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Kinesiology of the Musculoskeletal System Chapter 12

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Title: Kinesiology of the Musculoskeletal System Chapter 12


1
Kinesiology of the Musculoskeletal
SystemChapter 12
  • The Hip

2
Anatomical Structures of the Hip
  • Acetabulum
  • Acetabular labrum
  • Articular cartilage
  • Femoral head
  • Joint capsule and ligaments
  • Ligamentum teres
  • Hip musculature

3
Acetabulum
4
Femoral Angle of Inclination
  • Angle of Inclination angle within the frontal
    plane between the femoral neck and the medial
    side of the femoral shaft
  • Average adult measurement of 125 degrees
  • Newborns born with 140-150 degree angle which
    reduces to approximately 125 degrees with onset
    of standing/walking
  • Coxa Vara A of I markedly less than 125 degrees
  • Coxa Valga A of I markedly greater than 125
    degrees

5
Angle of Inclination
6
Femoral Torsion Angle
  • Torsion angle relative rotation (twist) that
    exists between the shaft and neck of the femur
  • Average adult measurement of 10-15 degrees of
    anterior rotation (Anteversion) of femoral head
  • Newborn TA typically 30 degrees of anteversion
    which reduces to 10-15 degrees by 6 years of age

7
Femoral Torsion Angle (cont.)
  • Normal Anteversion 10-15 degrees allows optimal
    alignment and joint congruency
  • Excessive Anteversion TA significantly greater
    than 15 degrees
  • Often associated with congenital dislocation in
    the infant marked joint incongruence and
    increased degenerative wear
  • Compensated excessive anteversion may result in
    toeing-in gait pattern (pigeon toed)
  • Retroversion TA significantly less than 15
    degrees (i.e. 5 degrees of anteversion)
  • Less common than excessive anteversion

8
Excessive Femoral Anteversion
9
Hip Joint Capsule Ligaments
10
Hip Labrum and Articular Cartilage
  • Acetabular labrum fibrocartilage extension of
    acetabulum adds depth and stability to the joint
  • Articular cartilage maximal thicknesses of
    acetabular and femoral articular cartilage is
    aligned at their superior-anterior aspects
  • Maximal joint reactive forces and pressures seen
    at the superior-anterior aspect of the acetabulum
  • Joint pressure increases 3X at mid stance phase
    of walking due to transfer of weight and IMA of
    ipsilateral pelvic stabilizing abductor muscle
    group

11
Hip Capsule and Ligaments
  • Hip joint capsule reinforced externally with
    tough capsular ligaments
  • Capsule lined internally with synovial membrane
  • Ligaments and capsules are secondary joint
    stabilizers
  • Normal capsule and
  • ligaments limit
  • extreme hip ROM
  • pathological tightness
  • may limit normal
  • functional hip joint
  • ROM

12
Hip Capsule and Ligaments (cont.)
  • Iliofemoral ligament -one of the thickest and
    strongest in the body can effectively prevent
    extreme hip extension can support body weight in
    pathological conditions such as Cerebral Palsy

13
Closed Pack Position of the Hip
  • CPP unique position of the hip joint where the
    articular surface is most congruent and the
    ligaments are maximally taut
  • Full passive hip extension coupled with slight
    internal rotation and abduction maximally
    stretches the capsule and maintains congruency
  • Passive hip flexion coupled with internal
    rotation and abduction stretches the capsule but
    is moving away from joint congruency this is a
    common pathological capsular pattern

14
Osteokinematics of the Hip
15
Femoral on Pelvic Motion
  • F on P Motion occurs when hip joint action occurs
    as a result of the femur moving on a relatively
    fixed or stationary pelvis
  • F on P motion can be closed or open chain
    movement
  • Closed Chain i.e. Squat Stance phase of gait
  • Open Chain Standing hip extension exercise
    Swing phase of gait

16
Femoral on Pelvic Motion (cont.)
  • Passive hip flexion limited to 80-90 degrees by
    hamstrings when knee is extended otherwise to
    120 degrees
  • Passive hip extension is to 20 degrees with an
    extended knee or to approximately 0 degrees with
    fully flexed knee due to rectus femoris tightness

