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Kinesiology Of Hip Joint & Pelvic Girdle

Ari Sudarsono, SST, SKM, M.Fis

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Introduction

The pelvic girdle provides a sturdy foundation for the trunk and spine. The hip joint, or acetabular femoral joint, performs free range of movement like the shoulder joint. The lower extremities depend on the hip joint to be relatively stable.

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PelvisA ring of bone providing articulation for the lower limbs with the trunk.

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What is the Mechanical Role of Pelvis?Pelvis Is Designed to Transfer of Weight from the Trunk

Lower Limbs Ischial Tuberosities

By Loosing of Mobility

Sacroiliac Joints Symphysis Pubis

Additional Roles to Transfer of Weight

Muscle AttachmentSupport the Vicers Support Birth Canal

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What is the structure of the Sacroiliac Joint? Synovial Joint between Illium and Sacrum. Due to the powerful ligaments in posterior

Anteriorly SinovialPosteriorly

Fibrous

The SIJs are unique in that both the structure and function of these joints change significantly from birth through adulthood

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Sacroiliac Joint

It is a C shape joint In first decade of life is smooth and

flat After puberty, a central ridge in Iliac

and groove on the sacral will appear

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What is the factors of Sacroiliac Joint Stability?

Line of Weight Pass Anterior to the Sacroiliac Joint

Causes

Sacral Move Downward into the Pelvis

Lower PartsTilt Upward

The Bony Surface does Not Bear the

Weight

The Weight is Suspended by the Ligaments

Slight Wedging of the Auricular Surface Resist Rotation and Gliding Movement of

Sacrum

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What is the Movement of Sacroiliac Joints? A little Movement is Allowed by Joint Surface and

Ligaments There is Slight Gliding and Rotational Movement

Sacroiliac Joint movement During Sacroiliac Joint movement During ChildbirthChildbirth

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Nutation and Counternutation Movement

15-10What is the Clinical Importance of Sacroiliac Joint?

Sudden Bending Forward

Tear the Tear the Posterior Posterior LigamentLigament

Dislocate Dislocate the the

Joint Joint surfacesurface

Painful Painful Trunk Trunk

FlexionFlexionManipulation often Produce a Manipulation often Produce a

Successful ResultSuccessful Result

15-11How do we may test the accessory Movement of Sacroiliac Joints?

These Movements are Limited by the Powerful Ligaments.

To Test These To Test These MovementsMovements

Prone PositionProne Position

Pressure by the Heel of Pressure by the Heel of the Handthe Hand

On the Apex of Sacrum On the Apex of Sacrum DownwardDownward

Small Rotation of the Small Rotation of the SacrumSacrum

15-12What is the Biomechanics role of Sacroiliac Joints?

Two Trabecular Systems From Sacrum to Pelvisand Then to the head of Femur

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Trabecular sysem

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What is the Symphysis Pubis? Secondary Cartilaginous Joint. A Thin Layer of Hyaline Cartilage Cover the Bone. This Cartilage is Joined to the Opposite Cartilage by a

Fibrocartilage Interpubic Disc. Two Ligaments Support the Joint:

1) Superior Pubic Ligament2) Arcuate Pubic Ligament

The anterior portion of the joint is reinforced by aponeurotic expansions from a number of muscles that cross the joint

No Normally Movement Pathology:

Slipping of one pubic Slipping of one pubic to other (Osteitis Pubis)to other (Osteitis Pubis)

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The aponeurotic extensions of the muscles crossing the anterior aspect of the symphysis pubis

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Bones

The head of the femur connects with the cup-shaped acetabulum of the pelvic girdle. Bony landmarks, the greater and lesser trochanter, provide attachments for many muscles spanning from the pelvic bones and even the vertebrae anteriorly.

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Bones (cont.)

The pelvic girdle consists of the right and left pelvic bone joined together posteriorly by the sacrum; inferior to the sacrum is the coccyx. The pelvic bones consist of three bones: the ilium, the ischium, and the pubis.

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Bones (cont.)

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Bones (cont.)

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Bones (cont.)

