Kinesiology of lower limb

Hip movement
SESSION 3

Dr Atefeh Aboutorabi
Ph.D Orthotics and Prosthetics
Assistant Prof., Department of Prosthetics & Orthotics,
University of Social Welfare and Rehabilitation Sciences
Arthrokinematics refers to the movement of joint surfaces.
Arthrokinematics differs from Osteokinematics
Osteokinematics means bone movement and Arthrokinematics joint movement.
 A roll is a rotary movement, one bone rolling on another.
 A spin is a rotary movement, one body spinning on another.
 A slide is a translatory movement, sliding of one joint surface over another.
 Arthrokinematics
 The convex-concave rule is the basis for determining
the direction of the mobilizing force when joint
mobilization gliding techniques are used to increase a
certain joint motion.
 The direction in which sliding occurs depends on
whether the moving surface is concave or convex.
 If the moving joint surface is CONVEX, sliding is in
the OPPOSITE direction of the angular movement of
the bone.
 If the moving joint surface is CONCAVE, sliding is in
the SAME direction as the angular movement of the
bone.
From neutral position: extension "anterior spin"
From neutral position: Flexion “posterior Spin”
 Movement of convex on concave
 Femoral glides opposite motion of distal femur
 Flex = Head roll posterior
 Ext = anterior roll

 When wt. bearing

 Femur fixed, concave acetabulum
moves over convex femoral head
 glides in same direction
Movement Summary:
 Hip Joint:
 Multiaxial ball and socket
 F/E, Abd/Add, I/E rotation, Circ.
 Pelvic Girdle:
 Rotation in all three planes
 Hip joint
 ROM
 Flexion 120–135 degrees with knee flexed 90
 Hypertext 0-100
 Abd 0-450
 Add across 30-400
 ER 0-450
 IR 0-350

 Normal gait on level ground requires

 300 hip flexion
 100 hyperextension
 50 abd/add/IR/ER
Hip joint
 Close-packed
 Full ext, IR, Abd

 Open-packed
 300 flex
 300 abd
 Slight ER
Hip capsule

 capsule has major contribution to stability

 femoral neck = intracapsular
 greater & lesser trochanters = extracapsular
 thickened anterosuperiorly

 thin & loose posteroinferiorly

Hip ligaments

 Iliofemoral ligament
 Y ligament

 Origin = AIIS
2 arms fan out to insert = intertrochanteric line of
femur
 Strongest ligament of hip
 Taut in hyperextension
 Superior fibers taut in adduction
 Inferior tense during abduction
Hip ligaments

 Pubofemoral ligament
 Origin = anterior pubic ramus
 Insertion= anterior
intertrochanteric fossa
 Taut in hip abd & ext
 Ischofemoral ligament
 Origin = posterior acetabular
rim, acetabulum labrum
 Insertion = spiral around femoral
neck
 Spiral
fibers taut during ext,
loosen in flex
 Hip capsule & ligaments
Position of stability
 Full extension of hip

Ligamentum teres
 Triangular

 Ligament of head of femur

 an intra‐articular structure which
runs between the acetabulum
and fovea capitis femoris (FCF)
of the head of femur
Limitations of hip Movements
 When the knee is flexed, hip flexion is limited by the
anterior surface of the thigh coming in contact with the
anterior abdominal wall

 When the knee is extended, hip flexion is limited by the

tension of the hamstring muscles

 Abduction is limited by the tension of

the pubofemoral and lower band of Iliofemoral
Limitations of hip Movements
 Hip Adduction is limited by contact with the
opposite limb and by the tension of the ligament of
the head of the femur and illiofemural (upper band)

 Lateral rotation is limited by the tension in the

iliofemoral and pubofemoral ligaments

 Medial rotation is limited by the ischiofemoral

ligament
 Active Insufficiency
versus passive insufficiency
 The active insufficiency of a muscle that crosses two or more joints
occurs when the muscle produces simultaneous movement at all the
joints it crosses and reaches such a shortened position that it no longer
has the ability to develop effective tension
For example :The shortening of the Rectus femoris limits full hip flexion
when the knee is fully extended.
 When the opposing muscle (antagonist) is stretched to a point where it
can no longer lengthen and allow further movement, passive
insufficiency is reached. Passive insufficiency occurs when a multi-joint
muscle is lengthened to its fullest extent at both joints, but also
preventing the full range of motion of each joint it crosses.
Muscles that assist Movements
 Flexion: It is performed by the iliopsoas, rectus
femoris, sartorius, also by adductor muscles

 Extension: it is performed by the gluteus maximus

and the hamstring muscles

 Abduction: It is performed by the gluteus medius

and minimus, assisted by sartorius, tensor fasciae
latae, and piriformis
Muscles that assist Movements

 Adduction: It is performed by the adductor longus and brevis

and the adductor fibers of the adductor magnus

 Lateral rotation: It is performed by the piriformis, obturator

internus and externus

 Medial rotation: It is performed by the anterior fibers of gluteus

medius and gluteus minimus and the tensor fasciae latae
Pelvic Girdle Movements

Anterior pelvic tilt

 Sagittal plane
 Hip flexion
 ASIS anteriorly & inferiorly
Pelvic Girdle Movements

 Posterior pelvic rotation/tilt:

 Sagittal plane
 Iliac crest tilts backward
 Hip extension
 Symphisis pubis up
 Pelvic Girdle Movements
 transverse pelvic rotation:
 Occurs in single-limb support around axis
of supporting hip jt.
 Forward rotation
 Sideopposite supporting hip moves
anteriorly
 Backward rotation
 Sideopposite supporting hip moves
posteriorly
Lateral Tilt

 tilting of the pelvis from

neutral position to the right
or left
 lateral tilt tends to occur
naturally when you support
your weight on your leg
 this allows you raise your
opposite leg enough to
swing through during gait
 Pelvic Girdle Movements
 lateral pelvic tilt:
 Frontal plane
 One hip joint serves as pivot/axis
 Opposite iliac crest elevates (hip hike) or drop
(pelvic drop)
 Reference is side farthest from supporting hip
 Pelvic
Rotation
 rotation of the pelvis defined
by the direction in which the
anterior aspect of the pelvis
moves
 occurs naturally during
unilateral leg movements
(walking)
 as the right leg swings forward during gait the
pelvis rotates left
Open and Closed chains of the hip joint
 Lumbar-Pelvic Rhythm
 Open-chain (aims to increase ROM than might be available to one segment)
 E.g. reaching the floor
 Hip flexion up to 900 only
 Anterior tilt of pelvis on femurs
 Flexion of lumbar spine adds 450
 E.g. side-lying abduction
 Lateral tilt of pelvis & lumbar spine adds 450

 Closed chain response to motions of pelvis

 Keeps one or both feet on the ground
 Maintain head upright & vertical
 Anterior pelvic tilt during hip flexion = head & trunk displaced forward + lumbar extension
 Posterior pelvic tilt + lumbar flexion to keep head forward over sacrum
Trunk flexion
A) normal rhythm B) limited hip flexion C) limited lumber flexion.
Osteokinematics
compensatory
pelvic motion co-hip motion lumbar

anterior tilt hip flex lumbar ext

posterior tilt hip ext lumbar flex

lateral tilt (drop) right hip add right lateral flex

lateral tilt (hike) right hip abd left lateral flex

forward rot right hip IR rotation to left

backward rot right hip ER rotation to right

Trunk extension
A) Early phase by extension hip B) Middle phase occurs by extension of lumbar spine C)
In last phase the muscle activity reduced.
Relationship of Hip and Pelvic Motion in
Sagittal Plane
Lateral Pelvic Tilt – Frontal Plane