Hip and Pelvis

Sartorius

O: ASIS

I: Pes anserinus on tibia

action: flexes, abducts and laterally rotates the hip, flexes and medially rotates at the knee

innervation: femoral nerve

Rectus femoris

O:AIIS and ilium above acetabulum
I: Tibial tuberosity via patellar ligament
action: extends the knee and flexes the hip
innervation: femoral nerve

Greater trochanter of the femur

Position: in side lying with bottom leg extended and top leg bent with knee resting forward on the bed. puts top leg into relative ADDuction which makes the GT more prominent

Gluteus medius

O: Ilium between anterior and posterior gluteal lines
I: Lateral aspect of greater trochanter
action: abducts and medially rotates the hip. posterior parts can externally rotate the hip
innervation: superior gluteal nerve

position: side lying, hip extended and uppermost knee flexed to 90 degrees. get patient to abduct thigh

Tensor fascia Latae (TFL)

O: Anterior aspect of the iliac crest and the anterior superior iliac spine (ASIS)
I: Iliotibial band (ITB) into the lateral aspect of the tibia
action: abducts, flexes, and medially rotates the hip
innervation: superior gluteal nerve

position: side lying, hip extended and uppermost knee flexed at 90 degrees. ask patient to lift their heel off the bed which puts them into internal rotation

AROM hip flexion

position: supine, modesty towel in place

instruction: keeping knee bent, bring your knee as far as you can towards your chest

goniometer: axis; greater trochanter, stationary arm; up the midline of the trunk, moving arm; down the lateral aspect of the thigh towards the lateral femoral condyle

AROM hip extension

position: prone, knee to to 90 degrees, place pillow under the hips to start patient in small amount of hip flexion and reduce stress on the lumbar spine

as a therapist, place one hand on pelvis to limit lumbar extension and other hand under knee to guide initial movement

goniometer; axis: greater trochanter, stationary arm: up the midline of the trunk, moving arm: down the lateral aspect of the thigh towards the lateral femoral condyle.

AROM hip abduction

position: supine, modesty towel

keep knee and toes to the ceiling, watch for trick movements by externally rotating to get more range

goniometer: axis: ASIS, stationary arm; ASIS to ASIS, moving arm; down the femur towards the midpoint of the patella

AROM hip internal/external rotation

position: sitting on edge of the bed, hip and knee at 90 degrees flexion or prone with knee bent

PROM accessory inferior glide at 90 degrees

Purpose: to assess inferior glide of the femoral head in the acetabulum (to combat the superior roll that happens in hip flexion)

position: supine, hip at 90 degrees, knee bent resting on your shoulder

muscle strength hip flexors

position: supine or seated, resistance must be applied at 90 degrees to the thigh

G2; sidelying

G3: seated or supine with slight resistance at last part of movement

G4,5: supine

muscle strength hip extensors

position: prone, knee flexed for gluteal focus, knee extended to hamstring focus

bed low at waist height so can get force straight down

can use functional testing for hip extension with glute bridges

muscle strength hip abductors

position: supine for G2 with a slide board or with socks, G3 and above, side lying with bottom leg bent and top leg straight. towel between waist and bed

ensure patient doesnt roll back or forwards and does not hitvh the trunk or externally rotate at the hip

a functional test can be single leg standing

muscle strength hip adductors

position: supine for G2. G3 above side lying, testing the bottom leg - top leg is in front of the bottom leg with either top leg having knee or ankle resting on the bed

often use isometric for this

muscle length for psoas and rec fem

modified thompson test

adjust bed height to the height of patients sacrum and is supported back on to the bed, or patient is supine and shuffles down the bed.

non testing limb is held to the patients chest with assistance from therapist

modesty towel is key

with knee relaxed an extension force is applied to the thigh to take into hip extension

for rec fem addition, flex the patients knee with your leg

ITB muscle length testing

position: side lying diagnoally across the bed to allow room to lower the upper leg into adduction)

bottom leg held to chest by the patient to keep the trunk and pelvis still

top leg lowered into hip adduction

being behind the patient to support them to not roll back