The Hip

Jennifer Stoskus, PT

Iliofemoral Joint
Ball and socket

Deep joint

Very Stable
All forces come up through the lower extremity, down from the spine and distribute through the iliofemoral joint and pelvis

Hip joint = Acetabulum of pelvis + femur

Bony Structures: Anterior Pelvis

Bony Structures: Posterior Pelvis

Bony Structures: Femur

Hip Kinematics
Ball and socket joint

Deepened by labrum

Convex surface= _______________ Concave surface= _______________ Roll and glide happen in the OPPOSITE directions

What other joint is this like? Shoulder!

Kinematics (cont.)
Flexion and abduction

Roll UP Glide DOWN

Extension

Roll BACK Glide FORWARD

External rotation

Roll BACKWARD Glide FORWARD

Internal rotation

Roll FORWARD Glide BACKWARD

Hip Musculature
Anterior= flexors Lateral= _____________ Posterior= ____________

Deep External Rotators

Medial= ____________

All movements in all planes

Hip Musculature
Anterior Muscles: Rectus Femoris, Sartorius, Iliopsoas Lateral Muscles: Tensor Fasciae Latae (TFL), Gluteus Medius, Gluteus Minimus Posterior Muscles: Gluteus Maximus, Biceps Femoris, Semitendinosus, Semimembranosus

Plus 6 deep rotators

Medial Muscles: Pectineus, Adductor Magnus, Adductor Brevis, Adductor Longus, Gracilis

Anterior Hip: Rectus Femoris

Biarticulate= crosses two joints Proximal Attachment

Anterior surface of the pelvis (inferior iliac spine) Inserts into the patella tendon with the quadriceps muscles at the tibial tuberosity Weak hip flexion, stronger knee extension with other muscles of the quadriceps

Distal Attachment

Action

Rectus Femoris

Anterior Hip: Sartorius

Longest muscle in the body

Crosses lateral to medial

Anterior portion of the pelvis (superior iliac spine) Medial plateau of the tibia

Proximal Attachment

Distal Attachment

Action

Stronger hip flexion with external rotation and slight knee flexion
IE: soccer kick, ballet battements/developee What type of contractions are these?

Sartorius

Anterior Hip: Iliopsoas

Deepest and strongest hip flexors

Psoas Major/Minor + Iliacus

P Ma= Transverse processes of L1-L5 P Mi= Side of T12, L1 Iliacus= Anterior portion of iliac crest Medial portion of the femur Psoas Major/Minor= Strong hip flexion, weaker lumbar flexion Iliacus= only hip flexion

Proximal Attachment

Distal Attachment

Action

Iliopsoas

Hip Flexor Exercises

To Strengthen

Against gravity: Standing, Supine Isometric: Yoga Activities of Daily Living: walking, running, stairs
Lunge (hip extension) Bridging you want to extend the hip

To Stretch

Lateral Hip: Tensor Fasciae Latae

Small muscle, long tendon= Ilio- Tibial Band (ITB) Proximal Attachment

Lateral portion of the anteior iliac crest Lateral plateau of the tibia via the ITB Stronger hip abduction (stabilizer),
weaker hip flexion with internal rotation of the hip

Distal Attachment

Action

Tensor Fascia Latae

Lateral Hip: Gluteus Medius

Gluteal muscles are not all synergists Proximal Attachment

Lateral portion of posterior to anterior iliac crest Greater trochanter of the femur

Distal Attachment

Action

Stronger hip abduction, weaker hip internal rotation

Gluteus Medius

Lateral Hip: Gluteus Minimus

Deepest and smallest gluteal muscle

Lies slightly anterior to the glute medius

Inferior portion of the lateral iliac crest Greater trochanter of femur with Gluteus Medius Stronger hip abduction, weaker hip internal rotation, aides in some hip flexion

Proximal Attachment

Distal Attachment

Action

Gluteus Minimus

Hip Abductor Exercises

To Strengthen

Against gravity: Standing, Sidelying Isometrics:

Sildelying Pilates exercises (top or bottom leg?) Seated bound ankle Standing: single leg balance, also with moving contralateral leg

To Stretch

Movement into adduction and internal rotation

Pigeon, supine leg cross,

Posterior Hip: Gluteus Maximus

Largest and most superficial muscle of the buttocks Proximal Attachment

Gluteal surface of posterior ilium, lumbar fascia and sacrum Gluteal tuberosity on the posterio-lateral femur and ITB Powerful hip extension

Distal Attachment

Action

Gluteus Maximus

Gluteus Maximus Exercises

To Strengthen

Standing or prone hip extension Hip extension from a flexed position

IE: squats, sit-to-stand, grande plie

Fast walking, running (powerful hip extension), biking Movement into hip flexion
Childs pose, supine spinal twist

To Stretch

Posterior Hip: Biceps Femoris

Lateral most and largest hamstring muscle

Biceps= two heads Crosses hip and knee joints= _____________ Long head= ischial tuberosity Short head= posterior portion of proximal femur
Head of Fibula

Proximal Attachment

Distal Attachment

Posterior Hip: Semitendinosus and Semimembranosus

Medial portion of the hamstrings Proximal Attachment

Ischial tuberosity Medial portion of tibial plateau

Distal Attachment

Action of the hamstrings

Stronger knee extension, also hip extension since crosses the hip joint

Hamstrings

Hamstring Exercises
To Strengthen

Hip extension and knee extension

Prone leg curls, Pilates single leg kicks Standing leg extension kicks and curls, pile, squats

To Stretch

Hip flexion and knee extension- any position Standing Barre stretch, forward fold, supine HS stretch

Medial Hip: Adductor Group

Most superficial adductor

This is the groin area

Pubis Medial portion of proximal femur Primarily hip adduction, some hip flexion depending on attachment sites

Proximal Attachment (generally)

Distal Attachment (generally)

Action

Pectineus, Adductor Magnus, Brevis, and Longus, Gracilis

Proximal Attachment

Pubis
Pectineus (smallest)= medial portion of proximal femur Magnus (largest)= medial length of the femur Brevis (shortest)= medial portion of proximal femur distal to Pectineus Longus (longest)= medial portion of proximal femur distal to Brevis insertion Gracilis (thinnest)= crosses to medial tibial plateau (biarticulate) Hip adduction, main stabilizer of the body, especially the pelvis, in standing or single leg stance

Distal Attachment

Action

Hip Adductors

Hip Adductor Exercises

To Strengthen

Sidelying lift (bottom leg) Single leg stance with contralateral leg motion Isometric adduction (sitting, pilates V)
Bound ankle pose (seated, supine) Seated wide leg stretch Standing supported hip abduction

To Stretch

Six Deep External Rotators

Located deep to the gluteal muscles 1. 2. 3. 4. 5. 6. Piriformis Gemellus Superior Gemellus Inferior Obturator Internus Obturator Externus Quadratus Femoris Proximal attachments

Posterior pelvis

Common distal attachments

Greater trochanter

Deep Rotators

Exercises for External Rotators

To Strengthen

Sitting, supine, standing rotation (un-weighted)

Weighted exercises- rond de jambe (supporting leg with contralateral movement)

To Stretch

Full internal rotation or extreme adduction/internal rotation combination

Pigeon stretch, figure 4, seated foot-to-chest for buttocks

Hip Internal Rotators

Gluteus medius Gluteus minimus Tensor fasciae latae Semitendinosus Semimembranosus Gracilis Pectineus Exercises for main action and any exercise for external rotators, substitute internal rotation Stretch for internal rotators= external rotation!