The Lower Extremity The Hip ESAT 3600 Fundamentals of Athletic Training

Lower Extremity Introduction 4 subunits Hip Knee Ankle Subtalar joint Similar in structure to the upper extremity

Lower Extremity Introduction Difference in basic function Upper extremity Reaching Throwing Grasping Lower extremity Locomotion Weight bearing

Nerves Lumbar plexus L1-L4 Femoral nerve Obturator nerve

Femoral and Obturator Nerves

Sacral plexus L5-S3 Sciatic nerve L4/S5 Common peroneal nerve Tibial nerve

Sciatic Nerve

Peroneal and Tibial Nerves

Pelvic Girdle Pelvis is a segmental bridge between the vertebral column and the lower extremity Articulations of Pelvic Girdle Sacroiliac joint Iliac and sacrum Pubic symphysis

Movements of the Pelvis Anterior tilt Posterior tilt Lateral tilt Rotation

Hip Joint Articulation of the Pelvis and femur Acetabulum and head of femur Ball and socket

Bony Landmarks of the Hip Acetabulum Pubis Anterior superior iliac spine (ASIS) Anterior inferior iliac spine Illiac crest Ischial tuberosity

Bony Landmarks of the Hip Head of femur Neck of femur Great and lesser trochanter Linea aspera Adductor tubercle

Hip Joint Stability VERY STABLE JOINT Moderately strong bony arrangement Strong ligaments Strong muscle stability

Ligamentous Stability Iliofemoral ligament Y ligament Superior band Inferior band Pubofemoral

Ligamentous Stability Ischiofemoral Posterior capsule Triangular shape Limits medial rotation and adduction in flexed position

Ligamentous Stability Acetabular ligament Transverse ligament Ligamentum capitas femoris AKA - Ligamentum teres Intracapsular ligament Links head of femur to transverse ligament

Lower Extremity Alignments–Hip Changes in angle between femoral neck and femoral shaft throughout life span Coxa valga Large angle Coxa vara Small angle

Lower Extremity Alignments–Hip Normal projection of femoral neck relative to femoral condyle Adult = 8-15 degrees Anteversion Increased hip IR Squinting patella Retroversion Increased hip ER Feet rotated outward

Hip Movements

Closed-packed Position of Hip Full extension Slight internal rotation Slight abduction

Hip Arthrokinematics Abduction/adduction Internal/external rotation Roll direction of motion Slide in opposite Internal/external rotation Flexion/extension Spin

Anterior Hip Muscles

Psoas Major O: anterior surfaces of transverse processes, lateral borders of vertebral bodies and corresponding intervertebral discs of T12-L5 I: lesser trochanter of femur and for short distance below along medial border of shaft A: flexion of thigh at the hip, minimal action in lateral rotation of thigh

Iliacus O: superior 2/3 of iliac fossa, internal border of iliac crest, anterior sacroiliac, lumbrosacral and iliolumbar ligaments I: lesser trochanter of femur and for a short distance below along medial border of shaft A: flexes thigh at the hip, minimal action in lateral rotation of the thigh

Sartorius O: ASIS I: anterior and medial surface of the shaft of the tibia just below the condyle (Pes Anserines) A: flexes, external rotation and abduction of thigh, flexes and assists in medial rotation of the leg

Rectus Femoris O: anterior inferior iliac spine I: upper border of patella and through patellar ligament into tibial tuberosity A: flexion of the thigh at the hip, extension of the leg at the knee

Tensor Fascia Lata O: anterior part of outer lip of iliac crest, outer surface of ASIS I: IT band of fascia lata on the anteriolateral aspect of thigh, about 1/3 of way down A: thigh flexion at the hip, abduction, and medial rotation, stabilizes knee laterally, tenses the IT tract

Pectineus O: superior surface of the pubis, pectineal line between iliopectineal eminence and pubic tubercle I: pectineal line of femur, from lesser trochanter to linea aspera A: adduction of thigh at hip, assists in thigh flexion and medial rotation at the hip

Medial Hip Muscles

Adductor Longus O: front of pubis in angle between crest and symphysis I: middle 1/3 of medial lip of linea aspera A: adducts thigh at hip, assist in thigh flexion, medial rotation of hip

Adductor Brevis O: outer surface of body and inferior ramus of pubis I: on a line extending from lesser trochanter to upper part of linea aspera A: adduction of thigh at the hip, assists in thigh flexion and medial rotation at the hip

Adductor Magnus O: anterior fibers – ramus of ischium and pubis; posterior fibers – ischial tuberosity I: from a line extending from the gluteal tuberosity along the linea aspera, medial supracondylar line and adductor tubercle on medial condyle of femur A: adduction of thigh at the hip, assists in medial rotation

Gracilis O: anterior aspect of lower ½ of symhysis pubis and medial margin of inferior ramus of pubis I: anterior and medial surface of the shaft of the tibia just below the condyle A: adducts and medially rotates thigh; flexes and medially rotates leg

Posterior Hip Muscles

Biceps Femoris (Long Head) O: ischial tuberosity and the sacrotuberous ligament I: lateral side of the head of the fibula, lateral condyle of the tibia and the deep fascia on the lateral side of the leg A: flexion and lateral rotation of the leg at the knee, extends, adducts and laterally rotates the thigh at the hip

Semitendinosus O: ischial tuberosity with tendon of the long head of the biceps femoris I: anterior and medial surface of the shaft of the tibia just below the condyle A: flexes and medially rotates the leg at the knee, extends adducts and medially rotates the thigh at the hip

Semimembranosus O: upper and lateral aspect of ischial tuberosity I: posterior surface of the medial condyle of the tibia A: flexes and medially rotates the leg at the knee; extends, adducts and medially rotates the thigh at the hip

Gluteus Maximus O: posterior gluteal line of ilium, aponeurosis of erector spinae, dorsal surface of sacrum, coccyx and sacrotuberous ligament I: gluteal tuberosity of femur and IT band A: extends thigh at the hip, assists in lateral rotation. upper 2/3 abducts, lower 1/3 is inactive as an abductor or an adductor in the standing position

Gluteus Medius O: outer surface of ilium from iliac crest and posterior gluteal line above to the anterior gluteal line below, gluteal aponeurosis I: lateral surface of greater trochanter A: abducts and medially rotates femur at hip, lateral pelvic stabilization, aids in early hip flexion

Gluteus Minimus O: outer surface of ilium between anterior and inferior gluteal lines and margin of greater sciatic notch I: anterior border of greater trochanter A: abducts and medially rotates femur at the hip, lateral pelvic stabilizer, aid in early hip flexion

6 Deep External Rotators Piriformis Superior gemellus Internal obturator Inferior gemellus External obturator Quadratus femoris

Muscular Stability