Pelvis and Hip Kinesiology PDF

PELVIS AND BIOMECHANI HIP CS Introduction to Pelvis and Hip ▪ The pelvis and hip biomechanics play a vital role in supporting human movement and posture. ▪ Understanding the intricate structure and mechanics of the pelvis and hip joint is essential for addressing issues related to mobili...

PELVIS AND BIOMECHANI HIP CS Introduction to Pelvis and Hip ▪ The pelvis and hip biomechanics play a vital role in supporting human movement and posture. ▪ Understanding the intricate structure and mechanics of the pelvis and hip joint is essential for addressing issues related to mobility, stability, and overall musculoskeletal function. Why Are Pelvis and Hip so Important? ▪ Anatomy, ▪ Biomechanics, ▪ Common injuries, ▪ Assessment, ▪ Diagnosis, ▪ Treatment options and ▪ Rehabilitation exercises Role of the Pelvis ▪ It bears the weight of the trunk and upper limb ▪ GROUND REACTION ? ▪ If insufficiency occurs in the pelvic ring for any reason, both a disorder in the relationship with the lower extremities, a disorder in the intrapelvic organs and problems in the lumbar region occur. ▪ Since being in the oblique position increases rotational forces, it requires strong soft structures as well as bone structure. Anatomy of the Pelvis 3 bones as a bone roof The pelvis consists of 4 bones as a pelvic ring. The pelvis consists of the following; On the sides os ilium, Ahead os pubis, Back and bottom os ischium The arrangement of these bones forms a protective basin for the vital organs and supports the weight of the upper body. Anatomy of the Pelvis Ilium ischium, and pubis merge , through Y-shaped cartilages. This cartilage tissue obliterates over time to form a cavity called the acetabulum. The hip joint is a ball-and- socket joint, allowing for a wide range of motion in activities such as walking, running, and jumping.  Soft Tissues The sacrospinal ligament starts from the sacrum and extends to the spine Sacrotuberous ligament starting from the sacrum and extending to the ischial tuberositas Through these foramen passes the sciatic nerve. The foramen obturator is sealed to the membrane with a membrane called obturator and passes through N. Obturatorius.  The relationship between the sacrum and the iliac crista Crista iliaca expands its wings towards the back of the sacrum, and the sacrum merges with the sacro-iliac joint into the ilium. The relationship between the sacrum and the iliac crista Although the sacroiliac joint is a real joint with its synovia, capsule, and ligaments, it shows a feature that does not allow movement. The convergence of the iliac crista in the back and the narrowing of the sacrum in this region eliminates the chance of pushing the sacrum posteriorly, against the fact that the sacrum is forced under a force in the front background. The relationship between the sacrum and the iliac crista The fact that the entire body weight is placed on the sacrum through the vertebral L5 pathway forces the upper part of this structure to rotate forward and the lower part to the back around the frontal axis in the sagittal plane. Iliolumbal ligament that prevents the upper part from rotating forward the sacrotuberous and sacrospinous ligaments prevent the rotation of the lower part to the back. The pelvic ring has an extremely important intrinsic balance thanks to these ligaments.  Balance of the Pelvis ▪ The pelvis is like a horizontal column resting on the hip joints. The oblique superposition of the vertebral column on S1 is important in terms of balance supply. There are some features in providing pelvic balance in various planes, static and dynamic conditions. Balance of the Pelvis Under Static Conditions Conditions of Balance in the Frontal Plane: ▪ Each of the 2 hips is equally usable. While in the hip joint, 2 force components are formed. ▪ Vertical force component ▪ The horizontal travel force component ▪ R R LEFT RIGH ▪ R=R T 1 ▪ The joint force on both sides travels into the pelvis. Since the two coherent forces are equal to each other and their directions are opposite, they neutralize each other. Balance of the Pelvis In humans, the balance can be achieved passively, but this balance is very short-lived. If the body goes slightly to lateral flexion, the gravitational force shifts out of the hip joint on the side of the lateral flexion. In lateral flexion to the left, the abductors of the left side become inactive. Against this, the abductors of the right side are activated and balance is achieved. When each of the 2 hips is equally in this position, the balance is maintained with very little muscular activity, but this is ACTIVE balance. Balance of the Pelvis If the abduction is increased in 2 hips, the 2 combined forces are again equal and opposite to each other and neutralize each other. When it is increased, the compression effect of the resulting combined force on the sacroiliac joints also increases. Balance can be achieved with very little