Hip Biomechanics SRS

THE HIP COMPLEX BIOMECHANICS
1
HIP JOINT
• Diarthrodial joint with 3 DoF.
• Flexion/extension in sagittal
plane
• Abduction/adduction in frontal
plane
• Medial/lateral rotation in
transverse plane
• The primary function of the hip
joint is to support the weight of
the Head, Arms, and Trunk
(HAT) both in static erect posture
and in dynamic postures.
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PROXIMAL ARTICULAR SURFACE
• The acetabulum (lunate surface)
is formed by the union of the
three bones of the pelvis, with
only the upper horseshoe-
shaped area being articular.
• Full ossification of the pelvis
occurs between 20 and 25
years of age.
• The acetabulum is positioned
laterally with an inferior and
anterior tilt.
Levangie PK, Norkin CC. Joint structure and function : a comprehensive analysis. 5th ed. Philadelphia, Pa: F.A.
Davis Company; 2011. p. 356–94. Sreeraj 3
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ACETABULAR ANTEVERSION
• Acetabular anteversion angle
describes the extent to which the
acetabulum surrounds the
femoral head in the horizontal
Anterior edges
plane.
• A value of 20 degrees is typical.
• Excessive anteroversion may Posterior edges
lead to anterior joint dislocation
(especially during excessive
external rotation).
Nick D, Jim N, Stefan K .Combined Acetabular and Femoral Version Angle in Normal Male and Female
Populations From CT Data. The British Editorial Society of Bone & Joint Surgery. 2013 95(15): 168-168.
doi: 10.1302/1358-992X.95BSUPP_15.ISTA2012-168 Sreeraj 4
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ACETABULAR TILT ANGLE
• Acetabular tilt is an index of
rotational position of the ASIS
acetabulum with reference to the
anterior pelvic plane.
• tilted 20° in sagittal plane.
pubic
tubercles
Fujii M, Nakashima Y, Sato T, Akiyama M, Iwamoto Y. Acetabular tilt correlates with acetabular
version and coverage in hip dysplasia. Clin Orthop Relat Res. 2012;470(10):2827–2835.
doi:10.1007/s11999-012-2370-z Sreeraj 5
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ACETABULAR INCLINATION ANGLE
• Defined as the angle between
the supero inferior acetabular
axis and the longitudinal axis in Superior edge
frontal plane.
• 50° is typical.
Inferior edge
Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg
Br. 1993 Mar;75(2):228-32.
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CENTRE EDGE ANGLE
• Centre edge angle of Wiberg:

25 – 300 normal
• <16°definite dysplasia
• 16° to 25° possible dysplasia
• >40° may indicate Coxa
profunda
The CEA is formed between a vertical line
through the center of the femoral head and a
line connecting the center of the femoral head
and the bony edge of the acetabulum.
The acetabular labrum deepens the acetabulum.
Levangie PK, Norkin CC. Joint structure and function : a comprehensive analysis. 5th ed.
Philadelphia, Pa: F.A. Davis Company; 2011. p. 356–94. Sreeraj 7
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ACETABULAR LABRUM
1. A fibrocartilaginous rim
attached to the margin of the
acetabular socket.
2. Deepens the acetabular socket.
3. With the transverse acetabular
ligament it forms a complete
circle.
• Nerve endings within the labrum
not only provide proprioceptive
feedback but can also be a
source of pain.
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DISTAL ARTICULAR SURFACE
• The articular area of the
femoral head forms
approximately two thirds of a
sphere and is more circular than
the acetabulum.
• The femoral neck is angulated so
that the femoral head faces
medially, superiorly, and
anteriorly with respect to the
femoral shaft and distal femoral
condyles.
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ANGLE OF INCLINATION
• The axis of the femoral head
and neck forms an angle with Coxa Valga Normal Coxa Vara
the axis of the femoral shaft
called the angle of inclination.
• The angle of inclination of the
femur approximates 125°
normally
• With a normal angle of
inclination, the greater
trochanter lies at the level of the
center of the femoral head.
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• Coxa valga leads to;
•  bending force across
femoral neck
•  in lateral trabecular system
•  Abductor force
•  the contact of femoral
articular surface with
acetabulum.
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• Coxa vara leads to;
•  bending force along
femoral neck.
•  tensile stress on lateral
trabecular system
•  the predisposition toward
femoral neck fracture.
•  chance of slipped capital
femoral epiphysis in
adolescence
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ANGLE OF TORSION
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ANGLE OF TORSION
• Anteversion: > 15-180
• Retroversion: < 15-180
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ANTEVERSION
In the supine position with the femoral condyles In standing, the anteverted femur tends to
parallel to the supporting surface, the medially rotate within the acetabulum, resulting
anteverted femoral head is exposed anteriorly. in medial rotation of the femoral condyles in
Lateral rotation will be limited, but medial relation to the plane of progression leading to
rotation is relatively excessive. medial femoral torsion.
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ANTEVERSION
• Reduces hip joint stability because the femoral articular surface is more
exposed anteriorly.
• Excessive femoral anteversion can cause instability, damage of the
articular cartilage and acetabular labrum, and eventually osteoarthritis.
• It can cause a decrease in the length of the abductor lever arm resulting
in additional abductor muscle force requirement.
• May cause increased hip and knee adduction moments, an intoeing gait
and patellofemoral maltracking, with resultant knee pain and arthritis.
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RETROVERSION
• Femoral retroversion can cause damage to the labrum and articular
cartilage, due to impingement between the femoral neck and
acetabulum leading to osteoarthritis of the hip.
• An increased risk of slipped capital femoral epiphysis
• Susceptibility to a traumatic posterior hip dislocation.
• Residual, untreated femoral retroversion may be a reason why hip
preserving surgeries may fail, especially after the arthroscopic
treatment of hip impingement.
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COAPTATION OF THE ARTICULAR SURFACES
• In the neutral or standing
position, the articular surface of
the femoral head remains
exposed anteriorly and
somewhat superiorly.
• Not a true physiological position
of the hip joint. (Kapandji)
• Maximum articular contact of Levangie PK, Norkin CC
the head of the femur with the

