Podcast
Questions and Answers
What is the primary function of the iliofemoral ligament?
What is the primary function of the iliofemoral ligament?
In which direction does the convex femoral head glide during hip flexion in open chain movements?
In which direction does the convex femoral head glide during hip flexion in open chain movements?
What is the relationship between the acetabulum and femoral head during closed kinetic chain movements?
What is the relationship between the acetabulum and femoral head during closed kinetic chain movements?
What is the primary role of the acetabular labrum?
What is the primary role of the acetabular labrum?
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Which ligament primarily reinforces the inferior and anterior portion of the hip capsule?
Which ligament primarily reinforces the inferior and anterior portion of the hip capsule?
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Which statement regarding the femur's articular surface is correct?
Which statement regarding the femur's articular surface is correct?
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Which hip joint motion is primarily limited by the ischiofemoral ligament?
Which hip joint motion is primarily limited by the ischiofemoral ligament?
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What is a common aggravating factor for individuals with gluteal tendinopathy when walking?
What is a common aggravating factor for individuals with gluteal tendinopathy when walking?
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Which treatment strategy is advised against during the acute phase of gluteal tendinopathy?
Which treatment strategy is advised against during the acute phase of gluteal tendinopathy?
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What condition is more prevalent among women and may contribute to gluteal tendinopathy?
What condition is more prevalent among women and may contribute to gluteal tendinopathy?
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Which exercise should be specifically avoided during the treatment of gluteal tendinopathy in its acute phase?
Which exercise should be specifically avoided during the treatment of gluteal tendinopathy in its acute phase?
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During the treatment of gluteal tendinopathy, what is emphasized in the early phases?
During the treatment of gluteal tendinopathy, what is emphasized in the early phases?
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What occurs during anterior pelvic tilt?
What occurs during anterior pelvic tilt?
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Which of the following is a common effect of decreased flexibility at the hip?
Which of the following is a common effect of decreased flexibility at the hip?
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During hip extension in a closed kinetic chain, what motion occurs at the knee?
During hip extension in a closed kinetic chain, what motion occurs at the knee?
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What is the primary muscle that initiates hip extension during gait?
What is the primary muscle that initiates hip extension during gait?
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What motion occurs in the hip during a weight bearing lateral pelvic tilt?
What motion occurs in the hip during a weight bearing lateral pelvic tilt?
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What contributes to hip external rotation in a closed kinetic chain?
What contributes to hip external rotation in a closed kinetic chain?
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What is the effect of hip hiking during a lateral pelvic tilt?
What is the effect of hip hiking during a lateral pelvic tilt?
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Which muscles assist in creating pelvic rotation?
Which muscles assist in creating pelvic rotation?
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What describes the primary motion during maximum forward bending of the trunk in relation to lumbopelvic rhythm?
What describes the primary motion during maximum forward bending of the trunk in relation to lumbopelvic rhythm?
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Which tendon is most commonly affected in gluteal tendinopathy?
Which tendon is most commonly affected in gluteal tendinopathy?
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What is a primary symptom of gluteal tendinopathy?
What is a primary symptom of gluteal tendinopathy?
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Which type of bursitis is characterized by pain near the hip joint due to repetitive trauma?
Which type of bursitis is characterized by pain near the hip joint due to repetitive trauma?
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Which structural change is commonly associated with a hip fracture?
Which structural change is commonly associated with a hip fracture?
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What type of stretching may be beneficial for individuals recovering from hip syndromes?
What type of stretching may be beneficial for individuals recovering from hip syndromes?
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In the context of painful hip syndromes, which muscle group is most likely to be involved?
In the context of painful hip syndromes, which muscle group is most likely to be involved?
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Which of the following is NOT categorized as a painful hip syndrome?
Which of the following is NOT categorized as a painful hip syndrome?
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Which of the following conditions is MOST likely to cause hip pain due to overuse?
Which of the following conditions is MOST likely to cause hip pain due to overuse?
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What consequence might result from a hip fracture regarding joint mobility?
What consequence might result from a hip fracture regarding joint mobility?
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Which condition is associated with repetitive trauma to the hip joint?