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Bones (cont.)

Additional important bony landmarks include the ischial tuberosity of the posterior ischium and the linea aspera on the posterior femur. Anterolaterally, Gerdy’s tubercle provides the insertion point for the iliotibial tract.

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Name the landmarks

Iliac crest

Anterior spine

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Name the landmarks1. Acetabulu

m2. Sciatic

notch3. Ischial

tuberosity

1

2

3

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Joints

The pelvic bones join in the front to form the symphysis pubis, an amphiarthrodial joint. The sacrum is located between two bones and form the sacroiliac joint made up of strong ligaments.

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Joints (cont.)

The hip joint is classified as an enarthrodial-type joint with a dense ligamentous capsule.

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Joints (cont.)

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Joints (cont.)

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The Hip Joint

Type: Synovial (Ball & Socket)Articular Surfaces: head of femur & acetabulum

15-29Articular surfaces: 1- Acetabulum has: - C- shaped articular surface = lunate surface, Acetabular fossa,- Acetabular notch -----► converted into acetabular foramen by

transverse ligament of the acetabulum- - Labrum acetabulare deepens the acetabular cavity.- 2- Head of femur

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Capsule & Synovial Membrane:

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Ligaments:

1- Ilio-femoral lig.: Y- shaped, strong, attached between AIIS and both ends of trochantric line. Prevents hyper-extension.

2- Pubo-femoral lig.:Triangular in shape, supports the inferomedial part of the joint, attached between ilio-pubic eminence and the capsule. Prevents hyper-abduction.

3- Iscio-femoral lig.: from ischium to the back of the capsule. It becomes tense in medial rotation.

4- round ligament of the head of femur: Inside the joint, between head of femur to acetabular notch and transverse lig., carries blood supply to head of femur.

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Relations of the hip joint: Anteriorly:Pectineus, Iliopsoas, RF

(straight head), femoral vessels.

Laterally:Tensor fascia latae, gluteus

minimus & medius.

Posteriorly:Piriformis, obturator

internus, 2 gemelli, quadratus femoris, sciatic nerve.

Above:RF (reflected head), gluteus

minimus.

Below:Obturator externus.

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Stability of the hip joint:

The hip joint is very stable joint due to:1- The head of femur fits accurately to the

acetablum.2- The three strong ligaments outside the capsule.3- The surrounding strong muscles.

Hip dislocation is usually posterior as in car accidents. It occurs with no fracture of the acetabulum (if the hip is flexed and adducted) or with fracture acetabulum (if the hip is flexed and abducted). The sciatic nerve may be injured in posterior hip dislocation.

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Blood supply to the head of femur:

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Blood supply to acetabular fossa and ligament of the head of femur:

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X-Ray of the hip joint:

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MRI of the hip joint:

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Movements

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Movements (cont.)

15-40What is the Pelvic Motions?•open kinematic chain motions

•anterior tilt ： ASIS moves anteriorly and inferiorly •posterior tilt ： ASIS moves posteriorly and superiorly •lateral tilt to the left/right ： one ASIS is higher than the other (Pelvic list during Gait)•Lateral forward and Backward displacement

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Movements (cont.)

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Movements (cont.)

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Muscles

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Muscles (cont.)

The hip flexor iliopsoas muscle is composed of the iliacus, the psoas major, and the psoas minor. The posterior gluteal region contain the gluteal maximus, gluteus medius, and gluteus minimus.

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Muscles (cont.)

The deep six lateral rotators are the piriformis, obturator externus, obturator internus, gemellus superior, gemellus inferior, and quadratus femoris. The tensor fasciae latae attaches anteriorly and laterally to abduct and flex the hip.

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Muscles (cont.)

The thigh has three compartments. The anterior compartment houses the quadriceps; the rectus femoris and the knee extenders vastus medialis, vastus intermedius, and vastus lateralis. The sartorius runs superficial to the quadriceps.

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Muscles (cont.)

The posterior compartment contains the hamstrings consisting of the biceps femoris, the semitendinosus, and the semimembranosus.

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Muscles (cont.)