acetabulum is obtained when the
femur is flexed, abducted, and
laterally rotated slightly.
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• The stability of the hip joint is assisted
by gravity, in the straight position by
opposing forces (ascending white arrow)
opposite to the body weight (descending
white arrow).
• The acetabular labrum, widens and

deepens the acetabulum (black arrows),
setting the stage for a fibrous
https://en.wikipedia.org/wiki/Zona_orbicularis
interlocking and retaining system.
• The labrum retains the femoral head
with the help of the zona orbicularis of
the fibrous capsule , which holds the
femoral neck tightly (shown in small blue
arrows). Kapandji AI
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• Atmospheric pressure plays an
important part in securing the
articular coaptation of the hip
joint.
• The acetabular fossa may be
important in setting up a partial acetabular fossa
vacuum in the joint so that
atmospheric pressure contributes
to stability by helping maintain
contact between the femoral
head and the acetabulum. Kapandji AI
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• The periarticular ligaments and
muscles are vital in maintaining the
coaptation of the articular surfaces.
• Their functions are reciprocally
balanced. (Figure horizontal section)
• Thus anteriorly the muscles are very
few (blue arrow) and the ligaments (black
arrows) are strong, while posteriorly the
muscles (red arrow) predominate.
• This coordinated activity keeps the Kapandji AI
femoral head (green arrow) closely
applied to the acetabulum.
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extension
• Tensed ligaments in extension are
efficient in securing coaptation.
• In flexion the ligaments are slack, and
the opposite happens.
• This mechanism can be easily
understood using the mechanical
model, where
a. parallel strings run between two flexion
wooden circles
b. When one circle is rotated relative
to the other, they are brought
closer together.
Kapandji AI Sreeraj 22
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• The position of flexion is a

position of instability for the hip
joint because of the slackness of
the ligaments.
• Flexion with adduction as in legs
crossed position is easy to cause
a posterior dislocation of the hip
joint on a femoral impact.
• Dashboard injury Kapandji AI
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THE ARTICULAR CAPSULE
• The capsule is attached

proximally to the entire
periphery of the acetabulum
beyond the acetabular labrum.
• Fibers near the proximal
attachment forms a tight ring just
below the femoral head known
as the zona orbicularis.
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THE ARTICULAR CAPSULE
• It is like a cylindrical sleeve helps to unite
the articular surfaces
• Made up of four types of fibres:
1. Longitudinal fibres, run parallel to the
axis of the cylinder
2. Oblique fibres, spiral around the cylinder
3. Arcuate fibres, attached to the hip bone
and forming an arc whose apex lies
towards the middle of the sleeve.
4. Circular fibres, which are particularly
abundant in the middle of the capsule
and form the zona orbicularis (Weber's
ring), which hugs the neck tightly. Kapandji AI
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THE LIGAMENTS
• The hip joint is reinforced by four
ligaments, of which three are
extracapsular and one
intracapsular.
• The extracapsular ligaments are
the iliofemoral, pubofemoral,
and ischiofemoral ligaments.
• The intracapsular ligament,
the ligamentum teres, is attached
to the acetabular notch and on
the fovea of the head.
https://en.wikipedia.org/wiki/Hip#Ligaments
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THE LIGAMENTS
“Y” ligament of
Bigelow.
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THE LIGAMENTS
• During the change from the
quadruped to the biped erect
posture the pelvis moved into a
position of extension relative to
the femur
• This made all the ligaments
coiled around the femoral neck
in the same direction.
• Thus extension winds the
ligaments around the neck more,
tightening them, and flexion
unwinds and relaxes them.
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ROLE OF THE LIGAMENTS IN EXTENSION
• During hip extension:
• all the ligaments become taut
especially the inferior band of
the iliofemoral ligament.
• Thus responsible for checking the
posterior tilt of the pelvis.
Example:
the iliac bone rotates backwards while the femur stays put
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ROLE OF THE LIGAMENTS IN FLEXION
• During hip flexion:
• All the ligaments are relaxed
• This relaxation of the ligaments
is one of the factors responsible
for the instability of the hip in
this position.
Example:
the iliac bone tilts forward while the femur stays put
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ROLE OF THE LIGAMENTS IN LATERAL ROTATION
• During lateral rotation of the

