Transcript Lower Limb Kinesiology

Hip Joint Kinesiology
Amir H. Bakhtiary
PhD, PT
Associate Professor
Physiotherapy Department
Rehabilitation faculty
Semnan University of Medical Sciences
Hip Joint Musculature
Important characters of Hip
Joint Muscles
Five important point to consider
1) Best position for muscle work is in the middle length or a
little bit stretch of optimum length-tension position.
2) Two Joint Muscles could produce extreme force if do NOT
work on both Joints simultaneously
3) Best Tension is provided during eccentric, then isometric
and finally concentric contractions
4) Muscles are responsible to move 2/3 of HAT Weight and
then 1/3 of lower limb Weight (wide attachment on trunk)
5) The function of hip joint muscles is dependent on
1) Joint position
2) Possible joint movement in proximal and distal segments
Describe the action of Flexor
Muscles during OKC and CKC
• In Open Chain
• Move forward the lower limb
• In closed Chain
• Resist against Extension force which act on the WB leg
• The action line of 9 Hip muscles are front of the hip
joint, but there are only four main flexor:
•
•
•
•
Iliopsoas
Rectus Femoris
Tensor Facia Lata
Sartorious
Iliopsoas
Muscles
Some facts about Iliopsoas muscle
• Its connection on the vertebral causes 1) Ant Tilt
and 2) forward tension on the lumbar
• In closed chain, (upright standing position), is
responsible for lumbar lordosis increase to
compensate Ant Tilt of Pelvic
• Its action is necessary for hip flexion during the
sitting position (above 90 degree)
• Its unilateral activity cause Lumbar Lateral Flexion
• Its bilateral activity cause lumbar flexion
• Its line of action create shear stress on the lumbar
vertebrate
Some facts about Rectus Femoris
•
•
•
•
•
Only part of Quadriceps which is two joints
Hip flexor and Knee Extensor
Knee position affect its activity
Simultaneous two joint activity cause insufficient
Knee flexion may improve its activity
Sartorius and
Tensor Fascia
Lata Muscle
Some facts about Sartorius muscle
•
•
•
•
Strip shape
Flex, Abd, Lat Rot on Hip Joint
Flex and Med Rot on Knee joint
Important activity on simultaneously flexion in knee
and Hip joints
• Its small cross section state its inability to provide
strong force
Some facts about TFL muscles
• Its fibers connect to the ITB at the upper ¼ of thigh
• The tension of ITB come from TFL and GM
• It pass behind the lateral side of knee cause Ext and lat
Rot of knee
• Flex, Abd, Med Rot Of Hip
• Increase the tension of ITB
• Release the tensile stress due to the WB on the
lateral side of femur shaft
• Activation of osteoblast
snapping hip syndrome
Movement of the IT band anteriorly and
posteriorly over the greater trochanter during
functional activities has been implicated in
“snapping hip syndrome” which is an
inflammation of the trochanteric bursa
TFL and ITB
Illitobial Band Stretch
What is the Secondary flexor muscles
• The secondary flexor muscles Included
•
•
•
•
Pectineus
Add Long
Add Magnus
Gracilis
• Is two joint muscles (hip and knee flexor)
• It may act in just one Joint
• These are Adductor muscles
• Their flexion activity depend on their position
related to the femur (only up to 40° -50° of hip flexion)
• If the femur places in a higher position their activity
changes to extension of Hip
Pectineus
muscle
Adductor
Muscles
Hip Adductor Muscles
• Incuded:
•
•
•
•
• Pectineus
• Add Mag
• Add Brev
• Add Long
• Gracilis
%22.5 of thigh muscles
Their important action is adjustment of pelvic by synergist activity of
Abductor muscle (create a balanced position for Pelvic) especially in
unilateral standing
In bilateral Standing, side to side stability of Pelvic, provided by coactivation of Abd and Add
The adductors are also capable of generating a maximum isometric
torque greater than that of the abductors
Some facts about Gluteus Maximus
• Main extensors
• Helped by
− posterior fiber of G Med,
− upper Fiber of Add Mag and
− Piriformis
•
•
•
•
Upper fiber correct the TFL Tension on ITB
