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Kinesiology Of Hip Joint & Pelvic Girdle

Ari Sudarsono, SST, SKM, M.Fis

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Introduction
The pelvic girdle provides a sturdy foundation for the trunk and spine. The hip joint, or acetabular femoral joint, performs free range of movement like the shoulder joint. The lower extremities depend on the hip joint to be relatively stable.

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Pelvis
A ring of bone providing articulation for the lower limbs with the trunk.

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What is the Mechanical Role of Pelvis?

Lower Limbs

Pelvis Is Designed to Transfer of Weight from th

Ischial Tuberositie

By Loosing of Mobility
Sacroiliac Joints Symphysis Pubis

Additional Roles to Transfer of Weight

Support the Vicers Muscle Attachment Support Birth Ca

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What is the structure of the Sacroiliac Joint?

Synovial Joint between Illium and Sacrum. Due to the powerful ligaments in posterior
Posteriorly Fibrous Anteriorly Sinovial

The SIJs are unique in that both the structure and function of these joints change significantly from birth through adulthood

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Sacroiliac Joint

It is a C shape joint In first decade of life is smooth and flat After puberty, a central ridge in Iliac and groove on the sacral will appear

What is the factors of Sacroiliac Joint Stability?

Causes

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Line of Weight Pass Anterior to the Sacroiliac Joint

Sacral Move Downward into the Pelvis The Bony Surface does Not Bear the Weight Lower Parts Tilt Upward The Weight is Suspended by the Ligaments

Slight Wedging of the Auricular Surface Resist Rotation and Gliding Movement of Sacrum

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What is the Movement of Sacroiliac Joints?

A little Movement is Allowed by Joint Surface and Ligaments There is Slight Gliding and Rotational Movement Sacroiliac Joint movement During

Childbirth

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Nutation and Counternutation Movement

What is the Clinical Importance of Sacroiliac Joint?

Sudden Bending Forward

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Tear the Posterior Ligament

Dislocate the Joint surface

Painful Trunk Flexion Manipulation often Produce a Successful Result

How do we may test the accessory Movement of Sacroiliac Joints?

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These Movements are Limited by the Powerful Ligaments. To Test These Movements Prone Position
Pressure by the Heel of the Hand

On the Apex of Sacrum Downward Small Rotation of the Sacrum

What is the Biomechanics role of Sacroiliac Joints?

Two Trabecular Systems From Sacrum to Pelvis and Then to the head of Femur

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Trabecular sysem

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What is the Symphysis Pubis?

Secondary Cartilaginous Joint. A Thin Layer of Hyaline Cartilage Cover the Bone. This Cartilage is Joined to the Opposite Cartilage by a Fibrocartilage Interpubic Disc. Two Ligaments Support the Joint: 1) Superior Pubic Ligament 2) Arcuate Pubic Ligament The anterior portion of the joint is reinforced by aponeurotic expansions from a number of muscles that cross the joint No Normally Movement Pathology:

Slipping of one pubic to other (Osteitis Pubis)

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The aponeurotic extensions of the muscles crossing the anterior aspect of the symphysis pubis

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Bones
The head of the femur connects with the cup-shaped acetabulum of the pelvic girdle. Bony landmarks, the greater and lesser trochanter, provide attachments for many muscles spanning from the pelvic bones and even the vertebrae anteriorly.

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Bones (cont.)
The pelvic girdle consists of the right and left pelvic bone joined together posteriorly by the sacrum; inferior to the sacrum is the coccyx. The pelvic bones consist of three bones: the ilium, the ischium, and the pubis.

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Bones (cont.)

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Bones (cont.)

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Bones (cont.)

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Bones (cont.)
Additional important bony landmarks include the ischial tuberosity of the posterior ischium and the linea aspera on the posterior femur. Anterolaterally, Gerdys tubercle provides the insertion point for the iliotibial tract.

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Name the landmarks

Iliac crest

Anterior spine

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Name the landmarks

1. 2.

3.

Acetabulu m Sciatic notch Ischial tuberosity

1 2

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Joints
The pelvic bones join in the front to form the symphysis pubis, an amphiarthrodial joint. The sacrum is located between two bones and form the sacroiliac joint made up of strong ligaments.

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Joints (cont.)
The hip joint is classified as an enarthrodial-type joint with a dense ligamentous capsule.

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Joints (cont.)

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Joints (cont.)