The medial compartment contains the adductor group of adductor brevis, adductor longus, adductor magnus, pectineus, and gracilis.

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Muscles (cont.)

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Muscles (cont.)

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Muscles (cont.)

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Muscles (cont.)

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Muscles (cont.)

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Nerves

The hip and pelvic girdle muscles are all innervated from the lumbar plexus and sacral plexus known as the lumbosacral plexus.

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Nerves (cont.)

The femoral nerve innervates the anterior muscles of the thigh and provides sensation to the anterior and lateral thigh and medial leg and foot. The obturator nerve innervates the adductor as well as the obturator externus and sensation to the medial thigh.

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Nerves (cont.)

The sciatic nerve is composed of the tibial nerve and common peroneal nerves. The sciatic nerve tibial division innervates the hamstrings and adductor magnus. Both nerves continue down the lower extremity to function the muscles of the leg and foot.

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Nerves (cont.)

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Nerves (cont.)

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Individual Muscles of the Hip Joint and Pelvic Girdle – Anterior

Iliopsoas

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Individual Muscles of the Hip Joint and Pelvic Girdle – Anterior (cont.)

Iliopsoas

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Individual Muscles of the Hip Joint and Pelvic Girdle – Anterior (cont.)

Sartorius

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Individual Muscles of the Hip Joint and Pelvic Girdle – Anterior (cont.)

Sartorius

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Individual Muscles of the Hip Joint and Pelvic Girdle – Anterior (cont.)

Rectus Femoris

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Individual Muscles of the Hip Joint and Pelvic Girdle – Anterior (cont.)

Rectus Femoris

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Individual Muscles of the Hip Joint and Pelvic Girdle – Anterior (cont.)

Tensor Fasciae Latae

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Individual Muscles of the Hip Joint and Pelvic Girdle – Anterior (cont.)

Tensor Fasciae Latae

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Individual Muscles of the Hip Joint and Pelvic Girdle – Posterior

Gluteus Maximus

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Individual Muscles of the Hip Joint and Pelvic Girdle – Posterior (cont.)

Gluteus Maximus

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Individual Muscles of the Hip Joint and Pelvic Girdle – Posterior (cont.)

Gluteus Medius

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Individual Muscles of the Hip Joint and Pelvic Girdle – Posterior (cont.)

Gluteus Medius

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Individual Muscles of the Hip Joint and Pelvic Girdle – Posterior (cont.)

Gluteus Minimus

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Individual Muscles of the Hip Joint and Pelvic Girdle – Posterior (cont.)

Gluteus Minimus

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Individual Muscles of the Hip Joint and Pelvic Girdle – Posterior (cont.)

Lateral Rotators

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Individual Muscles of the Hip Joint and Pelvic Girdle – Posterior (cont.)

Lateral Rotators

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Individual Muscles of the Hip Joint and Pelvic Girdle – Posterior (cont.)

Hamstrings

The hamstrings provide hip extension and knee flexion. (Diterangkan di Kinesiologi Lutut)

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Individual Muscles of the Medial Thigh Adductor Brevis

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Individual Muscles of the Medial Thigh (cont.)

Adductor Brevis

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Individual Muscles of the Medial Thigh (cont.)

Adductor Longus

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Individual Muscles of the Medial Thigh (cont.)

Adductor Longus

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Individual Muscles of the Medial Thigh (cont.)

Adductor Magnus

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Individual Muscles of the Medial Thigh (cont.)

Adductor Magnus

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Individual Muscles of the Medial Thigh (cont.)

Pectineus

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Individual Muscles of the Medial Thigh (cont.)

Pectineus

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Individual Muscles of the Medial Thigh (cont.)

Gracilis

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Individual Muscles of the Medial Thigh (cont.)

Gracilis

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Chapter Summary

The bones, joints, movements, muscles, and nerves of the hip joint and pelvic girdle are explored in this chapter.

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Chapter Summary (cont.)

Individual muscles of the hip joint and pelvic girdle are reviewed in depth with regard to palpation, origin, insertion, action, and innervation. Each muscle includes information with clinical notes, muscle specifics, clinical flexibility and strengthening.