hip:
• all the anterior ligaments running
horizontally, i.e. the superior
band of the iliofemoral and
pubofemoral are taut.
• and slackening of the ischio
femoral ligament
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ROLE OF THE LIGAMENTS IN MEDIAL ROTATION
• During medial rotation:
• all the anterior ligaments running
horizontally are slackened,
• while the ischiofemoral ligament
becomes taut
• The vertical inferior band of the
iliofemoral ligament limits medial
rotation, when the hip is in
extension.
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ROLE OF THE LIGAMENTS IN ADDUCTION
Ischiofemoral
• The superior band is tightened
considerably,
• the inferior band only slightly,
• pubofemoral ligament relaxes.
• The ischiofemoral ligament is
stretched during adduction
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ROLE OF THE LIGAMENTS IN ABDUCTION
Ischiofemoral
• The pubofemoral ligament is
tightened considerably
• The superior and the inferior
bands are relaxed.
• The ischiofemoral ligament
tenses up during abduction.
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ROLE OF THE LIGAMENTUM TERES
• A strong intrinsic stabilizer that resists joint subluxation forces.
• It is most taut when the hip is in its least stable positions i.e. flexion,
adduction, and external rotation.
• Adduction is the only position where the ligament is really under tension.
• And is lax in hip abduction and internal rotation.
Cerezal L, Kassarjian A, Canga A, et al. Anatomy, Biomechanics,

Imaging, and Management of Ligamentum Teres
Injuries. RadioGraphics. 2010;30(6):1637-1651.
doi:10.1148/rg.306105516 Sreeraj 35
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CAPSULOLIGAMENTOUS TENSION
• Hip joint extension, with slight abduction and medial rotation, is the
close-packed position for the hip joint.
• The capsuloligamentous tension at the hip joint is least when the hip is in
moderate flexion, slight abduction, and midrotation.
• In this position, the normal intra-articular pressure is minimized, and the
capacity of the synovial capsule to accommodate abnormal amounts of
fluid is greatest.
• This is the position assumed by the hip when there is pain arising from
capsuloligamentous problems or from excessive intra-articular pressure
caused by extra fluid (blood or synovial fluid) in the joint.
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STRUCTURAL ADAPTATIONS TO WEIGHT BEARING - FEMUR
• The trabeculae are calcified
plates of tissue within the
cancellous bone as a result of
interaction between mechanical
stresses and structural
adaptation created by the
transmission of forces between
bones.
• The trabeculae line up along
lines of stress and form systems
that normally adapt to stress
requirements.
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• The HAT loads the head of the
femur,
• The GRF comes up the shaft of
the femur,
• resulting in a moment arm (MA)
• This bending moment creates
tensile stress on the superior
aspect of the femoral neck and
compressive stress on the inferior
aspect.
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• A complex set of adaptive
forces prevents the rotation and
resists the shear forces that the
force couple causes;
• These forces are the structural
resistance of two major and
three minor trabecular systems
• Two major are the medial
compressive and lateral tensile
trabecular systems.
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• The zone of weakness is an
area in the femoral neck in
which the trabeculae are
relatively thin and do not cross
each other.
• The zone of weakness of the
femoral neck is particularly
susceptible to the bending forces
across the area and can fracture
as it has less reinforcement and
thus more potential for failure.
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• Changes in trabecular patterns
due to altered angle.
• Coxa valga leads to more
compression trabeculae, coxa
vara to more tension trabeculae.
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• The forces of HAT and the ground
reaction force also act on the femoral
shaft.
• As the shaft of the femur lies at an
angle instead of vertical,
• loading on the oblique femur results in
bending stresses in the shaft.
• The medial cortical bone of the
femoral shaft (diaphysis) must resist
compressive stresses, whereas the
lateral cortical bone must resist
tensile stresses
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STRUCTURAL ADAPTATIONS TO WEIGHT BEARING - ACETABULUM
• The primary weight-bearing
surface of the acetabulum, or
dome of the acetabulum, is
located on the superior portion
of the lunate surface.
• In the normal hip, the dome lies
directly over the center of
rotation of the femoral head.
• Peak contact pressures during
unilateral stance to be located
near the dome.
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STRUCTURAL ADAPTATIONS TO WEIGHT BEARING - ACETABULUM
• Normal stress distribution can be
altered; Coxa Valga Normal Coxa Vara
• with a lack of femoral head
coverage by the acetabulum
due to decreased center
edge angle
• Excessive acetabular
anteversion
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STRUCTURAL ADAPTATIONS TO WEIGHT BEARING – ARTICULAR CARTILAGE
• The superior femoral head
receives compression from
• the dome in standing
• from the posterior
acetabulum in sitting and
• the anterior acetabulum in
extension.
• Full loading of the hip joint
ensures congruence and load
distribution between the larger
femoral head and the
acetabulum.
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STRUCTURAL ADAPTATIONS TO WEIGHT BEARING – ARTICULAR CARTILAGE
• Persisting incongruence of the acetabulum could result in;
• incomplete compression of the dome cartilage and,
• inadequate fluid exchange to maintain cartilage nutrition.
• The articular cartilage is avascular, so it dependent on compression &
release forces to move nutrients through the tissue;
• Both too little compression and excessive compression can lead to
compromise of the cartilage structure.
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MOTION OF THE FEMUR ON THE ACETABULUM
• The motions of the hip joint are the movement of the convex femoral
head within the concavity of the acetabulum as the femur moves through
its three degrees of freedom:
1. flexion/extension,
2. abduction/adduction, and
3. medial/lateral rotation.
• The femoral head will glide within the acetabulum in a direction
opposite to motion of the distal end of the femur.
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• Flexion and extension of the femur occur as an almost pure spin of the
femoral head around a coronal axis.
• However, flexion and extension from other positions (e.g., in abduction
or medial rotation) must include both spinning and gliding of the
articular surfaces, depending on the combination of motions.
• The motions of abduction/adduction and medial/lateral rotation must
include both spinning and gliding of the femoral head within the
acetabulum
• The intra-articular motion occurs in a direction opposite to motion of the
distal end of the femur.
• For Example, The head spins posteriorly in flexion and anteriorly in
extension. Sreeraj 48
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• Flexion of the hip is generally about 120° with the knee flexed.
• It is limited to 90° with the knee extended due to passive tension in the
two joint hamstrings muscle group
• Hip extension is considered to have a range of 10 ° to 30°.
• When hip extension is combined with knee flexion, passive tension in the
two-joint rectus femoris muscle may limit the movement.
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• The femur can be abducted 45° to 50° and adducted 20° to 30°.
• Abduction can be limited by the two-joint Gracilis muscle
• Adduction limited by the Tensor Fascia Lata (TFL) muscle and its
associated Iliotibial (IT) band.
• Medial and lateral rotation of the hip are usually measured with the hip
joint in 90° of flexion; the typical range is 42° to 50°.
• Femoral anteversion is correlated with decreased range of lateral
rotation and increased range of medial rotation.
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• Normal gait on level ground requires at least the
• following hip joint ranges:
• 30° flexion,
• 10° extension,
• 5° of both abduction and adduction, and
• 5° of both medial and lateral rotation.
• Walking on uneven terrain or stairs increase the need for joint range.
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MOTION OF THE PELVIS ON THE FEMUR
• The motion of the pelvis are the same three degrees of freedom for the
hip joint are accomplished by the pelvis rather than by the femur.
• Anterior and posterior pelvic tilts are motions of the entire pelvic ring
in the sagittal plane around a coronal axis.
A. The pelvis in its normal position in

