of the tensor fasciae latae? Abduction of hip Flexion of hip Internal rotation of hip Name some exercises to strengthen the TFL? Hip abduction (multi-hip) Supine leg raises with femur internally rotated

Tensor Fasciae Latae

Primary hip abductors

Notes: The tensor fasciae latae aids in preventing external rotation of the femur as it is flexed. It helps keep the foot placed straight forward in walking and running. This muscle also prevents collapse of the knee in walking. D. External rotators - the external rotators are part of the abductor group as well as the extensor group.

Primary hip adductors

A. Adductor brevis - This muscle is found deep to the adductor longus. It is the smallest adductor muscle. What are the actions of the adductor brevis? Adduction and external rotation Exercises to strengthen the adductor brevis include medial leg raises from a side-lying position, a multi-hip machine and the thigh master.

Adductor Magnus Adductor Brevis Adductor Longus Gracilis

Primary hip adductors

B. Adductor longus muscle-This muscle can be palpated just below its proximal attachment at the medial aspect of the groin. What are the actions of the adductor longus? Adduction and hip flexion (assistor) Exercises to strengthen the adductor longus include the same as those for the adductor brevis as well as hip flexion exercises.

Primary hip adductors

C. Adductor magnus muscle - the adductor magnus is the longest and deepest adductor muscle. What are the actions of the adductor magnus? Adduction and external rotation Exercises to strengthen the adductor magnus would be the same as the other adductors with the inclusion of external rotation exercises.

Primary hip adductors

D. Gracilis muscle - the femoral shaft and the gracilis form the shape of the letter V. It is the most superficial adductor. What are the actions of the gracilis? Hip adduction, internal rotation and knee flexion Strengthening exercises would include adduction exercises as well as knee flexion and internal rotation exercises.

Hip Injuries
Most serious hip injuries happen to older individuals. Fortunately, athletes do not suffer many hip injuries since the joint is so well protected. A. Contusions - usually the result of a direct blow to a body part such as the quads (charlie horse) or pelvic area (hip pointer). Very painful and debilitating. If not treated properly, can lead to myositis ossificans.

Hip Pointer (Contusion)

Hip Injuries
B. Myositis ossificans - condition in which calcification develops following repeated trauma. Can be caused by poor treatment such as over vigorous massage, overly strenuous exercise or returning too soon from an injury.