Chapter 9
The Hip Joint and Pelvic Girdle
Hip joint (acetabular femoral) is stable due to: bony architecture, strong ligaments, large supportive muscles (more stable than
GH joint - deep acetabulum cavity)
Bones: ilium (upper ⅔), ischium (lower ⅖), pubis (lower ⅕); acetabulum = 80% ilium and ischium, 20% pubis
Joints: (anterior) symphysis pubis - amphiarthrodial, (posterior) sacroiliac joints
Bony Landmarks
,Anterior Pelvis: origin for hip flexors → anterior iliac crest - tensor fasciae latae, anterior superior iliac spine - sartorius, anterior
inferior iliac spine - rectus femoris
Sacrum: extension of spinal column with 5 fused vertebrae
Lateral Pelvis: origin for hip extensors → just below iliac crest - gluteus medius and minimus
Posteriorly: origin for hip extensors → posterior iliac crest and posterior sacrum and coccyx - gluteus maximus
Posteroinferiorly: origin for hip extensors → ischial tuberosity - hamstrings (biceps femoris, semitendinosus, semimembranosus
Patella: insertion for all 4 quad muscles (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius)
Proximal Tibia or Fibula: insertion for remainder of hip muscles → upper anteromedial tibial surface below medial condyle -
sartorius, gracilis, semitendinosus, posteromedially on medial tibial condyle - semimembranosus
Ligaments
Ligamentum teres aka ligamentum capitis femoris or round ligament: connects femur to acetabulum cavity
Pubofemoral ligament: located antero-inferior to joint; limits abduction and lateral rotation
Iliofemoral ligament: y shaped; located anterior to joint; limits extension
Ischiofemoral ligament: located posterior to joint; limits medial rotation
Joints ROM
Abduction: 0-35° Adduction: 0-30° IR: 0-45° ER: 0-50°
Pelvic Rotation Lumbar Spine Motion Right Hip Motion Left Hip Motion
Anterior rotation Extension Flexion Flexion
Posterior rotation Flexion Extension Extension
Right lateral tilt Left lateral flexion Abduction Adduction
Left lateral tilt Right lateral flexion Adduction Abduction
Right transverse rotation Left lateral rotation Internal rotation External rotation
Left transverse rotation Right lateral rotation External rotation Internal rotation
Hip Flexors: (primary) iliopsoas, Tensor fasciae latae, Sartorius, Rectus femoris, Adductor longus, Pectineus (secondary) Adductor
brevis,Gracilis, Gluteus minimus - anterior fibers
Hip Adductors: (primary) Adductor longus, Adductor brevis, Pectineus, Gracilis, Adductor magnus - both heads (secondary) Biceps
femoris - long head), Quadratus femoris, Gluteus maximus - lower fibers
Hip Internal Rotators: (secondary) Gluteus minimus - anterior fibers, Gluteus medius - anterior fibers, Tensor fasciae latae,
Adductor longus, Adductor brevis, Pectineus, Semitendinosus, Semimembranosus
Hip Extensors: (primary) Gluteus maximus, Biceps femoris - long head, Semitendinosus, Semimembranosus, Adductor magnus -
posterior head (secondary) Gluteus medius - posterior fibers
, Hip Abductors: (primary) Gluteus medius, Gluteus minimus, Tensor fasciae latae (secondary) Piriformis, Sartorius
Hip External Rotators: (primary) Gluteus maximus, Piriformis, Obturator internus, Gemellus superior, Gemellus inferior, Quadratus
femoris, Sartorius (secondary) Gluteus medius - posterior fibers, Gluteus minimus - posterior fibers, Obturator externus, Biceps
femoris - long head
Angles and Positions
Angle of Inclination: angle between the shaft of the femur and the neck of the femur
Q Angle: angle formed between the top of the hip down to the patella; womens are usually wider due to child bearing causing more
ACL tears in women
Torsion Angle: degree of internal or external rotation of the femoral neck relative to the shaft → toes in = anteversion; toes out =
retroversion
Triple line position: hip, knee and ankle extension (running)
Movements
Anterior pelvic rotation: anterior movement of upper
pelvis; iliac crest tilts forward in a sagittal plane
(anterior tilt)
Posterior pelvic rotation: posterior movement of
upper pelvis; iliac crest tilts backward in a sagittal
plane (posterior tilt)
← Lumbopelvic Rhythm: movement synchronization
between pelvis and trunk
- during flexion, lumbar curve flattens itself
- After 50° of flexion, the continuation of
flexion is a result of APTilt
- A typical lumbopelvic rhythm is ~40° of
lumbar flexion and 70° of hip flexion
- With limited flexion at the hips, greater
lumbar flexion is required of lumbar and thoracic spine,
and vice versa