erect stance.
B. Posterior tilting of the pelvis moves
the symphysis pubis superiorly on
the fixed femur. The hip joint
extends.
C. In anterior tilting, the anterior
superior iliac spines move inferiorly
on the fixed femur. The hip joint
flexes. Sreeraj 52
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• Lateral pelvic tilt is a frontal
plane motion of the entire pelvis
around an anteroposterior axis.
• In the normally aligned pelvis, a
line through the anterior superior
iliac spines is horizontal.
A. Hiking of the pelvis around
the right hip joint results in
right hip abduction.
B. Dropping of the pelvis
around the right hip joint
results in right hip joint Sreeraj 53
adduction. SR
• Lateral Shift of the Pelvis can
also occur in bilateral stance.
• When the pelvis is shifted to the
right in bilateral stance, the right
hip joint adducted, and the left
hip joint abducted.
• To return to neutral position in
same stance the right abductor
and left adductor muscles work
synergistically to shift the weight
back to center.
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• Pelvic Rotation is motion of the entire pelvic ring in the transverse plane
around a vertical axis.
• Rotation can occur both in bilateral stance as well as in single-limb
support around the axis of the weight-bearing hip joint.
A. Forward rotation of the pelvis

around the left hip joint results in
medial rotation of the left hip
joint.
B. Neutral position of the pelvis and
the left hip joint.
C. Backward rotation of the pelvis
around the left hip joint results in
lateral rotation of the left hip
joint. Sreeraj 55
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56
COORDINATED MOTIONS OF THE FEMUR, PELVIS, AND LUMBAR SPINE
• When the pelvis moves on a relatively fixed femur, there are two
possible outcomes to consider.
1. Either the head and trunk will follow the motion of the pelvis (moving
the head through space) open chain responses or
2. The head will continue to remain relatively upright and vertical

