PELVIS

AND
HIP
 REFERENCE:
• PELVIS AND HIP- Brunnstrom’s Clinical Kinesiology 5th
and 6th ed. revised by Smith, Weiss and Lehmkuhl

• EXCERPTS FROM:
GOLD RANK REVIEW CENTER
Sir Mike’s Lecture
LUMBAR PLEXUS
SACRAL PLEXUS
 PELVIS
• 4 BONES:
• SACRUM
• COCCYX
• 2 HIP BONES
• FUNCTIONS:
• WEIGHT TRANSFER
• ATTACHMENTS OF MUSCLES
• ROTATES DURING WALKING
Parts of PELVIS
 BONES
1) HIP BONE
⮚OSSIFIED: 20-25 Y/O
⮚AKA: OS COXA, INNOMINATE BONE
⮚3 BONES:
a. I- LIUM
b. P- UBIS
c. IS- CHIUM
⮚TRI-RADIATE LIGAMENTS
• HOLDS AND CONNECTS 3 BONES
 BONES
1) HIP BONE
a. ILIUM
⮚ Largest
⮚ Ant. & Sup.
⮚ Share 40% to acetabulum
⮚ PARTS:
❑ILIAC CREST
⮚ Tensor Fascia Lata (Pocket Muscle)
❑ASIS
⮚ Sartorius (Tailor’s Muscle) 🡪 longest muscle
 BONES
1) HIP BONE
a. ILIUM
⮚PARTS:
❑AIIS
⮚ Straight Head of Rectus Femoris
❑ILIUM ABOVE ACETABULUM
⮚ Reflected Head of Rectus Femoris
❑PSIS
⮚None
❑PIIS
⮚None
 BONES
1) HIP BONE
a. ILIUM
⮚PARTS:
❑ ILIAC FOSSA
⮚ Iliacus
❑ T12-L5 (Post.)
⮚ Psoas
❑ Post. Surface of Ilium
⮚ Gluteals
 BONES
1) HIP BONE
b. PUBIS
⮚Smallest
⮚Ant. & Inf.
⮚Share 20 % of acetabulum
⮚ PARTS:
❑SUPERIOR RAMUS
⮚ Pectineus
❑BODY OF PUBIS
⮚ Adductor Longus (Medial to pubic tubercle)
⮚MC Strained Adductor
PARTS OF PUBIS
 BONES
1) HIP BONE
b. PUBIS
⮚PARTS:
❑INFERIOR RAMUS OF PUBIS
⮚ M- Adductor Magnus
⮚ Origin: Inferior Ramus of Pubis, Ramus of Ischium and Ischial
Tuberosity
⮚ Action: Adduction & Extension of Hip
⮚ Dually innervated: Obturator & Tibial Nerve
⮚ G- Gracilis
⮚ B- Adductor Brevis
 BONES
1) HIP BONE
c. ISCHIUM
⮚ Post. And Inf.
⮚ Share 40 % to acetabulum
⮚ PARTS:
❑ ISCHIAL SPINE
⮚ Gemellus Superior
❑ ISCHIAL TUBEROSITY
⮚ Gemellus Inferior, Quadratus Femoris, Hamstring, Hams
Portion of Adduct
 BONES
2) SACRUM
⮚ ANT: PIRIFORMIS
⮚ POST: G. MAX
3) COCCYX
PARTS OF SACRUM & COCCYX
 LANDMARKS:
1) PELVIC BRIM
⮚ Divides Pelvis into:
a. TRUE Pelvis
b. FALSE Pelvis
⮚ An imaginary line with boundaries
❑Ant: Symphysis Pubis
❑Post: Sacral Promontory
❑Lat: Iliopectineal Line
PELVIC BRIM
 LANDMARKS:
1) PELVIC BRIM
a. FALSE Pelvis
(Superior)
▪ Ant: Lower Abdomen
▪ Post: Lumbar Spine
▪ Lat: Iliac Fossa
 LANDMARKS:
1) PELVIC BRIM
b. TRUE Pelvis (Inferior
Portion of Pelvic Brim)
▪ PELVIC INLET: (Same with
Pelvic Brim)
▪ PELVIC OUTLET:
▪ Ant: Pubic Arch
▪ Post: Coccyx
▪ Lat: Ischial Tuberosity
 PELVIC MOTION:
Anterior Pelvic Tilt Posterior Pelvic Tilt

Hip Flexion (CKC) Hip Extension (CKC)

Iliopsoas & Erector Spinae G. Max. & Abs

↑ Lumbar Curve Flattens Lumbar Curve

APT VS PPT
APT VS PPT
PELVIC MOTIONS
 PELVIC MOTIONS

Figure 9.11—cont’d B) Lateral tilt. C) Anterior rotation or protraction (left) & posterior rotation or
retraction (right). D) Pelvic inclination in sitting contrasted with position in standing. Arrows on the
drawing in D1 and D2 contrasts original method used by Fick to determine pelvic inclination by drawing
a line between the PSIS and pubic symphysis to the later use of the “plane of the inlet” represented by
line a-b, between L-S junction and pubic symphysis.
 PELVIC MOTIONS

E) Current clinical method to evaluate pelvic inclination using an inclinometer.