Its MA is bigger than Hamstrings
Best Optimum length-tension is in 70° Flexion
Work as Lat Rot, but change to Med Rot at hip flex
Gluteus
Maximus
Other Hip Extensors
• Two Joints muscles
• Biceps Femoris (long head)
• Flexor and lat rot of Knee
• Semitendinosos and Semimembranosos
• Flexor and Medial Rot of Knee
• These muscles work in all situation
• Load and Unload
• Maximum MA in 35° hip flexion
• However, their MA is always less than GM
• Their function depends on the knee position
• %30 increase in Knee Ext
Balance between Flex/Ext
muscles
• Pelvic is like a pulley
• Flex muscles pull down on it from the
front
• Ext muscles pull down on it from the back
• Ideally a balance between two
muscles is needed
• Otherwise faulty posture will be appear
such as
• Swayback posture
• Flat back posture
Hip Abductors
• Main included:
• Gluteus Med and
• Gluteus Min
• Accessory Hip Abductors muscles included:
• Upper part of Gluteus Max and
• Sartorius and
• TFL (Just during its flexion activity)
Hip Abductors
• Gluteus Minimus
• Deep to the G Med
• Work with G Med to
• Abd Hip
• Stabilize the hip during unilateral standing
• Prevent dropping of pelvic
• Best function in Neutral position or a few Hip Add
• Loss their efficiency to 25% in Hip Abduction
Hip Abductors
• Gluteus Medius
•
•
•
•
•
•
Deep to G Max
Ant part cause Hip Flex and Med Rot
Med Part cause Hip Abd
Post Part cause Hip Ext and Lat Rot
In hip flexion, all portions medially rotate the hip.
All portions of the muscle abduct, regardless of hip joint
position
• Trochantric Burse separate it from great trochanter
• It may origin of pain during inflammation
Hip Abductor
• Gluteus Minimus
• is consistently an Hip abductor and flexor of
the hip,
• its rotator function dependent on hip position
• Because of its attachment to the joint capsule
• Retracts the capsule during hip abduction to
prevent entrapment or
• Tightens the capsule to add to the gluteus
minimus’s primary function of stabilizing the
femoral head in the acetabulum
Abductor muscles
• Activity of gluteus Min and Med muscles together
• to either abduct the femur (distal level free) or,
• to stabilize the pelvis (and superimposed HAT) in
unilateral stance against the effects of gravity.
• They physiologically work most effectively in a
neutral or slightly adducted hip (slightly lengthened
abductors).
• Isometric abduction torque in the neutral hip position is
82% greater than abduction torque when the hip is in 25
of abduction (shortened abductors)
Hip Abductor Weakness
a) Normal Gait
b) Trendelenburg Gait
Abductor muscles
• Lateral Hip Pain Syndrome
• Seen among both the elderly and athletes
• the bursae around the greater trochanter are commonly
involved
• Included
• 1) the subgluteus minimus bursa,
− Serve to reduce friction between gluteus Min and Ant Facet
• 2) the subgluteus medius bursa,
− Serve to reduce friction between gluteus Med and Lat Facet
• 3) the large trochanteric bursa
− serves to reduce friction between the posterior facet and the overlying
gluteus maximus, as well as between the IT band and the trochanter.
Hip Lateral Rotators Muscles
• Main
•
•
•
•
Obterators (Int & Ext)
Gemelus (Sup & Inf)
Quadratus Femoris
Piriformis
• Accessory
• Post part of G Med & G Min
• Upper part of G Max
Lateral
Rotators
Some facts about Hip Lateral
rotators
• Attach to femur in vertical direction
• Press the head of femur to acetabulum
• Their action line is parallel to the neck of femur
• They are ideal to stabilize head and neck of femur
• Their efficiency for Lat Rot reduce by hip flexion
Some Facts about Hip Medial
Rotators
• There is no Special med rotator muscles
• Every muscles that its line of action is in front of
joint work as Med Rot in some ROM
• More important muscles in this part are
• G Med and
• TFL
• The Medial Rotator Torque increases by hip flexion
(3 times more than Lat Rot)
• Lat rotator torque decrease by hip flexion
Hip Joint Forces and Muscle
Function in Stance