despite the pelvic motions, closed chain responses.
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• Pelvifemoral Motion is a coordinated movement of femur, pelvis, and
spine to produce a larger ROM than is available to one segment alone.
• The lower, caudal end of the axial skeleton is firmly attached to the
pelvis by way of the sacroiliac joints. Therefore, rotation of the pelvis
over the femoral heads typically changes the configuration of the lumbar
spine. This important kinematic relationship is known as lumbopelvic
rhythm
• Predominantly an open-chain motion but not exclusive.
• AIanalogous to scapulohumeral motion.
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• Closed-Chain Hip Joint Function is
formed because both ends of
the chain (both feet in this
example) are “fixed” and
movement at any one joint in the
chain invariably involves
movement at one or more other
links in the chain.
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PELVIC MOTION HIP JOINT MOTION LUMBAR SPINE MOTION
Anterior pelvic tilt Hip flexion Lumbar extension
Posterior pelvic tilt Hip extension Lumbar flexion
Lateral pelvic tilt (pelvic drop) Right hip adduction Right lateral flexion
Lateral pelvic tilt (pelvic hike) Right hip abduction Left lateral flexion
Rotation to the left (in closed
Forward rotation Right hip medial rotation
chain)
Rotation to the right (in closed
Backward rotation Right hip lateral rotation
chain)
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MUSCLES OF THE HIP
• The line of pull of a muscle is the
long axis of the muscle.
• The angle of pull is the angle
between the long axis of the
bone (lever arm) and the line of
pull of the muscle.
• The angle of pull and moment
arm of the muscle both change
as the joint goes through its
range of motion.
A lateral view shows the sagittal
plane line of force of several hip
muscles. Sreeraj 62
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MUSCLES OF THE HIP
• A muscle action describes the potential direction of rotation of the joint
following its activation
• A muscle torque describes the “strength” of the action.
• A muscle torque can be estimated by the product of the muscle force (in
Newtons) and the muscle’s associated moment arm length (meters).
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HIP FLEXORS
• Primary • Secondary
1. Iliopsoas 1. Adductor brevis
2. Rectus femoris 2. Gracilis
3. Sartorius 3. Gluteus minimus (anterior
4. Tensor fasciae latae fibers)
5. Pectineus
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HIP FLEXORS
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HIP FLEXORS
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HIP FLEXORS
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HIP FLEXORS
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HIP FLEXORS
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PELVIC-ON-FEMORAL HIP FLEXION
• The anterior pelvic tilt is performed by
a force-couple between the hip
flexors and low-back extensor
muscles.
• Any muscle capable of hip flexion is
equally capable of tilting the pelvis
anteriorly.
• Also note a consequent increase in
lordosis at the lumbar spine.
• Greater lordosis increases the
compressive loads on the lumbar
apophyseal joints and shear force at
the lumbosacral junction.
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FEMORAL-ON-PELVIC HIP FLEXION
• Open chain action.
• The synergistic action of one
representative abdominal muscle
(rectus abdominis) in SLR.
A. With normal activation of the
abdominal muscles, the pelvis is
stabilized and prevented from
anterior tilting by the downward pull
of the hip flexor muscles.
B. With reduced activation of the
abdominal muscles, contraction of
the hip flexor muscles is shown
producing a marked anterior tilt of
the pelvis (increasing the lumbar
lordosis) Sreeraj 71
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HIP ADDUCTORS
1. Pectineus 1. Biceps femoris (long head)
2. Adductor longus 2. Gluteus maximus (lower
3. Gracilis fibers)
4. Adductor brevis 3. Quadratus femoris
5. Adductor magnus
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HIP ADDUCTORS
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HIP ADDUCTORS
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HIP ADDUCTORS
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HIP ADDUCTORS
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HIP ADDUCTORS
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HIP ADDUCTORS
The anatomic organization and proximal attachments of the adductor muscle group.
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FRONTAL PLANE FUNCTION IN HIP ADDUCTION
• The bilateral cooperative action
of selected adductor muscles.
• Example: kicking a soccer ball.
• The left adductor magnus is
shown actively producing pelvic -
on - femoral adduction.
• Several right adductor muscles
are shown actively producing
femoral - on - pelvic adduction
torque, needed to accelerate the There is concentric activation of the left
adductor muscles and eccentric activation of
ball. the left gluteus medius to decelerate and
control the motions.
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SAGITTAL PLANE FUNCTION IN HIP ADDUCTION
• Adductor muscles are considered
flexors from the extended position.
• When outside the 400 to 700 flexed
position, the individual adductor
muscles regain leverage as significant
extensors of the hip.
• From a hip position of near extension,
the line of force of the adductor longus
is well anterior to the medial-lateral
axis of rotation. These contrasting actions are based on the
change in line of force of the adductor longus,
• The adductor longus now has a flexor
relative to the medio lateral axis of rotation at
moment arm and generates a flexion the hip.
torque.
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HIP INTERNAL ROTATORS
Not applicable 1. Gluteus minimus (anterior
fibers)
2. Gluteus medius (anterior
• no muscle with any potential to fibers)
internally rotate the hip lies even close
to the horizontal plane. From the 3. Tensor fasciae latae
anatomic position, therefore, it is 4. Adductor longus
difficult to assign any muscle as a
primary internal rotator of the hip. 5. Adductor brevis
6. Pectineus
7. Piriformis
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• A superior view depicts the
horizontal plane line of force
of several muscles that cross
the hip.
• The external rotators are
indicated by solid lines and
• the internal rotators by
dashed lines.
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• The adductor muscles as
secondary internal rotators of the
hip.
A. Because of the anterior bowing of
the femoral shaft, a large segment
of the linea aspera runs anterior to
the longitudinal axis of rotation.
B. A superior view of the right hip
shows the horizontal line of force
of the adductor longus causes an
internal rotation torque by
producing a force that passes
anterior to the axis of rotation
Sreeraj 83
SR
HIP EXTENSORS
1. Gluteus maximus 1. Gluteus medius (posterior
2. Biceps femoris (long head) fibers)
3. Semitendinosus 2. Adductor magnus (anterior
4. Semimembranosus head)
5. Adductor magnus (posterior
head)
With the hip flexed to at least about 70 degrees and beyond,