 7 JOINTS:
1) LUMBOSACRAL JOINT
2) SACROCOCCYGEAL JOINT
3) SYMPHYSIS PUBIS
4) 2 SACROILIAC JOINT
5) 2 HIP JOINTS (ACETABULOFEMORAL
JT.)
JOINTS:
 JOINTS:
1) SACROILIAC JOINT
⮚ Diarthrodial jt.
⮚ No muscle responsible
⮚ OPP: Counternutation/ Sacral
Unlocking
⮚ CPP: Nutation/ Sacral
Locking
⮚ Most Stable Position of SI
Joint
 JOINTS:
NUTATION COUNTERNUTATION

Sacral Promontory Ant. & Inf. Post. & Sup.

Coccyx Post. Ant.

Iliac Crest Move Closer Move Apart

Ischial Tuberosity Move Apart Move Closer

NUTATION VS COUNTERNUTATION
 ANGLES:

1) PELVIC TILT
▪ (N)= 7-15º
 ANGLES:

2) PELVIC INCLINATION
▪ (N) = 50-60º
 ANGLES:

3) SACRAL ANGLE
▪ (N) = 30º
 ANGLES:
4) LUMBOSACRAL ANGLE
⮚(N) = 140º
 JOINTS:
2) HIP JOINTS
⮚Acetabulofemoral Jt.
⮚Diarthrodial, triaxial
⮚ Ball & Socket type/ Enarthrodial
⮚ KINEMATICS:
▪ OPP: 30 Flexion, 30 Abduction, Slight ER
▪ CPP: EXABIR
▪ CP: IR>F>Ab or FABIR
▪ Fxnal Position: 120 Flexion, 20 Abd, 20 IR/ER
 JOINTS:
2) HIP JOINTS
⮚ Components:
❑ Acetabulum ❑ Femoral Head
▪ A- nterior ▪ S- uperior
▪ L- ateral ▪ A- nterior
▪ I- nferior ▪ M- edial
 JOINTS:
2) HIP JOINTS
❑ACETABULUM
▪ LUNATE
⮚ Articulating Surface of acetabulum
▪ ACETABULAR FOSSA
⮚ Non-articulating portion of acetabulum
⮚ Synovial Fluid
⮚ Proprioceptive Nerve endings
⮚ LIGAMENTUM TERES
⮚ Ligament of Femoral Head
⮚ A conduit for blood supply to the femoral head during early years
 JOINTS:
2) HIP JOINTS
❑ ACETABULUM
▪ ACETABULAR CANAL
⮚ Transverse Acetabular Ligament
⮚ Acetabular Notch - Floor
▪ ACETABULAR LABRUM 🡪 aka COTYLOID LIG.
⮚ Deepens acetabulum
⮚ Adds stability
⮚ Negative Atmospheric Pressure
FEMUR
⮚ Longest, largest,
heaviest bone
⮚ 25% of Body
Weight
PARTS OF FEMUR
 BONES
1) HIP BONE
PARTS: ❑LINEA ASPERA
⮚Adductors
❑LESSER TROCHANTER
❑ADDUCTOR TUBERCLE
⮚ Insertion of Iliopsoas
⮚Adductor Magnus
❑GREATER TROCHANTER ❑QUADRATE TUBERCLE
⮚ Insertion of: ⮚Quadratus Femoris
▪ Red carpet muscles (Except: ❑PECTINEAL LINE
Quadratus Femoris) ⮚Pectineus
▪ G. Med.; G. Min. ❑GLUTEAL TUBERCLE
⮚G. Max.
 LIGAMENTS
1) ILIOFEMORAL LIGAMENT 🡪 aka “Y Ligament of Bigelow”
⮚Strongest Ligament
⮚Primary Resist Extension
⮚Resist Ext, Add, ER
2) PUBOFEMORAL LIGAMENT
⮚Primary Resist Abd
⮚Resist Ext, Abd, ER
3) ISCHIOFEMORAL LIGAMENT
⮚Primary Resist IR
⮚Resist Ext, Add, IR
LIGAMENTS
OF HIP JOINT
 ANGLES:
1) ANGLE OF INCLINATION
⮚Aka “Neck-Shaft Angle/ Frontal Plane
Angulation”
⮚(N):
▪ Child: 150-160º
▪ Adult: 125 º
⮚DEFORMITIES:
▪ COXA VALGA
⮚Longer
⮚↑ Neck Shaft Angle
▪ COXA VARA
⮚Shorter
⮚↓ Neck Shaft Angle
 COXA VALGA COXA VARA
Posterior Pelvic Tilt Anterior Pelvic Tilt

