1. The Lower Extremity The Hip
ESAT 3600
Fundamentals of Athletic Training

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

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

4. Nerves
Lumbar plexus
L1-L4
Femoral nerve
Obturator nerve

5. Femoral and Obturator Nerves

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

7. Sciatic Nerve

8. Peroneal and Tibial Nerves

9. 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

10. Movements of the Pelvis
Anterior tilt
Posterior tilt
Lateral tilt
Rotation

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

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

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

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

15. Ligamentous Stability
Iliofemoral ligament
Y ligament
Superior band
Inferior band
Pubofemoral

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

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

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

19. 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

20. Hip Movements

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

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

23. Anterior Hip Muscles

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. Medial Hip Muscles

31. 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

32. 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

33. 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

34. 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

35. Posterior Hip Muscles

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. 6 Deep External Rotators
Piriformis
Superior gemellus
Internal obturator
Inferior gemellus
External obturator
Quadratus femoris

43. Muscular Stability