Which condition is associated with repetitive trauma to the hip joint?
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Which condition is NOT a potential cause of hip joint degeneration?
Which condition is NOT a potential cause of hip joint degeneration?
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What is the most common movement limitation in the capsular pattern associated with hip joint hypomobility?
What is the most common movement limitation in the capsular pattern associated with hip joint hypomobility?
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What symptom would NOT be expected in a patient with hip joint hypomobility?
What symptom would NOT be expected in a patient with hip joint hypomobility?
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Which of the following interventions is aimed at correcting faulty mechanics in patients with joint hypomobility?
Which of the following interventions is aimed at correcting faulty mechanics in patients with joint hypomobility?
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Which functional limitation would a patient with hip joint hypomobility most likely experience?
Which functional limitation would a patient with hip joint hypomobility most likely experience?
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In the context of joint hypomobility, what is a potential result of SIJ dysfunction?
In the context of joint hypomobility, what is a potential result of SIJ dysfunction?
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What type of pain is commonly associated with hip joint hypomobility?
What type of pain is commonly associated with hip joint hypomobility?
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What is an interruption of normal hip mechanics potentially indicated by joint hypomobility?
What is an interruption of normal hip mechanics potentially indicated by joint hypomobility?
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Which muscle imbalance is commonly addressed in the management of joint hypomobility?
Which muscle imbalance is commonly addressed in the management of joint hypomobility?
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What is NOT a common complaint in patients with joint hypomobility?
What is NOT a common complaint in patients with joint hypomobility?
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Study Notes
Therapeutic Exercise II: The Hip
- The course covers important aspects of hip structure and function.
- Students will learn to implement therapeutic exercise programs to manage soft tissue and joint lesions in the hip, considering the stages of recovery following inflammatory insults.
- Post-operative hip programs for common surgical procedures will be discussed.
- The course includes exercise progressions to improve range of motion (ROM), muscle performance, and functional use of the hip and lower extremity.
Hip Anatomy and Arthrokinematics
- The pelvis consists of the ilium, ischium, and pubic bones, with the pubic symphysis as the anterior joint and sacroiliac joints posteriorly.
- The femur transmits forces through the hips, pelvis, and trunk, supporting the weight of the head, trunk, and upper extremities.
- The hip joint is a ball-and-socket, triaxial joint, reinforced by three ligaments: iliofemoral (Y ligament of Bigelow, strongest), pubofemoral, and ischiofemoral.
- The iliofemoral ligament limits hip extension and external rotation.
- The pubofemoral ligament limits hip extension and abduction.
- The ischiofemoral ligament limits hip extension and internal rotation.
- The acetabulum is a concave surface, faced laterally, anteriorly, and inferiorly. It's reinforced by the acetabular labrum and articular cartilage (horse-shoe shape, thicker laterally).
- The femoral head is convex and attaches to the femoral neck, projecting anteriorly, medially, and superiorly.
- In open-chain movements, the convex femoral head slides in the opposite direction of the physiological motion of the femur. (e.g., flexion with internal rotation causes a posterior glide of the femur).
- In the distal fixation of the lower extremity (CKC), the concave acetabulum moves on the convex femoral head, gliding in the same direction as the osteokinematic motion.
- The pelvis connects the hip and lumbar spine, influencing movements across all three structures.
Pelvic Positions
- An anterior pelvic tilt results from the ASIS moving anterior and inferior, closer to the anterior aspect of the femur, creating hip flexion and lumbar extension.
- A posterior pelvic tilt results from the PSIS moving posterior and inferior, closer to the femur’s posterior aspect, creating hip extension and lumbar flexion.
- Lateral pelvic tilt involves frontal plane motion, defined by the weight-bearing extremity's opposite side elevating the pelvis. Weight bearing side adducts the hip and the opposite side abducts.
Review Questions
- What do each ligament do in the pelvis, and what motions stress each ligament?
- What are the arthrokinematics of the hip joint in closed vs. open chain?
Articulating Surfaces
- The acetabulum and femur articulate to form the hip joint. The shape, curvature, and relative position of the surfaces affect hip motion.