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The Hip Joint

Type: Synovial (Ball & Socket) Articular Surfaces: head of femur & acetabulum

Articular surfaces: 1- Acetabulum has: - C- shaped articular surface = lunate surface, Acetabular fossa, - Acetabular notch ----- converted into acetabular foramen by transverse ligament of the acetabulum - - Labrum acetabulare deepens the acetabular cavity. - 2- Head of femur

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Capsule & Synovial Membrane:

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Ligaments:
1- Ilio-femoral lig.: Yshaped, strong, attached between AIIS and both ends of trochantric line. Prevents hyperextension. 2- Pubo-femoral lig.:Triangular in shape, supports the inferomedial part of the joint, attached between iliopubic eminence and the capsule. Prevents hyperabduction. 3- Iscio-femoral lig.: from ischium to the back of the capsule. It becomes tense in medial rotation. 4- round ligament of the head of femur: Inside the joint, between head of femur to acetabular notch and transverse lig.,

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Relations of the hip joint:

Anteriorly:

Pectineus, Iliopsoas, RF (straight head), femoral vessels.

Laterally:
Posteriorly:

Tensor fascia latae, gluteus minimus & medius.

Piriformis, obturator internus, 2 gemelli, quadratus femoris, sciatic nerve.

Above: Below:

RF (reflected head), gluteus minimus.

Obturator externus.

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Stability of the hip joint:

The hip joint is very stable joint due to: 1- The head of femur fits accurately to the acetablum. 2- The three strong ligaments outside the capsule. 3- The surrounding strong muscles. Hip dislocation is usually posterior as in car accidents. It occurs with no fracture of the acetabulum (if the hip is flexed and adducted) or with fracture acetabulum (if the hip is flexed and abducted). The sciatic nerve may be injured in posterior hip dislocation.

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Blood supply to the head of femur:

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Blood supply to acetabular fossa and ligament of the head of femur:

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X-Ray of the hip joint:

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MRI of the hip joint:

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Movements

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Movements (cont.)

What is the Pelvic Motions?

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open kinematic chain motions anterior tilt ASIS moves anteriorly and inferiorly posterior tilt ASIS moves posteriorly and superiorly lateral tilt to the left/right one ASIS is higher than the other (Pelvic list during Gait) Lateral forward and Backward displacement

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Movements (cont.)

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Movements (cont.)

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Muscles

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Muscles (cont.)
The hip flexor iliopsoas muscle is composed of the iliacus, the psoas major, and the psoas minor. The posterior gluteal region contain the gluteal maximus, gluteus medius, and gluteus minimus.

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Muscles (cont.)

The deep six lateral rotators are the piriformis, obturator externus, obturator internus, gemellus superior, gemellus inferior, and quadratus femoris. The tensor fasciae latae attaches anteriorly and laterally to abduct and flex the hip.

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Muscles (cont.)
The thigh has three compartments. The anterior compartment houses the quadriceps; the rectus femoris and the knee extenders vastus medialis, vastus intermedius, and vastus lateralis. The sartorius runs superficial to the quadriceps.

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Muscles (cont.)
The posterior compartment contains the hamstrings consisting of the biceps femoris, the semitendinosus, and the semimembranosus.

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Muscles (cont.)
The medial compartment contains the adductor group of adductor brevis, adductor longus, adductor magnus, pectineus, and gracilis.

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Muscles (cont.)

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Muscles (cont.)

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Muscles (cont.)

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Muscles (cont.)

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Muscles (cont.)

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Nerves
The hip and pelvic girdle muscles are all innervated from the lumbar plexus and sacral plexus known as the lumbosacral plexus.

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Nerves (cont.)

The femoral nerve innervates the anterior muscles of the thigh and provides sensation to the anterior and lateral thigh and medial leg and foot. The obturator nerve innervates the adductor as well as the obturator externus and sensation to the medial thigh.
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Nerves (cont.)

The sciatic nerve is composed of the tibial nerve and common peroneal nerves. The sciatic nerve tibial division innervates the hamstrings and adductor magnus. Both nerves continue down the lower extremity to function the muscles of the leg and foot.

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Nerves (cont.)

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Nerves (cont.)

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Individual Muscles of the Hip Joint and Pelvic Girdle Anterior Iliopsoas

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Individual Muscles of the Hip Joint and Pelvic Girdle Anterior (cont.) Iliopsoas

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Individual Muscles of the Hip Joint and Pelvic Girdle Anterior (cont.) Sartorius

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Individual Muscles of the Hip Joint and Pelvic Girdle Anterior (cont.) Sartorius

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Individual Muscles of the Hip Joint and Pelvic Girdle Anterior (cont.) Rectus Femoris

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Individual Muscles of the Hip Joint and Pelvic Girdle Anterior (cont.) Rectus Femoris

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Individual Muscles of the Hip Joint and Pelvic Girdle Anterior (cont.) Tensor Fasciae Latae

