Biomechanics of Hip and Pelvis

Produced by  Phil Austin

Phil Austin

Introduction to Hip Joint
Articulation of the acetabulum of the pelvis and the head of femur The 2 segments form a ball and socket joint with 3° of freedom Flex / ext Abd / Add Med / Lat rotation
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Primary Function
To Support weight of head, arms and trunk (HAT) During static erect posture and dynamic postures (e.g. running). Primarily structured to serve its weight bearing function (supports ⅔ body weight)
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001 Comprehensive

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Structure
Full ossification occurs at 20 – 25 years The acetabulum appears to be a hemisphere, BUT only the upper margin has a true circular contour. The “roundness” decreases with age. Only the upper horse shoe shaped area is articular.

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Acetabular Fossa – non articular. Contains fibro-elastic fat covered with synovial membrane
Netter F, Atlas of Human Anatomy, 2nd ed.

Proximal Articular Surface Located at lateral aspect of innominate. Bones form the acetabulum Ilium (2/5) Ischium (2/5) Pubis (1/5)

Acetabular notch – spanned by fibrous band (transverse acetabular ligament) T.A.L. This connects the 2 ends of the horse shoe.
Netter F, Atlas of Human Anatomy, 2nd ed

Creates a fibro-osseous tunnel through which blood vessels can pass to the deepest part of the acetabulum.

Central Edge Angle (CE)
In Males ≅ 38 ° In Females ≅ 35 ° Smaller CE angle – may result in diminished coverage of the head of femur.

∴ ↑ risk of superior dislocation.

CE angle increases with age have ↓ coverage over the head of the femur = ↓ coverage over the head of femur compared to adults
∴Children

Congenital dislocation is most common at the hip joint due to ↓CE angle.
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001

Acetabular Anteversion.
Anterior orientation – “Angle of acetabular anteverision” Men – 18.5 ° Women – 21.5 ° NB – Kapandji cites values of 30 - 40 ° ∴ ↑ Anteversion = ↓ joint stability + ↑ chance anterior dislocation.
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Acetabular Labrum
Covers entire periphery of acetabulum. Deepens the “socket” Increases concavity through its triangular shape Grasps the head of femur to maintain contact with acetabulum. Transverse acetabular ligament – considered part of the labrum (BUT contains no cartilage cells)

Netter F, Atlas of Human Anatomy, 2nd ed

Structure of Distal Articular Surface
Head of femur – fairly rounded hyaline cartilage covered – slightly larger than a true hemisphere. The radius of the femoral head is smaller in females when compared to the dimensions of the pelvis.
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed Comprehensive 2001

Phil Austin

Ligamentum Teres - Main Function – act as a
channel for secondary blood supply from the obturator artery and nerves. Blood supply via this is greater in childhood Sclerosis of the ligament in elderly. ∴ secondary supply cannot back up primary retinacular supply Absence increases risk of avascular necrosis to head with femoral neck trauma.

Fovea – Inferior to most medial point on femoral
head. Attachment point of the ligament of head of femur is attached.(Ligamentum Teres) Femoral head – attached to femoral neck; the neck is attached to shaft between the greater and lesser trochanter.

Netter F, Atlas of Human Anatomy, 2nd ed

Angulation of Femur
Femoral head faces medially, superiorly and anteriorly. Frontal plane – ∠ of inclination

Axis of femoral head, neck and longitudinal axis of shaft

Transverse plane - ∠ of torsion
Axis of femoral head and neck and an axis through the distal femoral condyles.
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Embryonic Development.
Early stages – both ↑ and ↓ extremity buds project laterally from body (full abduction). At 7 / 8 weeks gestation, adduction of the joints begin. By the end of week 8, the foetal position has been achieved.
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150 ° in infancy. 125 ° in adults. 120 ° in the elderly The ∠ varies among individuals and sexes Female = ↓ due to greater width of female pelvis.
Singleton. HC LeVeau BF: Stability & Stress, A review. Phys Ther 55, 957-973, 1975

Normal ∠ of inclination – the greater trochanter lies at the level of the centre of the femoral head.
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001

A pathological increase between neck and shaft – COXA VALGA Decrease – COXA VARA
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Angle of Torsion of Femur
Best viewed by looking down the length of the femur. This angle reflects the twist in the bone that occurs during foetal development. Normal torsion – anterior. This is due to the knee being aligned in a frontal plane. Allowing the knee to flex and extend in a sagittal plane.