most adductors muscles except pectineus can assist with hip
extension.
Sreeraj 84
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HIP EXTENSORS
Sreeraj 85
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HIP EXTENSORS
Sreeraj 86
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HIP EXTENSORS
Sreeraj 87
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PELVIC-ON-FEMORAL HIP EXTENSION
PERFORMING A POSTERIOR PELVIC TILT
• The force couple between

representative hip extensors and
abdominal muscles used to
posteriorly tilt the pelvis.
• Note the decreased lordosis at
the lumbar spine.
• The extension at the hip stretches
the iliofemoral ligament.
Sreeraj 88
SR
CONTROLLING A FORWARD LEAN OF THE BODY
A. Slight forward lean of the upper

body displaces the body weight
force slightly anterior to the
medial-lateral axis of rotation
at the hip.
• This slightly flexed posture is
restrained by minimal activation
from the gluteus maximus and
hamstring muscles.
Sreeraj 89
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CONTROLLING A FORWARD LEAN OF THE BODY
B. A more significant forward lean
displaces the body weight force even
farther anteriorly.
• The greater flexion of the hips rotates
the ischial tuberosities posteriorly,
thereby increasing the hip extension
moment arm of the hamstrings.
• The gluteus maximus, however,
remains relatively inactive in this
position
• The taut line (with arrowhead within
the stretched hamstring muscles)
indicates the increased passive
tension.
Sreeraj 90
SR
FEMORAL-ON-PELVIC HIP EXTENSION
• Consider the example of
climbing a steep hill carrying a
heavy pack.
• The flexed position favours
greater extension torque
generation from the hip extensor
muscles and many of the
adductor muscles.
• The flexed position of the right
hip also imposes a large Activation is also required in low-back
external (flexion) torque at the extensor muscles to stabilize the position
of the pelvis.
hip.
Sreeraj 91
SR
HIP ABDUCTORS
1. Gluteus medius 1. Piriformis
2. Gluteus minimus 2. Sartorius
3. Tensor fasciae latae
Sreeraj 92
SR
HIP ABDUCTORS
Sreeraj 93
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HIP ABDUCTORS
Sreeraj 94
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HIP ABDUCTORS
Sreeraj 95
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HIP ABDUCTORS
• The gluteus medius and minimum have been likened to the “rotator cuff”
of the hip, with the supraspinatus and subscapularis, respectively.
• Also analogous to the deltoid muscle of the glenohumeral joint.
• the anterior fibers of the gluteus medius are active in hip flexion and
• the posterior fibers function during extension.
• In the neutral hip,
• the posterior portion of the medius will produce a lateral rotational
moment and
• the middle and anterior portions have small medial rotational
moments.
• In hip flexion, all portions medially rotate the hip.
Sreeraj 96
SR
HIP ABDUCTOR MECHANISM:
CONTROL OF FRONTAL PLANE STABILITY OF THE PELVIS DURING WALKING
• During the stance phase the hip

abductor muscles have a role in
controlling the pelvis in the frontal
plane and the horizontal plane.
• During the single-limb support phase
of gait the opposite leg is off the
ground and swinging forward.
• Without adequate abduction torque
on the stance limb, the pelvis and
trunk may drop uncontrollably toward
the side of the swinging limb.
Sreeraj 97
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ROLE IN THE PRODUCTION OF COMPRESSION FORCE AT THE HIP
• The counterclockwise torque (solid
circle) is the product of the right hip
abductor force (HAF) times internal
moment arm (D)
• The clockwise torque (dashed circle) is
the product of body weight (BW)
times external moment arm (D1).
• Because the system is assumed to be
in equilibrium, the torques in the
frontal plane are equal in magnitude
and opposite in direction:
• HAF × D = BW × D1. The illustration assumes that the pelvis and trunk
are in static (linear and rotary) equilibrium about the
• The balance of opposing torques is right hip.
called static rotary equilibrium. Sreeraj 98
SR
ROLE IN THE PRODUCTION OF COMPRESSION FORCE AT THE HIP
• Note that the internal moment arm (D)
used by the hip abductor muscles is about
half the length of the external moment
arm (D1) used by body weight.
• So, hip abductor muscles must produce a
force twice that of body weight in order
to achieve stability during single-limb
support.
• This downward force is counteracted by a
joint reaction force (JRF) of equal
magnitude oriented in nearly the
opposite direction.
• The JRF angulation is strongly influenced
by the orientation of the hip abductor
muscle force vector.
Sreeraj 99
SR
HIP EXTERNAL ROTATORS
1. Gluteus maximus 1. Gluteus medius (posterior
2. Piriformis fibers)
3. Obturator internus 2. Gluteus minimus (posterior
4. Gemellus superior fibers)
5. Gemellus inferior 3. Obturator externus
6. Quadratus femoris 4. Sartorius
5. Biceps femoris (long head)
Sreeraj 100
SR
Sreeraj 101
SR
Sreeraj 102
SR
PELVIC-ON-FEMORAL HIP EXTERNAL ROTATORS
• With the right lower extremity
firmly in contact with the ground,
contraction of the right external
rotators accelerates the anterior
side of the pelvis and attached
trunk to the left - contralateral to
the fixed femur.
• This action of planting a foot
and “cutting” to the opposite
side is the natural way to
abruptly change direction while
running.
Sreeraj 103
SR
HIP ROTATORS
• The piriformis, reportedly an external rotator in full extension but an