energy consumption. R R1 R=R1 Balance of the Pelvis When one leg is abduction, the other is in add. (resting Abd. leg position); Add. R leg R1 R=R 1 (R travels into the pelvis) (R1 travels outward from the pelvis.) Since both forces at the junction are equal to each other but in the same direction, a force of up to R+R1 tends to push the pelvis, and the rotational force increases Passive equilibrium is not possible. The adductors of the leg in the abd work, and the abductors of the leg in the add. If the hip adductors cannot generate enough force, balance cannot be achieved Balance of the Pelvis While both legs are equally added: At both junctions, the force travels outward from the hip. R R1 R=R 1 Since the two coherent forces are equal and opposite directional to each other, they neutralize each other. It is possible to achieve balance with minimal energy consumption. Balance of the Pelvis Equally abd. or add. position; If the external force Balance can be achieved passes through the center without the need for any of the hip joint, muscle force. If the external force is passing in front of the hip joint center, the only Passive balance cannot force that will meet it is be achieved. the hip extensors and erector spine. If the external force shifts to the back, Passive balance cannot balance is achieved with abdominal muscles and be achieved. iliopsoas activity. Pelvis Sacroiliac Joint Simfizis Pubis Functions Connecting the lower Proximal section: Fibrocartilage joint extremities with the trunk sacrum Distal section: Includes interarticular disc Transferring the load of the trunk Ilium Movements: up-down to the lower extremities Joint type: Joint with glide, Absorbing shock from the ground irregular surface separation-compression Protecting internal organs Not crossed by muscles Movements: flexion, extension, torsion forward Highly stable joint Load Transfer ▪ Body weight is transferred from the L5 vertebra to the sacrum and sacroiliac joints, as well as to the iliac bones, acetabulum, and femur. ▪ The two-way compressive force in the femoral heads is met by pubic support. ▪ The force transmitted from L5 to S1 forces the upper part of the sacrum forward and the lower part to the rear. ▪ Sacral ligaments meet these forces Sacroiliac Joint Movement ▪ Ventral-caudal glide movement ▪ L5-S1 disc distance goes down and is maintained ▪ On the way to body flexion, the sacrum ▪ Ligamans limit slipping movement slides out of the sand over the SIE ▪ Both sup posts iliac crest converge Sacroiliac Joint Movement ▪ Function: ▪ To provide load distribution in sudden changes of body weight and absorption of energy. ▪ On ambulation: ▪ In normal gait, the trunk falls forward in a controlled manner and then oscillates back and forth. ▪ When the body is tilted forward: ▪ the sacrum innominate slides down between the bones to meet these shear forces. Pelvis Movements ▪ Clear kinematic chain movements (Foot in Air) ▪ Anterior tilt: SIAS moves down and forward ▪ Posterior tilt: SIAS moves up and back Pelvis Movements ▪ Right-left lateral tilt: One SIAS is above the other ▪ Right-to-left rotation: One SIAS ahead of the other Pelvis Movements ▪ Closed kinematic chain movements: pelvic movement when the foot is on the ground (in the compression phase) Pelvis Movements Combined Movements Pelvis Movements Spine Movements Hip Movements Anterior tilt Hyperextension Slight flexion Posterior tilt Extension Lateral tilt to left Lateral flexion to right Right hip: slight adduction Left hip: Slight abduction Rotation to left without moving foot Rotation to right Right hip: slight external rotation and rotato trunk Left hip: slight internal rotation Pelvis Movements Combined Movements Pelvis Movements Spine Movements Hip Movements Anterior tilt Hyperextension Slight flexion Posterior tilt Flexion Extension Lateral tilt to left Lateral flexion to right Right hip: slight adduction Left hip: Slight abduction Rotation to left without moving foot Rotation to right Right hip: slight external rotation and rotato trunk Left hip: slight internal rotation Pelvis Movements Combined Movements Pelvis Movements Spine Movements Hip Movements Anterior tilt Hyperextension Slight flexion Posterior tilt Flexion Extension Lateral tilt to left Lateral flexion to right Right hip: slight adduction Left hip: Slight abduction Rotation to left without moving Rotation to right Right hip: slight external rotation foot and rotato trunk Left hip: slight internal rotation Pelvis Movements Trunk Movements Secondary to Pelvis Movements TRUNK MOVEMENTS PELVIS MOVEMENTS flexion Posteriortilt extension Anterior tilt Lateral flexion to the left Lateral tilt to the left Rotation to left Rotation to the left Pelvis Movements Pelvic Movements Secondary to Hip Movements HIP MOVEMENTS PELVIS MOVEMENTS Bilateral hip flexion Posteriortilt Bilateral hip extension Anterior tilt Flexion in one hip and extension in the other On the front leg side: posteir