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Angle of Torsion of Femur
Each structural deviation needs careful consideration as to the impact on the hip joint AND function of joints both proximal and distal to it. Anteversion can cause significant dysfunction to both knee and foot. Both angles of inclination and torsion are

Properties of the Femur and exist independently to the hip joint.
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Pathological Anteversion

Age (y)
.

Anteversion (in degrees) 30 - 50 30 25 20 17 11 8

Pathological Retroversion

Birth - 1 y 2 3-5 6 -12 12 -15 16 - 20 20

Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001

Signs & Symptoms
Anteversion Toeing in Squinting patellae Subtalar pronation Medial tibial torsion Medial femoral torsion Retroversion Toeing out Subtalar supination Lateral tibial torsion lateral tibial torsion

www.clinicalsportsmedicine.com/chapters/24b.htm

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Articular Congruence
Considered congruent BUT - Significantly more articular surface on the head of femur than on the acetabulum. In standing position – head is exposed anteriorly and superiorly.
∴ Angle of torsion is poorly matched to anterior orientation of acetabulum.
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001 Comprehensive

Phil Austin

Articular Congruence
Coxa Valga, anteversion or a shallow acetabulum results with increased : Articular exposure of the femoral head Less congruence Reduced stability In an a neutral standing position. Increased articular contact can be achieved with flexion, abduction and slight lateral rotation.
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Contact of the femoral head on the acetabulum Increases during flexion and abduction b) = maximum articular contact of femoral head

Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001

Articular Congruence
The Acetabular fossa may set up a partial vacuum – so atmospheric pressure may contribute to stability. Maintaining contact of the 2 articulating surfaces. Atmospheric pressure plays a stronger role in stabilization than the capsuloligamentous structures
(Wingstrand H et al, Intracapsular and atmospheric pressure in the dynamics and stability of the the hip. Acta Orthop Scand, 61: 231-235. 1990) 231-

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Hip Joint Capsule
Strong and Dense Attached to entire periphery of bony acetabulum. Covers femoral neck and head Gtr / Lssr trochanter – Extra articular. 2 sets of fibres Superficial longitudinal fibres - Retinacular Deeper circular fibres – Zona Orbicularis (collar like)
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Iliofemoral lig - Referred to as – Y ligament – stronger / thickest of all hip ligaments. Bands of ilio pubo / femoral ligs Posterior portion Ischio-femoral ligament – Outer fibres spiral around femoral neck Deeper fibres arranged horizontally. Ligament and capsule allow minimal joint distraction

Netter F, Atlas of Human Anatomy, 2nd ed

Line of gravity (LOG)
Normal standing posture – LOG passes posteriorly to the hip joint. (Kendall; McCreary, & Provence, 1993,p 75) Produces a posterior tilt. In a closed chain, with the femur relatively fixed, posterior tilt → hip extension. What controls gravity’s hip extensor moment ??? Hip flexor muscle activity ????
moon.ouhsc.edu/dthompso/NAMICS/hipbmk.htm

Phil Austin

LOG

moon.ouhsc.edu/dthompso/NAMICS/hipbmk.htm Phil Austin

Gravity’s effect on the hip
We don’t need activate muscles to stabilise the hip during neutral standing. Anterior ligaments exist in the same line of application (LOA)

moon.ouhsc.edu/dthompso/NAMICS/hipbmk.htm Phil Austin

Gravity’s effect on the hip
The iliofemoral ligament elongates = very tight spring → elastic force. This force is PASSIVE & not active (muscle force) Directed to its point of attachments on the ilium / femur The force prevents the attachments being pulled further apart (PREVENTS EXTENSION)
moon.ouhsc.edu/dthompso/NAMICS/hipbmk.htm Phil Austin

Weight-Bearing
Trabeculae of bone line up along lines of stress. Along pubic rami, ischia and the dome of the acetabulae. (primary wt bearing areas) Primary wt bearing area is continuous with the MEDIAL TRABECULAR SYSTEM. (MTS) Trabeculae at the centre of the acetabulum – continuous with the LATERAL TRABECULAR SYSTEM. (LTS)
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Medial Trabecular System
Oriented along vertical compressive forces passing through the hip.
Kapandji. I The Physiology of Joints, Vol 2, ed 5, Williams & Wilkins, Baltimore 1987.