internal rotator at 90° or more of flexion.
• Restrictions in the extensibility of this muscle are typically described as
limiting passive hip internal rotation, and possibly compressing the
underlying sciatic nerve.
• A traditional method for stretching a tight piriformis is to combine full
flexion and external rotation of the hip, typically performed with the
knee flexed.
Sreeraj 104
SR
HIP JOINT FORCES AND MUSCLE FUNCTION IN STANCE
BILATERAL STANCE
• In erect bilateral stance,
• both hips are in neutral and
• weight is evenly distributed between both legs.
• The line of gravity falls just posterior to the axis for flexion/extension
of the hip joint.
• The posterior location of the line of gravity creates an extension
moment of force around the hip which is largely checked by passive
tension in the hip joint capsuloligamentous structures and activity of hip
flexors.
• In the frontal plane, the body weight is transmitted through the sacroiliac
joints and pelvis to the right and left femoral heads.
Sreeraj 105
SR
BILATERAL STANCE
• DR & DL : the gravitational
moment arms
• WR & WL : body weight
• Because WR = WL
• Magnitude of gravitational
torque around hip is:
WR X DR = WL X DL
• Total hip joint compression =
4/6 X body weight
Sreeraj 106
SR
BILATERAL STANCE
• In normal B/L stance, assuming • Example: Assuming a body
no muscular forces maintain weight of 84 Kg.
either sagittal or frontal plane
• The weight of HAT is 4/6 body
stability at the hip joint,
weight.
• the compression across each hip • 84 X 4/6 = 56 Kg.
joint should be half the
superimposed body weight • Each hip receives 56/2 = 28
Kg.
• or one third of HAT to each hip.
HAT: Head Arm Trunk

Sreeraj 107
SR
UNILATERAL STANCE
• Full superimposed body weight
(HAT) is being supported by the
right hip joint.
• The weight of the non-weight
bearing left limb must now be
supported along with the weight
of HAT.
• The magnitude of body weight
(W) compressing the right hip
joint is [4/6 X W] + [1/6 X W]
Sreeraj 108
SR
UNILATERAL STANCE
Example: Assuming a body weight of 84 Kg.
• The magnitude of body weight (W) compressing the right hip joint is
[4/6 X W] + [1/6 X W]
• 4/6 X 84 + 1/6 X 84
• 56 + 14 = 70
• So right hip joint compression body weight is 70 Kg
• Now the hip joint in unilateral stance being compressed by body weight
(gravity) concomitantly creating a torque around the hip joint.
Sreeraj 109
SR
UNILATERAL STANCE
• The force of gravity acting on HAT and the non weight bearing left
lower limb (HATLL) will create an adduction torque around the weight-
bearing hip joint ( drop of non weight bearing limb) and an abduction
counter torque by the hip abductor musculature.
• The result will be joint compression or a joint reaction force that is a
combination of both body weight and abductor muscular compression.
Sreeraj 110
SR
UNILATERAL STANCE
Example: Assuming a body weight of 84
Kg.
• So right hip joint compression body
weight is 70 Kg
• Add./LOG MA is 10 cm = 0.1m
• Abd. MA is 5 cm = 0.05 m
• HATLL torque add. = 70 X 0.1 = 7
Kg
• So torque abd. = Torque Add./
Abd. MA = 7/0.05 = 140 Kg
• The total hip joint compression, or joint
reaction force is abd. torque + HATLL
W
• i.e. 140 + 70 = 210 Kg Sreeraj 111
SR
COMPENSATORY LATERAL LEAN OF THE TRUNK
• When the trunk is laterally

flexed toward the stance limb,
the moment arm of HATLL is
substantially reduced.
• The compensatory lateral lean
of the trunk toward the painful
stance limb will swing the line of
gravity closer to the hip joint,
thereby reducing the
gravitational moment arm
Sreeraj 112
SR
COMPENSATORY LATERAL LEAN OF THE TRUNK
Example: Assuming a body weight of 84
Kg.
• So right hip joint compression body
weight is 70 Kg
• Add./LOG MA is 2.5 cm = 0.025m
• Abd. MA is 5 cm = 0.05 m
• HATLL torque add. = 70 X 0.025 =
1.75 Kg
• So torque abd. = Torque Add./ Abd.
MA = 1.75/0.05 = 35 Kg
• The total hip joint compression, or
joint reaction force is abd. torque +
HATLL W
• i.e. 35 + 70 = 105 Kg
Sreeraj 113
SR
USE OF A CANE IPSILATERALLY
• Pushing downward on a cane held in the hand on the side of pain or