tilt and extrnal rotation Onthe back leg side: anterior tilt and internal rotation Abduction in one hip On the abducted leg side: increase On the adducted leg side: decrease Muscles Around the Pelvis ▪ Muscles for anterior tilt ▪ Hip flexors: Iliopsoas, rectus femoris ▪ Waist extensors: Erector spina ▪ Muscles for posterior tilt ▪ Abdominal muscles: Rektus abdominis ▪ Hip extensors: Hamstrings, gluteus maximus M. Ilıopsoas Origin: Fossa Iliaca-Lumbal Vertebrae ▪ Insertion: Trochanter Minor ▪ Function: Flexion to Thigh ▪ Nerve: N.Femoralis (L2-L4)  Muscles for lateral tilt Lateral tilt muscles to the right Left quadratus lumborum- Right hip abductors Left lateral tilt muscles Right quadratus lumborum – Left hip abductors Muscles for pelvic rotation For right rotation Left lumbar rotators Left hip external rotators – Right hip internal rotators For left rotation Right lumbar rotators Right hip external rotators – Left hip internal rotators Hip Joint ▪ Proximally: Pelvis ▪ Distal: Femur ▪ Joint type: ball-socket joint ▪ Moves: F/E, Abd/Add, In/Out rotation ▪ When walking, 13% of the body weight is loaded in the oscillation phase and 300% in the compression phase.  Stabilit Factors affecting stability in the sagittal plane Bone structure y Ligaman and other connective tissue tension Iliolumbar ligament Sacroiliac ligament: ant, post, interosseoz Sacrospinous ligament Dynamic stability of muscles Sacrotuberosis ligament Tense vs weak vs adaptive-short (Kendall 1969) Joint Stability Bone structure Joint capsule Intra-articular negative pressure Maximum stability Ligaments 90 degrees of flexion Mild external rotation Muscles Abduction Minimum Stability Leg-to-leg throwing position Adduction Flexion Hip Kinematics Hip flexion/extension: Occurs in the sagittal plane and in the frontal axis passing through the center of the femoral head Hip flexion: 0-140° Hip extension: 0-45° For maximum flexion-extension, the hip joint must be at 5° abduction Hamstring tension at knee 90° flexion and hip joint flexion is limited at 90° Hip Kinematics Hip abduction: It happens in the frontal plane, in the sagittal axis that passes through the center of the femoral head Hip abduction: 0-45° Maximum abduction occurs at hip 40° flexion Hip Kinematics Hip inner/outer rotation: In the transverse plane, it is around the vertical axis that passes through the center of the femoral head Internal rotation 0-40° External rotation 0-45° Maximum rotation is achieved at 90° flexion of the hip !!! for Normal Walking Normal joint movements of the hip should be; 30 degree flexion 10 degree extension 5 degree abd and add 5 degree inner and outer rot Hip Movements in Daily Life To sit in a chair and get up: 80-100°F/E 63° for climbing stairs - 24-30° hip flexion for climbing stairs The maximum hip flexion when walking is 35-40 °, and at the end of the swing phase it reaches this value just before the heel stroke. Hip Movements in Daily Life Hip abduction/adduction 20° is sufficient. 12 ° abduction/adduction movement is performed in the walk. Maximum abduction occurs after finger lift in the oscillation phase. With the heel stroke, the hip goes to adduction. 18-20 ° hip abduction is required to squat and pick something up from the ground. Hip Movements in Daily Life In the walking release phase, the hip joint is in 8-10 ° external rotation. The heel stroke returns to 4-6° internal rotation just before and remains in the internal rotation until the end of the compression phase. It takes 10-15° external rotation to squat and pick something up from the ground. Pelvis Fixed Femur Movable Hip joint movement occurs with a fixed pelvis and a movable femur Can be closed or open kinematic chain movement Closed chain: squat, compression phase of walking Open chain: Hip extension exercise while standing, the oscillation phase of walking Pelvis Fixed Femur Movable Passive hip flexion is normally 120°, while the knee is extended and restricted by the hamstrings at 80-90° Passive hip extension may be 20 ° when the knee is in extension, while 0 ° may be due to rectus femoris tension if the knee is in full flexion Pelvis Fixed Femur Movable Abduction with capsular ligament, adductor and hamstring muscles is limited to 40°. Adduction is limited at 25° due to interaction with the other leg and/or abductor muscles, iliotibial band or hip capsule. Internal rotation approx. 35° The external rotation is approximately 45°, it can be limited to the hip capsule, iliotibial band or tensor fascia lata muscle. Anteversion Angle ▪ It is the angle between the longitudinal axis of the femoral neck and the line connecting the posterior faces of the femoral condyles in the transverse plane. ▪ Normal adult and child over 6 years old 12-15° ▪ 30-40 ° in a newborn  Anteversion Angle It makes the gluteus maximus more efficient as an external rotator. >If 14 degrees The femoral head is not fully covered by the acetabulum, the leg turns inward to get the femoral head into the cavity. Q angle increases and patellofemoral problems develop. Pronation occurs in the subtalar joint. Lumbar curvature increases.  