Lateral Trabecular System
Is oblique – may develop in response to shear stresses created by HAT pressing on the femoral head, while the GRF pushes up the femoral shaft.
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001
Kapandji. I The Physiology of Joints, Vol 2, ed 5, Williams & Wilkins, Baltimore 1987.

Trabecular Systems
Med / Lat systems also aid in resistance of bending stresses occurring at the femoral neck and shaft from weight from HAT. Med system resists bending compression forces medially Lat system resists bending tensile forces laterally.

Zone of weakness – Less reinforcement. Susceptible to
bending forces, May #
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001

Phil Austin

Wt bearing causes bending forces along the shaft of the femur = Compression forces medially Tensile forces laterally

Wt bearing through the head of the femur & contraction of the abductors cause tensile forces superiorly & compressive forces inferiorly

Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001

Primary Weight-bearing Areas
1) Dome of acetabulum Lies directly over the centre of rotation of femoral head. Greatest prevalence of degenerative change??
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2) Superior portion of femoral head Degenerative changes occur around / below the fovea or peripheral edge of articular surface. ∴ the primary weight bearing area is not in the area of greatest degenerative change.
Bombelli, R, et al: Mechanics of the normal and osteoarthritic hip: A new perspective, Clin Orthop, 182-69Orthop, 182-6978,1984

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AP view of the left hip in a patient with osteoarthritis. The superior weight-bearing area of the joint space is quite narrowed.

Motion of Femur at Hip (Open Chain)
Typical ROM
Flex – 90° (knee ext) Flex – 120 ° (knee flex) Ext – 10 – 30 ° Abd – 40 – 45 ° Add – 20 - 30 ° Lat / Med Rot – 42 - 50 ° (performed with hip at 90 ° flex)
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Osteokinematics

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Motion of femur at the hip (open Chain)
ROM is influenced if motion is a) passive OR active b) passive tension in a 2 joint muscle is encountered or avoided. E.G. - Hip flexion is 90° with extended knee “ “ “ 120° with knee flexed Release of passive tension on the 2 joint hamstring.
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001

Phil Austin

Motion of femur at the hip (open Chain)
Hip extension = 10 → 30° but is ↓ when knee flexion prompts passive flexion 2 joint rectus femoris. Abduction = 45° ish – limited by gracilis Adduction = 25° ish – limited by TFL Med / Lat rotation usually measured with 90° of flexion – 45 → 50°. NB – Femoral anteversion → ↓ lat rotation, due to the femoral head is torsioned more anteriorly ∴Encounter of capsuloligamentous / muscular restrictions sooner.
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Motion of Pelvis at Hip (Closed Chain)
Proximal segment moving on a fixed distal segment. Motion is the same as if the distal segment were the moving part.

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Anterior / Posterior Tilt
Motion of entire pelvis in a sagittal plane around a frontal axis Ant tilt – hip flex Post tilt – hip ext. Ant / post tilt results in flex / ext of hip joints together. Or at the closed chain joint if the opposite limb is open (none weight bearing)
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www.pt.ntu.edu.tw/.../KINspine/PelvicGirdle.htm Phil Austin

Lateral Tilt
A frontal plane motion of whole pelvis around a A/P axis. If ASIS’s are not horizontal – lateral tilt. Lateral tilt – 1 hip Jt is the pivot point (axis) for motion described on the other side. (hip hike or hip drop) ∴ None wt bearing hip is OPEN CHAIN Wt bearing hip is CLOSED CHAIN
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001

Phil Austin

Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001

Phil Austin

The pelvis & wt have shifted Rt hip into adduction & left hip into abduction. Returning to neutral requires while putting weight through both feet the rt abductor & the left adductor work synergistically.

Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001

Pelvic Rotation
Entire pelvis moving in a transverse plane around a vertical axis through the middle of the pelvis in a bilateral stance
Levangie, Norkin, Joint Structure and Function. 3rd edit 2001.

