Osteokinematics: Sagittal Plane Motions

of the femur at the hip joint

 Flexion: 90o-135o

 Extension: 0o-30o

 Role of 2 joint
muscles?
 Osteokinematics: Frontal Plane
Motions of the femur at the hip joint

 Abduction: 30o-50o

 Adduction: 10o-30o

 Role of 2 joint muscles?

 Osteokinematics: Transverse Plane
Motions of the femur at the hip joint
 IR (extension*): 35o-45o
(Luttgens & Hamilton)
 IR (flexion**): 30o-45o
 ER (extension*): 45o-50o
(Luttgens & Hamilton)
 ER (flexion**): 45o-60o
*Extension = Neutral -Terminal
**Flexion = 900
Osteokinematicmo
tions of the femur *
at the hip joint
during functional
activities
*
*
Hip Arthrokinematics

D. Neumann – Kinesiology of the MS System

 Osteokinematics: Sagittal plane
Motions of the Pelvis at the Hip Joint
Osteokinematics: Frontal plane Motions
of the Pelvis at the Hip Joint
Osteokinematics: Transverse Plane
Motions of the Pelvis at the Hip Joint
Open Kinematic Chain Motions:
LumboPelvic Rhythm
Closed Kinematic Chain Motions
 The system now strives
to keep the head & trunk
upright
 lumbar spine & pelvis
motion will now generally
be opposite of that during
lumbar-pelvic rhythm
Acetabular Spatial Orientation
 Faces laterally
 Faces anteriorly
 18.5o males
 21.5o women
 Faces inferiorly
 22o - 42o range
 38o in males
 35o in females
3 Acetabular Changes With Aging:

Ossification of the articulation of the

three bones of the pelvis
 increased “central stability”
 Decreased acetabular “roundness”
 reduced co-aptation
Increased Central Edge Angle
 increased superior stability
 Structure of the Proximal Femur
 Femoral Head

 more spherical than

acetabulum
 fovea capitis

 Spatial Orientation
Structure of the Proximal Femur:
Angle of ?
 Angle of Inclination
 Frontal plane angulation b/t the
shaft & neck of femur
 Contributes to the normal
valgus position of the knee
 Decreases with age
 150o early infancy
 125o in adults
 120o in elderly
Abnormal Femoral Inclination Angle
Coxa Valga
 Increase leg length produces hip adduction
 Increase “pre load” to hip abductors
 Decrease moment arm of abductors
Coxa Vara   leg length
 Relative hip abduction
 Poor hip abductor length
tension relationship
 Impingement may limit
abduction ROM
 Stress concentration superior
contact area
 Coxa Vara: congenital,
developmental or traumatic
Structure of the Proximal Femur:
Angle of ?
 o
>15 Angle of Torsion or Version:
Anteversion or Medial Femoral Torsion
 Abnormal Angles of Version
Eckoff DG: Orth Cl NA: 1994
 Femoral anteversion decreases with age
 But if anteversion is excessive at birth it will
generally persist throughout lifetime
Excessive Anteversion
If uncompensated
anteversion will
expose significant
amount of femoral
head anteriorly
 Excessive Anteversion
 In order to improve
congruency of joint
surfaces lower
extremity internal
rotation may occur.
 This may result in
occur in “toed in”
posture & gait.
 Abnormal Angles of Version

 If angle of version is less

than 15o: Retroversion or
Lateral Femoral Torsion
 o
<15 Angle of Torsion or Version:
Retroversion or Lateral Femoral Torsion
Retroversion
 If uncompensated may
expose excessive head
of femur posteriorly

 To improve
congruency, the
LE may externally
rotate and appear
“toed out”
Position of Greatest Hip Congruency?
 Combined position of:
 flexion
 abduction
 lateral rotation
 Frequently used position for
post hip dislocation
immobilization
 High compressive loads may
be necessary to achieve
maximum congruency
 Is this closed pack position?
 Position of Maximum Hip Congruency:
Impact on Ligamentous Tension
 Hip flexion, lateral rotation & abduction tends to “uncoil”
supporting hip ligaments

 Hip ligaments are tightened by extension

Frontal Plane Spatial Orientation
of Hip and Stability?
 Inferior angulation of
acetabulum < the
superior angulation of
the femoral neck.
 Therefore, a
significant portion of
the head remains
uncovered.
 This may lead to 
superior stability.
Iliopsoas
 Psoas major is attached
to anterior lumbar
vertebra
 Iliacus is attached to iliac
fossa
 Tension within this group
will group will “pull”
lumbar curvature
anteriorly increasing
lumbar lordosis
 Tensor Fascia Lata
 Flexes & internally rotates hip
 Abducts if the hip is already
flexed
 Influence of the Thomas test
 Most important contribution of
TFL is maintaining tension in the
ITB
 Tensor Fascia Lata
 ITB is considered to assist in
relieving the femur of some of
the tensile loads on the shaft.
 TFL (along with gluteus max)
has a roll in “taking up the
slack” in the ITB to enhance this
function
 Possible role in muscle
imbalances at hip
Gluteus medius
 Asynchronous function of three parts
 anterior
 middle
 posterior
 All fibers abduct
 Ant. fibers flex & IR
 Post. fibers extend & ER
 Possible role in muscle imbalances at
the hip
 Trochanteric Bursa
 Adductors
 Peak isometric
torque exceeds
that of abductors
 Attachment to
pubic ramus may
be clinically
significant.
 Gracilis is the
only adductor to
cross the knee
Medial Hip Rotators
 There is no muscle with a primary
function of hip medial rotation
 Muscles with lines of pull anterior to
the hip joint axis at some point of the
ROM may contribute to the activity
 TFL & anterior gluteus medius may
be the most significant of these.
 Ipsilateral Trunk
Unilateral Stance
List
Ipsilateral Cane Contralateral
Cane
Impact of a Carried Load:
Contralateral Upper Extremity
 EMG of hip abductor muscles
increased
 16.8% at 5% BW load
 38.9% at 10% BW load
 58.4% at 15% BW load

Neumann D, PT 76:
1320-1330, 1996
Impact of a Carried Load:
Ipsilateral Upper Extremity
 EMG of hip abductor
muscles decreased
 10.6% at 5% BW load
 16.9% at 10% BW load
 17% at 15% BW load

Neumann D, PT 76:
1320-1330, 1996