Hip Ligaments
- The three primary hip ligaments, iliofemoral, pubofemoral, and ischiofemoral, function to limit excessive ranges of motion, thereby supporting and stabilizing the joint.
Functional Relationships
- Lumbopelvic Rhythm involves the combined movement of the lumbar spine and pelvis during trunk flexion, with the pelvis shifting posteriorly to maintain center of gravity over the base of support.
- Muscle activation during gait or weight-bearing activities determines the efficiency of hip, knee, and ankle function and posture.
Lower Extremity Closed Kinetic Chain (CKC) Biomechanics
- Hip flexion in CKC is controlled by gluteus maximus & hamstrings.
- Hip extension in CKC occurs through screw home mechanism – internal rotation of femur on the fixed tibia.
- Hip rotation in CKC involves medial rotation (IR) with the force through the tibia causing eversion of the calcaneus & pronation of the foot during weight bearing.
- Hip rotation in CKC involves lateral rotation (ER) with force through tibia causing inversion of the calcaneus & abduction & dorsiflexion of the talus during weight bearing.
The Hip and Gait
- The movement of the hip flexors, extensors, and abductors influence gait.
Pathomechanics
- Decreased flexibility at the hip leads to increased force transmission to the spine
- Adaptively shortened hip flexors; Excessive lumbar extension as hip extends; excessive load on the knee unable to lock the knee if the hip is flexed; compensation occurs with excessive trunk flexion.
- Adaptively shortened hip adductors may result in contralateral hip drop and ipsilateral side bending of the trunk.
- Decreased strength of hip abductors creates excessive trunk motion and stress on the lumbar spine (Trendelenburg sign or compensatory Trendelenburg Sign).
Therapeutic Exercise Intervention
- Specific exercises are presented to address shortened muscle groups.
Muscle Imbalances
- Dominance of hip flexors (rectus femoris, TFL, sartorius) over ilioposas causes faulty hip mechanisms or knee pain.
- Limited glute maximus flexibility leads to increased tension on the ITB & PFJ, or trochanteric bursitis.
- Dominance of hamstrings over glute max leads to cramping with hip extensor exercises; increased muscle imbalance at the knee (overuse syndromes).
Hip Fractures
- Common hip fractures include intertrochanteric fractures (most common), subtrochanteric fractures, and intracapsular fractures (femoral head, subcapital, and femoral neck) that may cause disruption of vasculature and/or damage to joint cartilage.
- ORIF is a treatment option for hip fractures typically involving a displaced, non-displaced intra-capsular femoral neck fractures, fracture-dislocations, stable/unstable intertrochanteric sub-trochanteric fractures.
- ORIF management focuses on tissue protection—soft tissue healing takes about 6 weeks and bone healing up to 16 weeks depending on fracture site.
Hip Osteoarthritis
- OA, RA, traumatic arthritis, AVN, ankylosing spondylitis, non-union of a fracture, joint instability or deformity, bone tumors, or failure of previous procedures are some possible causes.
Hip Surgery and Post-operative Management
- Total Hip Arthroplasty (THA) and Hemiarthroplasty are surgical options.
- THA types include cemented and un-cemented, with indications, surgical approaches, and complications.
- Minimal invasive techniques & procedures.
- The post-operative management phases (Maximum Protection Phase, Moderate Protection Phase, and Minimum Protection Phase) include activities, and criteria to progress between phases.
- Motion precautions vary depending on the surgical approach (posterior vs. anterior) to prevent complications like dislocation
- Maximum protection phase focuses on preventing vascular and/or pulmonary complications, preventing dislocation, and achieving independent functional mobility thru transfer, bed, and gait training.
- Moderate Protection phases emphasizes restoring and increasing range of motion (ROM), regain strength/endurance, improve balance/postural awareness, progress WB activity to tolerance.
- Minimum phases (12 wks post-op): Improve muscle performance/cardiovascular endurance. Reinforce patients' knowledge of activity restriction to lessen excessive demands on the hip joint.
Review Questions
- What is the capsular pattern of the hip?
- Name a stretch to address loss of each movement due to the capsular pattern.
- What are some common exercises to activate glute max and glute med?
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