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Chapter Review

The Chapter Review is divided into true and false, short answers, and multiple choice questions.

The questions are designed for the students to test their knowledge.

Worksheets are at the end of the text as an aid for learning.

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Explore and Practice

Students should utilize the questions and charts at the end of the chapter to help focus on the content of the chapter.

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Manual of Structural Kinesiology The Hip Joint and Pelvic Girdle 9-90

Iliopsoas MuscleExternal rotation of External rotation of

femur femur Flexion

of hip

Transverse pelvic rotation contralaterally Transverse pelvic rotation contralaterally when ipsilateral femur is stabilized when ipsilateral femur is stabilized

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Rectus Femoris Muscle

Flexion of hip

Extension of kneeExtension of knee

Anterior pelvic Anterior pelvic rotationrotation

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Sartorius Muscle

External rotation of External rotation of thigh as it flexes thigh as it flexes hip & knee hip & knee

Flexion of kneeFlexion of knee

Flexion of hip

Abduction of hipAbduction of hip

Anterior pelvic Anterior pelvic rotationrotation

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Adductor Brevis Muscle

Adduction of hipAdduction of hip

External rotation as it External rotation as it adducts hipadducts hip

Assists in flexion of Assists in flexion of hiphip

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Adductor Longus Muscle Adduction of hipAdduction of hip

Assists in flexion of Assists in flexion of hiphip

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Adductor Magnus Muscle

External rotation as External rotation as hip adducts hip adducts

Adduction of hipAdduction of hip

Extension of hipExtension of hip

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Manual of Structural Kinesiology The Hip Joint and Pelvic Girdle 9-96

Gracilis Muscle Adduction of hipAdduction of hip

Weak flexion of kneeWeak flexion of knee

Internal rotation of hip Internal rotation of hip

Assists with flexion of Assists with flexion of hip hip

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Semitendinosus Muscle Flexion of kneeFlexion of knee

Extension of hipExtension of hip

Internal rotation of Internal rotation of hiphip

Internal rotation of Internal rotation of flexed knee flexed knee

Posterior pelvic Posterior pelvic rotationrotation

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Semimembranosus Muscle Flexion of kneeFlexion of knee

Extension of hipExtension of hip

Internal rotation of Internal rotation of hiphip

Internal rotation of Internal rotation of flexed knee flexed knee

Posterior pelvic Posterior pelvic rotationrotation

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Manual of Structural Kinesiology The Hip Joint and Pelvic Girdle 9-99

Biceps Femoris Muscle Flexion of kneeFlexion of knee

Extension of hipExtension of hip

External External rotation of rotation of hiphip

External External rotation of rotation of flexed knee flexed knee

Posterior pelvic Posterior pelvic rotationrotation

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Gluteus Maximus Muscle

Lower fibers assist in Lower fibers assist in adductionadduction

Upper fibers assist in Upper fibers assist in abductionabduction

Posterior pelvic Posterior pelvic rotationrotation

External External rotation of rotation of hiphip

Extension of hip

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Gluteus Medius Muscle

External rotation & External rotation & extension (posterior extension (posterior fibers)fibers)

Abduction of hip

Internal rotation & Internal rotation & flexion (anterior flexion (anterior fibers)fibers)

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Manual of Structural Kinesiology The Hip Joint and Pelvic Girdle 9-102

Tensor Fasciae Latae MuscleAbduction of hipAbduction of hip

Flexion of hip

Tendency to rotate hip Tendency to rotate hip internally as it flexesinternally as it flexes

Anterior pelvic Anterior pelvic rotationrotation

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Manual of Structural Kinesiology The Hip Joint and Pelvic Girdle 9-103

Six Deep Lateral Rotator Muscles

External External rotation of rotation of hip hip

Piriformis, GPiriformis, Gemellus superior, Gemellus inferior,emellus superior, Gemellus inferior,Obturator externus, Obturator internus, Quadratus femorisObturator externus, Obturator internus, Quadratus femoris

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