The Hip Joint and Pelvic Girdle
Hip joint (acetabular femoral) is stable due to: bony architecture, strong ligaments, large supportive muscles (more stable than
GH joint - deep acetabulum cavity)
Bones: ilium (upper ⅔), ischium (lower ⅖), pubis (lower ⅕); acetabulum = 80% ilium and ischium, 20% pubis
Joints: (anterior) symphysis pubis - amphiarthrodial, (posterior) sacroiliac joints
Bony Landmarks
,Anterior Pelvis: origin for hip flexors → anterior iliac crest - tensor fasciae latae, anterior superior iliac spine - sartorius, anterior
inferior iliac spine - rectus femoris
Sacrum: extension of spinal column with 5 fused vertebrae
Lateral Pelvis: origin for hip extensors → just below iliac crest - gluteus medius and minimus
Posteriorly: origin for hip extensors → posterior iliac crest and posterior sacrum and coccyx - gluteus maximus
Posteroinferiorly: origin for hip extensors → ischial tuberosity - hamstrings (biceps femoris, semitendinosus, semimembranosus
Patella: insertion for all 4 quad muscles (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius)
Proximal Tibia or Fibula: insertion for remainder of hip muscles → upper anteromedial tibial surface below medial condyle -
sartorius, gracilis, semitendinosus, posteromedially on medial tibial condyle - semimembranosus
Ligaments
Ligamentum teres aka ligamentum capitis femoris or round ligament: connects femur to acetabulum cavity
Pubofemoral ligament: located antero-inferior to joint; limits abduction and lateral rotation
Iliofemoral ligament: y shaped; located anterior to joint; limits extension
Ischiofemoral ligament: located posterior to joint; limits medial rotation
Joints ROM
Abduction: 0-35° Adduction: 0-30° IR: 0-45° ER: 0-50°
Pelvic Rotation Lumbar Spine Motion Right Hip Motion Left Hip Motion
Anterior rotation Extension Flexion Flexion
Posterior rotation Flexion Extension Extension
Right lateral tilt Left lateral flexion Abduction Adduction
Left lateral tilt Right lateral flexion Adduction Abduction
Right transverse rotation Left lateral rotation Internal rotation External rotation
Left transverse rotation Right lateral rotation External rotation Internal rotation
Hip Flexors: (primary) iliopsoas, Tensor fasciae latae, Sartorius, Rectus femoris, Adductor longus, Pectineus (secondary) Adductor
brevis,Gracilis, Gluteus minimus - anterior fibers
Hip Adductors: (primary) Adductor longus, Adductor brevis, Pectineus, Gracilis, Adductor magnus - both heads (secondary) Biceps
femoris - long head), Quadratus femoris, Gluteus maximus - lower fibers
Hip Internal Rotators: (secondary) Gluteus minimus - anterior fibers, Gluteus medius - anterior fibers, Tensor fasciae latae,
Adductor longus, Adductor brevis, Pectineus, Semitendinosus, Semimembranosus
Hip Extensors: (primary) Gluteus maximus, Biceps femoris - long head, Semitendinosus, Semimembranosus, Adductor magnus -
posterior head (secondary) Gluteus medius - posterior fibers
, Hip Abductors: (primary) Gluteus medius, Gluteus minimus, Tensor fasciae latae (secondary) Piriformis, Sartorius
Hip External Rotators: (primary) Gluteus maximus, Piriformis, Obturator internus, Gemellus superior, Gemellus inferior, Quadratus
femoris, Sartorius (secondary) Gluteus medius - posterior fibers, Gluteus minimus - posterior fibers, Obturator externus, Biceps
femoris - long head
Angles and Positions
Angle of Inclination: angle between the shaft of the femur and the neck of the femur
Q Angle: angle formed between the top of the hip down to the patella; womens are usually wider due to child bearing causing more
ACL tears in women
Torsion Angle: degree of internal or external rotation of the femoral neck relative to the shaft → toes in = anteversion; toes out =
retroversion
Triple line position: hip, knee and ankle extension (running)
Movements
Anterior pelvic rotation: anterior movement of upper
pelvis; iliac crest tilts forward in a sagittal plane
(anterior tilt)
Posterior pelvic rotation: posterior movement of
upper pelvis; iliac crest tilts backward in a sagittal
plane (posterior tilt)
← Lumbopelvic Rhythm: movement synchronization
between pelvis and trunk
- during flexion, lumbar curve flattens itself
- After 50° of flexion, the continuation of
flexion is a result of APTilt
- A typical lumbopelvic rhythm is ~40° of
lumbar flexion and 70° of hip flexion
- With limited flexion at the hips, greater
lumbar flexion is required of lumbar and thoracic spine,
and vice versa
