hip complex handout

7/26/2019 Hip Complex Handout

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The National Academy of Sports Medicine

Integrated Function of the Hip Complex

Course Objectives

Explain the interdependent relationship of the

Hip Complex as it works synergistically to

produce force, reduce force and stabilize the

entire kinetic chain during function

movements

Each muscle has a function in all three planes

of motion

Functional Anatomy: Hip Flexors

Psoas

Iliacus

Sartorius

Tensor Fascia Latae(TFL)

Rectus Femoris

Adductor Longus

Pectineus


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Iliacus

Origin

Iliac Fossa

Insertion

Lesser Trochanter

Innervation

L2-L4

Iliacus

Isolated Function

Hip Flexion

Hip External Rotation

Integrated Function

Decelerates hip

extension and internal

rotation

Dynamic stabilization of

the lumbo-pelvic-hip

complex

Iliacus

Chain Reactions

Compensates for

weakness in the other

hip flexor muscles

Compensates for weakintrinsic core stabilizers


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Tensor Fascia Latae (TFL)

Origin

Outer surface of the iliac

crest just posterior to

the ASIS

Insertion

Proximal 1/3 of the ITB

Innervation

Superior Gluteal Nerve


Isolated Function

Hip Flexion, abduction,

internal rotation

Integrated Function

Eccentrically decelerates

hip extension, adduction,

and external rotation

Dynamically stabilizes

the LPHC


Chain Reactions

Compensates for a weak

gluteus medius

Accelerates femoral

adduction via:

Tibial abduction (during

weight bearing)

Femoral IR function


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Rectus Femoris

Origin

Anterior inferior iliac

spine

Superior rim of

acetabulum

Insertion

Patella

Innervation

Femoral N. L2-L4

Rectus Femoris

Isolated Function

Knee extension

Hip flexion

Integrated Function

Eccentrically decelerates knee flexion, adduction, andinternal rotation at heel strike

Dynamically stabilizes the knee

Accelerates extension and external rotation during tripleextension

Decelerates hip extension and knee flexion

Rectus Femoris

Chain Reactions

Weak quadriceps increases eccentric load to the

patellar tendon

Tight rectus femoris creates increased anteriorpelvic tilt, which inhibits the gluteus maximus, thus

creating kinetic chain compensations


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Gluteus Medius

Origin

Posterior ilium b/w the

posterior and anterior

gluteal lines

Insertion

Greater trochanter

Innervation


Gluteus Medius

Isolated Function

Anterior Fibers Abduct and internally

rotate the femur

Integrated Function

Dynamically stabilize theLPHC during single legstance

Eccentrically deceleratesfrontal plane hipadduction

Gluteus Minimus

Origin

Ilium b/w the anterior

and inferior gluteal line

Insertion

Greater Trochanter

Innervation



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Gluteus Minimus

Isolated Function

Abduct and internally

rotates the femur

Integrated Function

Assists in dynamic

stabilization of the LPHC

during single leg stance

Assists in eccentric

deceleration of femoral

adduction

Hip Internal Rotators

Chain Reactions

In the presence of weakness to posterior fibers of

Gluteus Medius:

Anterior fibers of Gluteus Medius compensate

Gluteus Minimus compensates

TFL compensates

Functional Anatomy: Hip Extensors

Gluteus maximus

Hamstrings

Adductor magnus (posterior head vertical

fibers)


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Functional Anatomy: Hip Abductors

Gluteus medius

Gluteus minimis Tensor fascia latae (TFL)

Hip Abductors

Isolated Function

Abducts the femur

Internally Rotates the femur TFL

Gluteus Minimus

Anterior Gluteus Medius

Externally Rotates the femur Posterior Fibers of Gluteus Medius

Integrated Function

Decelerates frontal plane hip adduction

Gluteus medius assists in eccentrically decelerating

transverse plane hip rotation

Hip Abductors

Chain Reactions

Following ankle sprains, it has been demonstrated(Beckman) that the gluteus medius has decreasedelectromyograpy activity.

This leads to synergistic dominance of tensor fascialatae and gluteus minimus. These muscles internallyrotate the femur, which increases stress in the lowerleg

Tight psoas creates a sacroiliac joint dysfunctionwhich creates both myokinematic andarthrokinematic inhibition of the gluteus medius


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Obturator Externus

Origin

Superior and inferior

pubic ramus External surface of

obturator foramen

Insertion

Trochanteric fossa

Innervation

Obturator N.

Gemellus Superior

Origin

Ischial spine

Insertion

Greater trochanter

Innervation

N. to obturator internus

Gemellus Inferior

Origin

Ischial tuberosity

InsertionGreater trochanter

Innervation

N. to quadratus femoris


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Quadratus Femoris

Origin

Lateral border of ischial

tuberosity

Insertion

Quadrate line belowintertrochanteric crest

Innervation

Nerve to quadratusfemoris

Hip External Rotators

Isolated Function

Externally rotates femur (all)

Abducts femur (piriformis, obturator internus)

Integrated Function

Eccentrically decelerates hip internal rotation

Concentrically accelerates hip external rotation

Works as a major pelvo-femoral stabilizer during

functional movements to help maintain stability and proper

function of the lumbo-pelvic-hip complex

Hip External Rotators

Chain Reactions

Tight external rotators (piriformis) can create a

sacroiliac joint dysfunction, leading to lumbar

spine dysfunctionExternal rotators become synergistically dominant

to compensate for a weak gluteus maximus (tight

psoas), weak biceps femoris (anterior pelvic

rotation), weak gastrocnemius and weak gluteus

medius


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Summary

Covers a large group of muscles

Although there may be a primary plane ofmotion where a muscle is the strongest, all

muscles function in all planes of motion

All muscles function eccentrically,

isometrically, and concentrically

The National Academy of Sports Medicine

Thank you

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