Anteversion Angle < If it is 10 degrees (retroversion) During walking, the hip returns to external rotation. Supination in the ankle. There is a decrease in the Q angle. Inklination Angle ▪ It is the angle between the femoral neck and the femoral body in the frontal plane. ▪ 125° in the normal adult, 140-150° in newborn Inclusion Angle Disorders Frontal plan deformities Coxa valga: Coxa vara 125° > the angle of Inclusion angle < inclination 125° COXA VARA Congenital Acquired Causes Metabolic bone diseases Disruption of muscle balance between the abduction/adduction group of the hip Slippageof the pineal plaque/epiphyseal plate Intertrochanteric fractures and ASEPTIC NECROSIS REDUCES THE RESISTANCE OF THE COXA VARA Symptom s ▪ The angle of femoral inclusion narrows. ▪ If the femoral angle of inclination decreases to 90, the pineal line is parallel to the anatomical axis of the shaft. ▪ The angle between the mechanical axis and the anatomical axis of the shaft expands. COXA VARA-Symptoms ▪ The strut extends from the intertrochanteric midpoint to the mechanical axis. ▪ The normal anteversion angle decreases or takes a (-) value. ▪ The load on the femoral head shifts to the front of the upper outer quadrant of the head. ▪ Bending stress that falls on the intertrochanteric region increases.  COXA VALGA Congenital Causes In intrauterine life, the femoral head and neck should be in external rotation instead of internal rotation and the shaft that should be completed by the 7th month should not be adducted and internal rotation, whereas the head and neck should develop rapidly in the direction of abduction and external rotation. Normally, the angle of induction in the direction of valga is directed to its normal limit after birth with the effect of static and dynamic factors. COXA VARA Symptom s ▪ The angle of femoral inclination increases. ▪ If the femoral angle of inclination increases to 180, the plane passing through the pineal plate crosses the anatomical axis of the femoral shaft perpendicularly. ▪ The distance of the strut from the intertrochanteric midpoint to the mechanical axis decreases. COXA VALGA-Symptoms ▪ The angle between the mechanical axis and the anatomical axis of the shaft narrows. ▪ The anteversion angle increases. When the head goes to abduction, it is accompanied by external rotation. ▪ The stress of shredding on the head is reduced. ▪ The load on the femoral head falls on the lower quadrant of the head. Anteversion Angle Disturbances Transverse plan deformities Anteversion: introverted walking Retroversion: extroverted walking Anteversion Angle Disturbances Lumbopelvic Rhythm (LPR) LPR – is the kinematic relationship between the lumbar spine and hip joints in the sagittal plane. LPR in the same direction: The pelvis and lumbar spine move in the same direction; Reaching with arms is aimed at increasing the capacity to access. LPR in the opposite direction: The pelvis and lumbar spine move in different directions; it is used when walking, dancing or when the torso needs to be held in a fixed position. Flexion/Extension-LPR Flexion while standing – limited to 80-90°; LPR in the same direction Extension when standing – limited to 20°; LPR in the opposite direction Pelvic tilt: can be anterior or posterior. At the head of the fixed femur; LPR in the opposite direction Abduction/Adduction - LPR Abduction – active elevation of the opposite hip/pelvis with LPR in the opposite direction (hike); It is bounded at 30° by lumbar spine movements. Adduction – provided by lowering the opposite hip/pelvis with LPR in the opposite direction; total adduction is limited by side myofascial elements. DOUBLE ACTING MUSCLE Internal/External Rotation - LPR Internal rotation is the forward rotation of the opposite hip/pelvis in the horizontal plane. External rotation is the posterior rotation of the opposite hip/pelvis in the horizontal plane. Rotational movements are limited to the lumbar spine and hip capsule.  Sacroiliac Joint Dysfunction As a result of the decrease in sacrum movement, the load on the lumbosacral disc increases and low back pain develops. Hip Injury Mechanism Direct stress Femoral neck fracture Intertroquantteric fracture Repetitive stress Degenerative joint disease of the hip Deformities Congenital hip dislocation Congenital hip dysplasia Mechanism of Injury in the Pelvis Distorted array Direct stress Femoral neck fracture Intertroquantteric fracture Repetitive stress Degenerative joint disease of the hip Deformities Congenital hip dislocation Congenital hip dysplasia Mechanism of Injury in the Pelvis On the side of the long On the side of the short leg leg Adduction in the hip Hip abduction Elevation on the iliac wing Lateral tilt to the same side in the pelvis Compensatory scoliosis in the thoracic and Bending to the