Fwd rot of pelvis – side of pelvis opposite to supporting hip joint moves anteriorly. Stand on 1 leg and rotate pelvis – Feel relative rot.

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Lumbar-Pelvic Motion
OPEN CHAIN response due to the pelvis moving without necessitating motion elsewhere. NB – Subtle adjustments by other joints to assure that LOG remains within base of support. I.e. – planterflexion of ankles
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Femur, pelvis and LS produce a ↑ ROM than in 1 segment alone.

Fwd bending to the floor – isolated Flexion at the hip joints (anteriorly tilting pelvis on femurs) If the knees stay extended, hips only flex to 90° ∴Lumbar & thoracic flexion incline the head & trunk fwd so Hands can reach the grounds EG of open chain response in hips & trunk (from above) NB – not an eg of how to pick up An object
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Maximal abduction = 90°. ° If pure hip adduction = 45°

So must include lateral pelvic tilt & lateral flexion of the lumbar spine

Closed Chain Function
The 2 ends of the chain have to be fixed. Feet are fixed at 1 end. Head is functionally fixed at the other.
NB - Although the head can move in space, it remains upright / vertically oriented. This is due to the influence of labyrinthine and optical righting reflexes.

∴ Drive to keep head upright over the sacrum – effectively fixes the head in relative space. ∴ Functionally fixed rather than structurally fixed.
Phil Austin

Closed Chain Function
All the segments between the weight bearing part = 1 closed chain. ∴ Movement at 1 joint will create movement in at least 1 other linkage in the chain. ∴ Hip flexion cannot occur independently, but must be accompanied by motion at joints above and below.

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Open chain response to tight hip flexors a) Inclined forward (LOG falls outside base of support – No adjustment)

Closed chain response to tight hip flexors b) Spine extends to maintain LOG within base of support.

Muscle Function in Stance
BILATERAL STANCE LOG – posterior to to axis for Flex / ext at hips
∴ ext moment of force → posterior tilt on pelvis and femoral heads. Checked by passive tension in capsuloligamentous structures. Ilio-psoas may assist passive structures.

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Flexors
Function primarily as mobility muscles in open chain. Secondarily – resistance to extension forces occurring as body passes over foot Ilio-psoas – primary hip flexion Rectus Femoris – only 1 of quad group that crosses hip and knee joint. (flex of hip, ext of knee)

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Flexors
Sartorius – flex, abd, and lat rot of the hip + (flex, med rot of the knee). Most important when knee and hip are flexed (climbing stairs)
Williams: Gray's Anatomy ed 38, Churchill Livingston 1995

Ilio-tibial band – flex, abd, med rot of femur on hip. Relieves tensile stresses imposed on femur by weight bearing forces TFL – Maintains tension in the ITB

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Hip Joint Musculature

Netter F, Atlas of Human Anatomy, 2nd ed

Adductors Function, not as prime movers But by reflex response to gait activities.
Janda / Stara

Adductors may be synergists to Abductors when both feet are on ground - ↑ stability. 22.5% of muscle mass of lower extremity 18.4 % - flexors 14.9 % - abductors
Ito. I.Morphological analysis of human Lower extremity based on the relative Muscle weight. Okajimas Folia Anat, 73 – 247-252 1996.

Extensors One joint gluteus maximus and two joint hamstrings – primary hip extensors Secondary assistance – posterior fibres of gluteus medius and superior fibres of adductor magnus and from piriformis. Hip extension via hamstrings – reduced When the knee is flexed. Extension forces in the hip increase by 30% if the knee is extended.

Netter F, Atlas of Human Anatomy, 2nd ed

Abductors – Gluteus medius / minimus + assistance from sartorius when abduction occurs against strong resistance. Glut med / min off set gravitational adduction Torque at stance hip (pelvis drop).

Lateral Rotators Apart from lat rot, these muscles act as ‘compressors’ and act as stabilizers (similar To rotator cuff at G/H joint. Lat rot action decreases with hip flexion. Medial Rotators No muscles that primarily act as med rot. Evidence suggest that the adductors are also Med rotators. Trend to increased med rot torque during hip Flexion (reduced lat rot

Netter F, Atlas of Human Anatomy, 2nd ed

Muscle A flexes, internally rotates, and abducts the hip Muscle B extends, externally rotates, and abducts the hip Acting together, in a synergy, the two muscles can abduct the hip while producing little or no movement in other planes.

