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Kinesiology for Manual Therapies

Chapter 15

The Hip Joint and Pelvic Girdle

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Learning Outcomes

o 15-1 Define key terms.o 15-2 Identify on a human skeleton selected bony features of the hip joint and pelvic girdle.o 15-3 Label on a skeletal chart selected bony features of the hip joint and pelvic girdle.

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Learning Outcomes (cont.)

15-4 Draw on a skeletal chart the individual muscles of the hip joint, including origins and insertions.

15-5 Demonstrate all the active and passive movements of the hip joint and pelvic girdle with a partner.

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Learning Outcomes (cont.)

15-6 Palpate the muscles of the hip joint and pelvic girdle, including attachments, on a partner.

15-7 Organize and list the agonists, antagonists, and synergists that produce movement of the hip joint and pelvic girdle.

15-8 Practice flexibility and strengthening exercises for each muscle group.

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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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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, Gerdy’s tubercle provides the insertion point for the iliotibial tract.

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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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Movements

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Movements (cont.)

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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. They are saved for the knee joint chapter.

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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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