opposite side in the lumbar cervical region spine Compensatory scoliosis in the thoracic and cervical region Impaired Alignment in Load-Bearing Joints Genu valgum vs genu varum Genu rekurvatum Pes valgus vs pes planovarus Equinus vs pes calcaneus Congenital Hip Dislocation (CHD) CHD alone is not the presence of the femoral head outside the acetabulum. At the same time, a number of anatomical and pathological changes are found in all soft tissues around the hip joint. The incidence of newborn babies in the normal population is 0.4%. It is stated that the incidence rate is 20-30% in babies with CHD in their family, while it is higher in girls. Congenital Hip Dislocation (CHD) Reason s In primary acetabular theory, subluxation is said to develop as a result of acetabular dysplasia (Hilgenrainer and Putti). In the theory of dysplasia, it has been explained by the disorder between femoral neck anteversion and acetabulum compatibility in the fetal stage (Le Damany). It has been suggested that anteversion is excessive in the fetal circuit and that the incompatibility and dislocation of the femoral head and acetabulum develop with the passive extension of the legs after birth (Somerville). Congenital Hip Dislocation (CHD)-Reasons In recent years, it has been accepted that the CHD develops secondarily as a result of anomalies of the soft tissues around the joints. It is accepted that the main pathology in the hip is due to soft tissue anomaly and that the CHD occurs as a result of capsule laxity (Massi, Howarth). Excessive joint capsular laxity and liga. It can be thought to be the result of Teres elongation (McKibbin). Tension in the iliopsoas and hamstring muscles is also caused by joint capsules and liga. It is said that they play a role in hip dislocation by affecting sweat. It has been suggested that environmental factors play a role in the formation of CHD. The most important environmental factor is arson. TERATOGENIC GROUP It is a type of hip dislocation that develops in the case of a single anomaly in the intrauterine circuit or combination with other anomalies, as in Arthrogryposis Multiplex Congenital. In this group; a) When the baby is born, there is a hip dislocation. b) All anatomo-pathological changes in hip dislocation are present at birth. c) In this group, the anteversion angle is zero. d) The acetabulum is small and shallow, and the upper half is flattened. TYPICAL GROUP There are passively dislocable, unstable hips or dislocated hips in which the femoral head is located completely outside the acetabulum. Ferguson also examines typical congenital hip dislocation in two groups.. Neonatal type: Due to the capsule, which is pressed under the taut iliopsoas, the femoral head is separated from the acetabular pit. There are dislocations of this type Unstable hip type: Due to the looseness of the joint capsule and ligaments, the femoral head shifts inward and outward, sliding in the acetabulum.. Early Clinical Signs of Unilateral Hip Dislocation The side with dysplasia is less The dislocated trochanter area is mobile. The leg is loose and muscle more protruding than the opposite tone is reduced. side. The leg is in the external On the dislocated side, the rotation position. gluteal region is hypertrophic and silient. Their equal pleats on the inner face of the thigh are deeper and longer Abduction of the leg is limited and are asymmetrical. compared to the normal hip. When the baby is grabbed by the armpits and lifted, he bends his knee to the side with the hip dislocation Biomechanics of Walking and Running 1 Walking 2 Running During walking, the pelvis and hip joints Running places greater demands on the coordinate to provide stability and on the pelvis and hip biomechanics, facilitate the transfer of weight from biomechanics, requiring efficient one leg to the other. This motion energy transfer, shock absorption, and involves a smooth sequence of hip absorption, and powerful push-off. The flexion and extension, along with off. The hip flexors, abductors, and controlled pelvic rotation. extensors play crucial roles in running running gait mechanics.  Common Injuries and Conditions Related to the Pelvis and Hip 1 Overuse Injuries Conditions like hip bursitis, piriformis syndrome, and stress fractures can Traumatic Injuries 2 develop due to repetitive stress and strain Traumatic events such as hip dislocations, strain on the pelvis and hip joints, leading dislocations, pelvic fractures, and labral leading to inflammation and discomfort. labral tears can cause severe damage to discomfort. to the musculoskeletal structures, resulting in acute pain and functional impairment. 3 Arthritic Conditions Osteoarthritis and rheumatoid arthritis arthritis can affect the hip joint, causing causing degeneration of the articular cartilage and leading to pain, stiffness, and stiffness, and reduced range of motion. motion.  THANK YOU If you have any [email protected] / 11. floor office number