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Individual Muscles of the Hip Joint and Pelvic Girdle Anterior (cont.) Tensor Fasciae Latae

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Individual Muscles of the Hip Joint and Pelvic Girdle Posterior Gluteus Maximus

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Individual Muscles of the Hip Joint and Pelvic Girdle Posterior (cont.) Gluteus Maximus

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Individual Muscles of the Hip Joint and Pelvic Girdle Posterior (cont.) Gluteus Medius

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Individual Muscles of the Hip Joint and Pelvic Girdle Posterior (cont.) Gluteus Medius

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Individual Muscles of the Hip Joint and Pelvic Girdle Posterior (cont.) Gluteus Minimus

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Individual Muscles of the Hip Joint and Pelvic Girdle Posterior (cont.) Gluteus Minimus

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Individual Muscles of the Hip Joint and Pelvic Girdle Posterior (cont.) Lateral Rotators

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Individual Muscles of the Hip Joint and Pelvic Girdle Posterior (cont.) Lateral Rotators

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Individual Muscles of the Hip Joint and Pelvic Girdle Posterior (cont.) Hamstrings
The hamstrings provide hip extension and knee flexion. (Diterangkan di Kinesiologi Lutut)

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Individual Muscles of the Medial Thigh Adductor Brevis

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Individual Muscles of the Medial Thigh (cont.) Adductor Brevis

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Individual Muscles of the Medial Thigh (cont.) Adductor Longus

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Individual Muscles of the Medial Thigh (cont.) Adductor Longus

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Individual Muscles of the Medial Thigh (cont.) Adductor Magnus

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Individual Muscles of the Medial Thigh (cont.) Adductor Magnus

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Individual Muscles of the Medial Thigh (cont.) Pectineus

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Individual Muscles of the Medial Thigh (cont.) Pectineus

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Individual Muscles of the Medial Thigh (cont.) Gracilis

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Individual Muscles of the Medial Thigh (cont.) Gracilis

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Chapter Summary
The bones, joints, movements, muscles, and nerves of the hip joint and pelvic girdle are explored in this chapter.

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Chapter Summary (cont.)

Individual muscles of the hip joint and pelvic girdle are reviewed in depth with regard to palpation, origin, insertion, action, and innervation. Each muscle includes information with clinical notes, muscle specifics, clinical flexibility and strengthening.

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Chapter Review
The Chapter Review is divided into true and false, short answers, and multiple choice questions. The questions are designed for the students to test their knowledge. Worksheets are at the end of the text as an aid for learning.

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Explore and Practice

Students should utilize the questions and charts at the end of the chapter to help focus on the content of the chapter.

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Flexion of hip

Iliopsoas Muscle Transverse pelvic rotation contralaterally

External rotation of femur when ipsilateral femur is stabilized

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The Hip Joint and Pelvic Girdle

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Rectus Femoris Muscle

Flexion of hip
Extension of knee

Anterior pelvic rotation

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Sartorius Muscle
Flexion of hip
Flexion of knee External rotation of thigh as it flexes hip & knee

Abduction of hip

Anterior pelvic rotation

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Adductor Brevis Muscle

Adduction of hip External rotation as it adducts hip

Assists in flexion of hip

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Adductor Longus Muscle

Adduction of hip

Assists in flexion of hip

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Adductor Magnus Muscle

Adduction of hip External rotation as hip adducts

Extension of hip

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Gracilis Muscle
Adduction of hip Weak flexion of knee Internal rotation of hip Assists with flexion of hip

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Semitendinosus Muscle
Flexion of knee Extension of hip

Internal rotation of hip

Internal rotation of flexed knee

Posterior pelvic rotation

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Semimembranosus Muscle
Flexion of knee Extension of hip Internal rotation of hip Internal rotation of flexed knee

Posterior pelvic rotation

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Biceps Femoris Muscle

Flexion of knee Extension of hip External rotation of hip External rotation of flexed knee

Posterior pelvic rotation

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Extensio n of hip External

rotation of hip

Gluteus Maximus Muscle

Upper fibers assist in abduction

Lower fibers assist in adduction

Posterior pelvic rotation

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Gluteus Medius Muscle Abduction of

hip
Internal rotation & flexion (anterior fibers)

External rotation & extension (posterior fibers)

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Abduction of hip

Tensor Fasciae Latae Muscle

Flexion of hip

Tendency to rotate hip internally as it flexes

Anterior pelvic rotation

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Six Deep Lateral Rotator Muscles Piriformis, Gemellus superior, Gemellus inferior,
Obturator externus, Obturator internus, Quadratus femoris

External rotation of hip

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