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Muscle Function in Stance
Biomechanics

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Bilateral Stance
Erect bilateral stance – both hips are neutral or slight hyperextension & weight is evenly distributed through both legs. LOG – just posterior to axis of flex / ext. (frontal) = posterior tilt of pelvis on ”fixed” femoral heads. Gravitational tension – checked by passive tension of capsularligamentous structures + slight / intermittent activity form iliopsoas.
Levangie, Norkin, Joint Structure and Function. 3rd edit 2001.

Phil Austin

Bilateral Stance
In a frontal plane the superincumbent BW – transmitted through the SI´s, along the pelvic trabeculae system to Rt & Lt femoral heads. H.A.T. – (head, abdomen, thorax) ≅ ⅔ BW is distributed through both femoral heads. Gravitational torque occurs in the opposite direction BW on Rt hip drops the pelvis → Lt BW on Lt hip drops the pelvis → Rt

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These 2 opposing graviational moments of equal magnitude balance each other & the pelvis maintains equilibrium in a frontal plane.

Levangie, Norkin, Joint Structure and Function. 3rd edit 2001.

Bilateral Stance
If bilateral stance is not symetrical frontal plane muscles are required to control (adds & abds) Side to side motion Return to symetrical stance. In unilateral stance activity of adds in wt bearing or none wt bearing cannot contribute to stability of the stance limb. Sole domain of abductor function
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Unilateral Stance
Full weight of HAT through load bearing hip E.g. – 90kg subject HAT – ⅔ BW (60kg) 1 Lower limb – 1/6 BW (15kg). ∴ Supporting hip will endure 75kg (5/6 BW) of compression. Rt hip joint compression = [2/3 x W] + [1/6 x W] = 5/6 x BW
Levangie, Norkin, Joint Structure and Function. 3rd edit 2001.

Phil Austin

Hip abds – moment arm of 50mm The pull of the abds (Fms) on a horizontal pelvis will resolve the translatory component (Ft)
50mm

100mm

This pulls the acetabulum to the centre of the femoral head. The rotatory component (Fr) pulls the pelvis down on the superior aspect of the femoral head

Unilateral Stance
Force of gravity on HAT and none WB lower limb (HATLL) – add force to the supporting hip. LOG ≅ 100mm (0.1m) from right hip axis [MA = 100mm] Actual MA – slightly ↑ due to wt of hanging Lt leg will pull COG slightly → Lt Simple Hypothetical e.g. HATLL Torque adduction 75kg x 0.1m = 7.5 N-m
Phil Austin

Unilateral Stance
Maintenance of single limb support → countertorque abduction of equivilent force. This is produced at glut medius / minimus These muscles must generate an equivilent abduction torque of 7.5 N m
Torque abduction = 7.5 N m / 50mm (0.05m) = Fms Fms = 7.5 N m = 150kg 0.05m
Phil Austin

Unilateral Stance
∴ prevention of the pelvis falling → unsupported side The abds must generate a force of at least 150 kg. Assuming all the muscular force is transmitted through the femoral head, the 150kg must now be added to the 75 kg of compression due to BW. ∴ total hip compression or joint reaction force at the stance hip = 150 kg + 75 kg ≥ 225 kg total hip joint compression
Phil Austin

Unilateral Stance
Hypothetical figures simplify forces involved. Total joint compression / reaction forces = 2.5 -3 x BW in a unilateral stance. Investigations also calculate 4 – 7 x BW respectively at begining & end of ”stance phase” of gait & 7x when climbing the stairs
Phil Austin

Unilateral Stance
Wt loss may help reduce joint reaction. Magnitudes of force differ in different individuals i.e. ∠ of pull & and the ∠ of inclination of the femoral head. Physiological / biomechanical factors causing ↑ force production at hip abds – in time may accelerate joint deterioration.

Phil Austin

Compensatory Lateral Lean
Gravitational force can be ↓ by laterally leaning the trunk over the pelvis toward the side of pain / weakness when in a unilateral stance. May appear to be counterproductive (apparent ↑ BW) BUT – swings LOG closer to the hip joint ∴ ↓ graviational MA.