weakness should reduce the superimposed body weight by the amount
of downward thrust;
• that is, some of the weight of HATLL would follow the arm to the cane,
rather than arriving on the sacrum and the weight-bearing hip joint.
• The proportion of body weight that passes through the cane will not
pass through the hip joint and will not create an adduction torque
around the supporting hip joint.
Sreeraj 114
SR
USE OF A CANE IPSILATERALLY
• If 84 kg push down on the kane with 15% BW = 84 X 0.15 = 12.6 will pass
through kane
• So the magnitude of HATLL is 70 – 12.6 = 57.4
• So right hip joint compression body weight is 57.4 Kg
• Add./LOG MA is 10 cm = 0.1m
• Abd. MA is 5 cm = 0.05 m
• HATLL torque add. = 57.4 X 0.1 = 5.74 Kg
• So torque abd. = Torque Add./ Abd. MA = 5.74/0.05 = 114 Kg
• The total hip joint compression, or joint reaction force is abd. torque + HATLL W
• i.e. 114 + 57.4 = 172.2 Kg
Sreeraj 115
SR
USE OF A CANE CONTRALATERALLY
• When a cane is placed in the
hand opposite the painful
supporting hip, the weight
passing through the right hip is
reduced.
• Activation of the left latissimus
dorsi provides a counter torque
to that of HATLL and diminishes
the need for a contraction of the
right hip abductors.
• In this example the MA of the
cane is estimated to be 50 cm.
Sreeraj 116
SR
USE OF A CANE CONTRALATERALLY
• If 84 kg push down on the kane with 15% BW = 84 X 0.15 = 12.6 will pass
through kane
• So the magnitude of HATLL is 70 – 12.6 = 57.4
• So right hip joint compression body weight is 57.4 Kg
• Adduction/LOG MA is 10 cm = 0.1m
• Abduction MA is 50 cm = 0.5 m
• HATLL torque add. = 57.4 X 0.1 = 5.74 Kg
• Cane torque = 12.6 X 0.5 = 6.3
• If assume that the gravitational adduction torque and the counter torque provided
by the cane offset each other there would be no need for hip abductor muscle
force
• The total hip joint compression, or joint reaction force is abd. torque + HATLL W
• i.e. 0 + 57.4 = 57.4 Kg Sreeraj 117
SR
• https://hipandkneebook.com/bi
omechanics
Sreeraj 118
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1. Martin RL, Kivlan B. The Hip Complex. In: Levangie PK, Norkin CC, editors. Joint structure and
function : a comprehensive analysis. 5th ed. Philadelphia, Pa: F.A. Davis Company; 2011. p. 356–94.
2. Kapandji AI. The Hip. In: Physiology of the Joints: Volume 2 Lower Limb. 6th ed. Edinburgh ; New York:
Churchill Livingstone/Elsevier; 2011. p. 2–65.
3. Uritani D, Fukumoto T. Differences of Isometric Internal and External Hip Rotation Torques among
Three Different Hip Flexion Positions. Journal of Physical Therapy Science. 2012;24(9):863-865.
doi:10.1589/jpts.24.863
4. Neumann DA. Kinesiology of the Hip: A Focus on Muscular Actions. Journal of Orthopaedic & Sports
Physical Therapy. 2010 Feb;40(2):82–94.
5. Therapeutic Exercise for Musculoskeletal Injuries [Internet]. [cited 2020 Feb 4]. Available from:
https://humankinetics.com/AcuCustom/Sitename/DAM/153/Houglum_78-79.pdf
6. Lippert L. Chapter 17 Hip. In: Clinical kinesiology and anatomy. 4th ed. Philadelphia: F.A. Davis
Company; 2006. p. 233–49.
Sreeraj 119
SR

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THE HIP COMPLEX BIOMECHANICS

• Centre edge angle of Wiberg:

• Anteversion: > 15-180

• Retroversion: < 15-180

the head of the femur with the

• The acetabular labrum, widens and

• The position of flexion is a

• The capsule is attached

• During lateral rotation of the

Cerezal L, Kassarjian A, Canga A, et al. Anatomy, Biomechanics,

A. The pelvis in its normal position in

A. Forward rotation of the pelvis

2. The head will continue to remain relatively upright and vertical

PELVIC MOTION HIP JOINT MOTION LUMBAR SPINE MOTION

Anterior pelvic tilt Hip flexion Lumbar extension

Posterior pelvic tilt Hip extension Lumbar flexion

With the hip flexed to at least about 70 degrees and beyond,

• The force couple between

A. Slight forward lean of the upper

• During the stance phase the hip

• The piriformis, reportedly an external rotator in full extension but an

HAT: Head Arm Trunk

• When the trunk is laterally

• Pushing downward on a cane held in the hand on the side of pain or

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