17
Femoral on Pelvic Motion (cont.)
  • Abduction is to 40 degrees limited by capsular
    ligaments, adductor and hamstring muscles
  • Adduction limited to about 25 degrees due to
    interference from other limb, and/or due to
    abductor muscles, iliotibial band or hip capsule
  • Internal Rotation is to about 35 degrees
  • External Rotation is to about 45 degrees may be
    limited by hip capsule, iliotibial band or tensor
    fascia latae muscle

18
Femoral on Pelvic Motion
19
Lumbopelvic Rhythm
  • LPR the kinematic relationship between the
    lumbar spine and hip joints during sagittal plane
    movement
  • Ipsi-directional LPR when pelvis and lumbar
    spine move in same direction useful for
    activities such as extending the reaching
    capacity of the upper extremities
  • Contra-directional LPR when the pelvis and the
    lumbar spine move in opposite directions seen in
    walking, dancing, or any other activity in which
    the position of the supralumbar trunk must be
    held fixed

20
Lumbopelvic Rhythm
21
Pelvic on Femoral MovementFlexion/Extension
  • Standing Flexion limited to 80-90 degrees
    ipsi-directional LPR
  • Standing Extension limited to about 20 deg
    contra directional LPR
  • Pelvic tilt anterior or posterior movement of
    the pelvis (reference point on iliac crest) on
    stationary femoral heads, offset by
    contra-directional LPR

22
Contra-Directional Lumbopelvic RhythmPelvic Tilt
Anterior Posterior
23
Pelvic on Femoral Motion
24
Pelvic on Femoral MovementAbduction/Adduction
  • Abduction active hip hiking of opposite
    hip/pelvis via contra directional LPR limited to
    30 degrees by lumbar spine ROM
  • Adduction accomplished through lowering of
    opposite hip/pelvis via contra directional LPR
    total adduction determined by lateral myofascial
    elements in non-pathological hip rather than by
    lumbar spine ROM

25
Pelvic on Femoral MovementInternal/External
Rotation
  • Internal Rotation forward rotation (anterior)
    of opposite hip/pelvis in the horizontal plane
  • External Rotation backward (posterior) of
    opposite hip/pelvis in the horizontal plane
  • P on F Rotation on a relatively stationary trunk
    is limited by lumbar spine rotational limitations
  • If the lumbar spine rotation accompanies hip
    rotation, hip rotation becomes limited by hip
    joint capsular or boney limitations

26
Hip Muscle Groups
  • Hip Flexors
  • Primary iliopsoas, rectus femoris, TFL,
    sartorius, adductor longus, pectineus
  • Hip Adductors
  • Primary Adductor longus, brevis magnus,
    pectineus, gracilis
  • Hip Internal Rotators
  • Primary gluteus medius minimus, TFL

27
Hip Muscle Groups (cont.)
  • Hip Extensors
  • Primary gluteus maximus, hamstrings
  • Hip Abductors
  • Primary gluteus medius minimus, TFL
  • Hip External Rotators
  • Primary gluteus maximus, piriformis, deep
    external rotator muscles

28
Lumbopelvic Stabilization
29
P on F F on P Adduction
30
Dual Action of Muscles
31
P on F Hip Abduction and Pelvic Stabilization
32
Hip Abductors Pelvic Stabilization
  • Poor pelvic stabilization can occur as a result
    of functionally weak hip abductor muscles or as
    a result of underlying pathology (muscular
    dystrophy, hip arthritis, hip instability).
  • Trendelenburg sign dropping of the opposite hip
    and pelvis upon single leg support indicates
    poor pelvic stabilization does not identify
    cause of instability
  • May be compensated for by leaning over the
    unstable hip

33
Trendelenburg Sign
34
Posterior Pelvic Tilt
35
P o F External Hip Rotation
36
Hip External Rotators
Gluteus Maximus
37
P on F External Rotation
38
References
  • Neumann, D. Kinesiology of the Musculoskeletal
    System. 2002. Human Kinetics.
  • www.rad.washington.edu/atlas
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