Supination of foot Pronation of foot

External Tibial Torsion Internal Tibial Torsion

 ANGLES:
2) ANGLE OF TORSION
⮚(N) Angle:15
⮚Innate medial twist of femur
 ANGLES:
2) ANGLE OF TORSION
↑ ANTEVERSION RETROVERSION
In Toeing Out Toeing
Pronation of Foot Supination of Foot
Internal Tibial Torsion External Tibial Torsion
IR of Femur ER of Femur
Lateral patellar Displacement
 ANGLES:
3) CENTER EDGE ANGLE
⮚ Aka “Angle of Wiberg”
⮚ (N) = >25
⮚ Measures the depth of acetabulum
▪ Definite Dysplasia = <16
▪ Possible Dysplasia = 16-25
▪ Acetabular Protrusion = Over Coverage = >40
3) CENTER EDGE ANGLE
 ANGLES:
4) ACETABULAR
ANTEVERSION
⮚ (N) Angle: 15-20
 LANDMARKS:
1) FEMORAL TRIANGLE
⮚Best Position: FABER
⮚BOUNDARIES:
▪ Sup/ Base: Inguinal Lig./ Poupart lig.
▪ Lat: Sartorius
▪ Med: Adductor Longus
▪ Floor ( Lat🡪 Medial)
▪ I- liopsoas
▪ P- ectineus
▪ A- dductor longus
▪ CONTENTS: (Lat- Medial)
▪ Femoral NAVEL (Nerve, Artery, Vein, Empty Space, Lymphatics)
1) FEMORAL TRIANGLE
 LANDMARKS:
2) Hunter’s Canal
⮚ aka “ Adductor’s Canal/
Subsartorial Canal”
⮚ BOUNDARIES:
▪ Ant/ Med: Sartorius
▪ Lat: Vastus Medialis
▪ Post: Adductor Longus
 LANDMARKS:
3) Greater Sciatic Foramen
⮚ Piriformis
⮚ Sciatic
⮚ PFCN
⮚ Sup. Gluteal & Inf. Gluteal
⮚ Pudendal (S2-S4)
⮚ Nerve to Quadratus Femoris
⮚ Nerve to Obturator Internus
 MUSCLES
1) Hip Extensors
▪ G. Max
⮚ Largest muscle in the body
⮚ Responsible for the roundness of Buttocks
⮚ Strongest Hip Extensor
⮚ Covers the red carpet muscle
⮚ Most Superficial Among the gluteal muscles
 MUSCLES
2) Hip Abductors
▪ G. Med
⮚ Largest lateral hip muscle
⮚ Strongest Hip abductor: 60 %
⮚ Considered as the deltoids of hip
▪ G. Min.
⮚ Deepest gluteal muscle
▪ TFL 🡪 aka “Pocket muscle”
 MUSCLES
2) Hip Adductors (GAAAP)
▪ Gracilis
⮚ only 2 jt. Muscle; The most friendly muscle
⮚ “Slender muscle”
▪ Adductor Magnus
⮚ Dually innervated
▪ Adductor Brevis
▪ Adductor Longus
▪ Pectineus
 MUSCLES
2) Hip ER
▪ Red Carpet Muscles/ Rotator Cuff Muscles
▪ P – iriformis
▪ O – bturator Internus
▪ O – bturator Externus
▪ G – emellus superior
▪ G – emellus Inferior
▪ Q – Quadratus Femoris
 MUSCLES
2) Hip Flexors (SIRPT)
▪ Sartorius
⮚ Longest Muscle 🡪 aka “Tailor’s muscle”
▪ Iliopsoas
⮚Most important hip flexors
⮚Most consistent hip flexors
⮚Only muscles that can flex the hip beyond 90
▪ Rectus Femoris
⮚Only 2 jointed quad muscle
⮚SLR muscle
▪ Pectineus
▪ TFL
 MUSCLES
2) Hip IR (PGTPA)
▪ Piriformis
▪ G. Med. & G. Min.
▪ TFL
▪ Pectineus
▪ Adductors