1. Lecture 6
The Hip

2. Anatomy Review
Hip Joint
Multi-axial ball and socket synovial joint
It has maximum stability because of the deep socket (acetabulum)for the insertion of the head of the femur
Strong ligaments and capsule encase this joint
Acetabulum is deepened by a labrium

3. Hip Ligaments
Iliofemoral
Prevents excessive extension
Strongest in body
Ischiofemoral
Tight in extension
Pubofemoral
Prevents excessive abduction and extension
All three limit MR

5. Hip joint
Resting position 30 degrees flexion
30 degrees abduction and
slight lateral rotation

6. Forces on the hip
Standing X BW
Standing one leg 2.5 X BW
Walking X BW
Upstairs 3 X BW
Running 4.5 X BW

7. Common problems
referred pain from back (lumbar spine) or SI to hip

8. Nerves
Majority of nerve supply arises from the Lumbar Plexus
Lumbar Plexus - formed from the first four lumbar spinal nerves
Largest branch is the Femoral nerve- supplies to the muscles and skin of the anterior thigh
Another branch Obturator nerve which provides innervation to the adductor muscles

9. Sacral plexus - L4 through S4 spinal nerves
Sciatic nerve arise from the sacral plexus
Sciatic innervate the hamstrings

11. Rom of Hip / End Feels
Flexion/ Extension
LR/MR
Abduction / Adduction
Muscles?

12. Special Tests

13. Thomas Test Hip flexors Hip flexion contracture
Athlete is supine with knees hanging over edge of table
Athlete brings knee up to chest , examiner can help push up so it is tight to chest
Positive test- if the hip flexor (iliopsoas) is tight on the opposite side the upper leg will lift up off the table

15. Rectus Femoris contracture ( Kendall Test)
Same as above – make sure they are right on edge of table
Now when they pull the knee to the chest look at the angle of the knee
If negative the knee should hang at 90 degrees
positive test - if the leg straightens out

16. Slump Test Myofacial structures ( Dura)
Athlete is seated with both legs hanging over the edge of the table, tuck chin to chest and slump upper body forward
Examiner passively (or can be done actively by athlete) raises the leg to extension
Positive test- is pain ( limitations in Range)

17. Patrick FABER test
SI and General ROM of the hip
athlete Supine
foot on opposite knee
leg lowered in to abduction and LR
compare Left and right
positive test- is a difference in ROM and pain

18. Tripod sign
Hamstring contracture
Athlete is seated with both legs hanging over the edge of the table
Examiner passively raises the leg to extension
Positive test - if the individual leans back to relieve the stress on the hamstrings

19. Trendelenburg sign
Weak Glut medius ( on stance side)
athlete standing on one leg must be able to stabilize hip
pelvis is level from left to right
Positive test - if ASIS ( pelvis) drops on non-stance side
Indicates a weakness or instability on stance side

20. Tests for leg length
The leg is anatomically or functionally shorter
Spine and pelvis (and others) will be affected due to kinetic chain
May lead to scoliosis, pelvic rotations and neck issues

21. Anatomical or True Leg length
To test measure from ASIS to medial malleolus (or lateral if muscle or fat get in way) heels approx 6 to 8 inches apart
Slight difference acceptable (1-1.3 cm considered normal)
If more than normal – measure tib and femur to see where difference is (can eyeball this
Side view and Front view

22. Functional or Apparent Leg Length
Results due to a compensation for a change that may have occurred because of positioning rather than structure
Unilateral pronation – spinal scoliosis, pelvic rotations
Can measure from umbilicus to medial malleolus
The test is only meaningful if the test for true leg length in negative

24. Muscle testing
Psoas and iliacus
Hip flexors
Athlete is seated with knees flexed
Hands on the edge of the table
Athlete lifts the upper leg off the table and examiner applies pressure on anterior surface of thigh downwards
Examiner stabilizes opposite side
Positive test – pain and weakness

25. Sartorious
Hip flexor, abductor and lateral rotator
Athlete is sitting or supine
Athlete brings ankle to opposite knee
Resistance applied to medial malleolus and to the lateral side of the thigh by examiner in an attempt to straighten the leg
Positive test – pain and weakness

26. Gluteus Maximus
Hip extension
Athlete is prone on table
Knee is flexed
Resistance is applied by examiner to the proximal knee (post thigh) in attempts to flex the hip
Stabilize above the hip (low back )
Gluts work best when knee is flexed
Positive test – pain and weakness

27. Gluteus minimus and medius
As a hip abductor
Athlete is side lying with lower leg and hip flexed to 90 degrees
Resistance is applied to the proximal knee on the lateral side of the thigh
Movement should be without flexion or Lateral Rotator
Pelvis is stabilized
Positive test – pain and weakness

28. Gluteus minimus and medius
As a Medial Rotator
Athlete is supine or sitting
Knee flexed over the edge of table
Resistance is applied to the lateral malleolus pushing the leg medially
Positive test – pain and weakness

29. Adductors
Longus, magnus, brevis, gracillis and pectinus
Athlete is side lying
Non test limb is supported by the examiner
Lower limb is the test limb
Limb is adducted of the table and resistance is applied to the proximal knee joint medial thigh (pushing into abduction)
Positive test – pain and weakness

30. Lateral Rotators
Obturator Internus, Obturator Externus, Superior and Inferior Gemellies and Piriformis
Athlete is sitting with knee flexed over edge of table
Resistance is applied to the distal leg on the medial malleolus
Pushing lower leg laterally
Positive test – pain and weakness

31. Sport Specific Functional Tests
walking
going up and down stairs
running straight ahead , and variations
squatting
jumping