Phil Austin

Compensatory Lateral Lean
HATLL must pass through regardless ∴ leaning toward doesn’t increase joint compression. ∴ The shorter the gravitational adduction torque = ↓ need for abduction counter torque EG – If lateral lean is bought to 25mm of the right hip the gravitational torque would be.

Phil Austin

HATLL torque

adduction

=

5/6 BW (75kg) x .025m HATLL torque
adduction

= 1.875 N m

0.05m

If only 1.875 N m were produced by BW on the Rt hip – the abds force needed would be. Torque
abduction

= 1.875 N m / 0.05m = Fms

0.025m

Fms = 1.875 N m = 37.5kg .05m 37.5 kg of muscular joint compression + 75 kg of BW compression Total hip joint compression ≥ 112.5kg

Phil Austin

Sacral Articulating Surface
Auricular (c) shaped, Foetal – prepuberty – surfaces are flat and smooth Postpubertal – surface is marked by a central groove or surface depression that extends the length of the articulating surface Sacral cartilage is 1.5 : 1 to 3 : 1 thicker than iliac cartilage. ↑ thickness in females : males.
Bowen,Cassidy. Macroscopic and microscopic anatomy of sacroiliac from embryonic life until 8th decade. Spine, 6 sacroiliac 620-627. 1981 620-

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Articulating Surface of the Ilia
Also C-shaped Smooth / flat to prepuberty Postpuberty – central ridge along length. Corresponds with groove at sacral surface. Both surfaces lined with type II collagen (hyaline)

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Iliac Articulations
In Childhood – permits glide in all ranges (synovial joint). Postpuberty – joint surfaces change configuration and translation and rotation is restricted to a few mm’s (open to controversy)
Walker.JM. The sacroiliac joint, A critical review. Phys Ther 72, 903, 1992. 72,

Nutation – Anterior motion of sacral promontory. ↓ A/P dia at pelvic brim ↑ A/P dia at pelvic outlet. Important during pregnancy especially under influence of RELAXIN. Ligamentous structures are softened.

Phil Austin

Symphysis Pubis Articulation
Cartilaginous joint. Each end of the pubis bone – covered with articular cartilage. Joint formed by fibrocartilaginous disc – joins hyaline covered ends. The disc has a thin central cleft (in females may extend along the length.
Kapandji IA. Physiology of joints 3, ed 2 Churchill Livingstone, Edinburgh, 1974 Phil Austin

Symphysis Pubis Articulation
3 Ligaments associated with pubis joint Superior pubic lig – thick / dense fibrous band attaching to pubic
crest and tubercles – support of superior aspect of joint.

Inferior pubic lig – Arches from ramus to ramus. Posterior pubic lig – Continuous with the periosteum of the pubic
bones.

Anterior Pubis – re-enforced by aponeuroses from muscles
crossing the joint.
Phil Austin

Function of Sacral Region
HAT creates a nutation torque on the sacrum. Ground Force (GF) creates posterior torsion on the ilia. Nutation / counternutation & posterior torsion of the ilia are prevented by ligamentous tension and adjacent muscles.
Phil Austin

Function
SI’s and pubis – linked by closed kinematic chain ∴ any motion occurring at the pubis WILL be accompanied by motion at the SI’s and vice versa. SI’s / pubis – functionally related to hips. ∴ effect and affected by motion from trunk and ↓ extremity. ∴ Shifting weight from 1 leg to another WILL induce motion at the SI’s. Fusion of lower lumbars have been found to increase motion at the SI’s
Grieve, GP, The sacro-iliac joint. Physiotherapy 62.8. 1979 sacro-

Phil Austin

Function
Shearing forces created at the pubis during single leg support phase of walking due to lateral pelvic tilting. If pubis is dislocated = instability. ∴ ↑ stress on SI’s, hips and vertebral column.

Phil Austin

Pelvic Floor Muscles
Voluntary contraction of levator ani helps constrict openings of urethra and anus. Involuntary contraction occur during coughing or holding breath etc ↑ intra-abdominal pressure. In women, these muscles surround the vagina and help support the uterus. The coccygeus muscle assists the levator ani in supporting pelvic viscera + maintain intra- abdominal pressure.

Phil Austin

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