The Hip Joint

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The Hip Joint

• Exercises and Injuries

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Pelvis Abnormalities

• To appreciate the abnormalities that may occur,
  picture a box around the pelvis.
• The two most common situations are
• 1.the pelvis is tilted forward (anterior tilt)
  slightly rotate the box forward
• 2.one side of the pelvis is lower than the other
  (lateral tilt) slightly tip the box to one side.
• Each of these abnormalities has its own specific
  range of problems and sometimes both can occur.

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• How would weak hamstrings, and tight hip flexor
  muscles affect the lower back?

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Anterior Tilt
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Anterior Tilt
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Anterior Tilt

• How can this excessive anterior tilt be corrected?

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Anterior Tilt
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Anterior Tilt
Direction Injuries Cures
Anterior Tilt 1.) Low back pain 2.) hamstring strain 3.) knee problems A) Abdominal muscle strengthening B) Stretching and strengthening of gluteal muscles, hip external rotators, hip flexors, and hamstrings
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Lateral Tilt

• Which group of muscles would be stronger in the
  left leg with permanent left lateral tilt?
• Name the muscles

Left Lateral Tilt
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Lateral Tilt

• Contracting what group of muscles will limit the
  amount of left anterior tilt while walking?
• Name the muscles.

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Direction Injuries Cures
Lateral Tilt  1.) iliotibial band syndrome 2.) low back pain -- usually one sided 3.) adductor strains 4.) lateral hip pain A. Stretching and strengthening of hip adductors, abductors, extensors, and ext. rotator muscles. B. Others (look for leg length difference, overpronation in one foot, etc. and consider orthotics to correct.)
Lateral Tilt
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Exercises for the Hip Joint

• Good
• ExRx
• Qustionable
• Bodybuilding

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Terminology

• Compound
• An exercise that involves two or more joint
  movements.
• Isolated
• An exercise that involves just one discernible
  joint movement.

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Terminology
Closed Chain An exercise in which the end segment
of the exercised limb is fixed, or the end is
supporting the weight. Most compound exercises
are closed chain movements. Open Chain An
exercise in which the end segment of the
exercised limb is not fixed, or the end is not
supporting the weight. Most isolated exercise are
open chain movements.
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Gluteus Maximus
Compound/Isolated Open/Closed
Squats C C
Deadlift C C
Lunge C O
Step up C O
Leg Press C O
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Gluteus Maximus Squats
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Gluteus Maximus Dead Lift
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Gluteus Maximus Lunge
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Gluteus Maximus Step Up
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Gluteus Maximus Leg Press
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Hip Abductors/Adductors
Compound/Isolated Open/Closed
Cable I O
Seated I O
Lever I O


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Hip Abductors Cable
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Hip Abductors Seated
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Hip Abductors Lever
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Hip Adductors Seated
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Hip Adductors Lever
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Hip Flexors
Compound/Isolated Open/Closed
Leg Raise I O
Lever I O



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Hip Flexors Leg Raise
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Hip Flexors Lever
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Stretching

• Opposite action of the muscle
• For example, to stretch a hip extensor muscle,
  perform hip flexion.

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Gluteus Maximus - Stretching
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Abductors - Stretching
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Abductors (IT Band) - Stretching
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Hip Flexors - Stretching
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HIP INJURIES
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GROIN INJURIES
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Pathology

• Twisting, running, jumping
• Muscles most often involved
• Adductor longus
• Iliopsoas
• Gracilis
• Sartorius

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HIP POINTER

• A hip pointer is a contusion to the iliac crest,
  the surrounding soft tissue structures, or the
  greater trochanter of the femur.
• Typically, the injury is caused by a direct blow
  or fall.
• Hip pointer injuries occur most commonly in
  contact sports (eg, football, hockey), but they
  can also occur in noncontact sports (eg,
  volleyball) as a result of a fall onto the hip or
  side.
• Pain and tenderness in this region can limit an
  athlete's participation in sports.

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Hip Pointer
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HIP DISLOCATION
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Dislocation

• Any traumatic hip dislocation requires immediate
  treatment, ideally within six hours or less.
• This is because a traumatic hip dislocation
  interrupts the normal blood circulation to the
  top of the femur, depriving the bone of its vital
  oxygen supply.
• Unless the dislocated hip is reduced (replaced in
  its socket) promptly, and normal circulation is
  restored within the hip joint, there can be
  permanent damage to the head of the femur. This
  permanent damage is called avascular necrosis.

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Dislocation

• January 13, 1991, Bo Jackson partially dislocated
  his hip, tearing the blood vessels to the neck
  and head of the femur.
• X-rays revealed a small fracture to the posterior
  of the hip socket.
• Four weeks later, scans of the joint showed the
  beginning of vascular necrosis, in which the bone
  cells die because of deficient blood supply, and
  chondrolysis, in which cartilage degenerates.
• Eventually Jackson would require a total hip
  replacement which relieves him of pain and allows
  him full range of motion.

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HIP REPLACEMENT SURGERY
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Causes

• 1. Osteoarthritis is perhaps the most common
  cause for hip replacement surgery.
• 2. Avascular necrosis is another cause of
  degeneration of the hip joint.

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Causes

• 3. Abnormalities of hip joint function resulting
  from fractures of the hip and some types of hip
  conditions that appear in childhood can also lead
  to degeneration many years after an injury.

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Surgery
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Parts

• Acetabular component metal shell with plastic
  inner socket
• Femoral component metal stem with a metal or
  ceramic head

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Types

• Cemented epoxy cement holds metal to bone

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Types

• Uncemented mesh allows bone to grow into the
  prothesis

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Operation
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Removing the femoral head

• Dislocate the hip joint
• Cut femoral neck with power saw

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Reaming the Acetabulum

• Power drill and special reamer remove the
  cartilage
• Bone is formed to fit the metal shell

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Inserting the Acetabular Component

• Cemented
• Uncemented

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Preparing Femoral Canal
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Inserting the Femoral Stem
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Attaching the Femoral Head
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Completed