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"Knowing in part may make a fine tale, but wisdom comes from seeing the whole"

—Asian Proverb

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LEARNING OUTCOMES

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LEARNING OUTCOMES

This chapter investigates the pelvic and hip region. By completion of this chapter, the reader should be able to:

  • Identify the bones, joints, soft tissue, and muscles of the pelvic and hip region;

  • Discuss the relationship between the pelvis, hip, low back, and trunk and their contributions to functional movement;

  • Demonstrate the motions of the pelvis on the femur—anterior and posterior pelvic tilt, lateral tilt, and forward and backward rotation;

  • Demonstrate the motions at the hip joint and list the muscles that are responsible for motion of the femur on the pelvis at the hip joint—flexion, extension, abduction and adduction, lateral and medial rotation;

  • Name the prime muscles that move the pelvis and hip to accomplish specific functional activities;

  • List the muscles at the hip that contribute to motions in varying planes and describe the uniqueness of these contributions to functional movement;

  • Describe the function of the hip and its musculature in closed kinematic chain as compared to open kinematic chain movements;

  • Explain frontal plane control of the pelvis including the role of the gluteus medius and adductor muscles in unilateral stance and describe the implications for function;

  • Describe commonly encountered pathological conditions of the pelvic and hip region and their functional consequences.

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CLINICAL SCENARIO

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CLINICAL SCENARIO

Noelle notices that the retired man she is working with is walking with an unsteady gait. Every time he takes a step onto his left lower extremity, he laterally leans his trunk over to that side. Noelle is concerned with the long-term effects that this gait deviation will have on Mr. Reyes' lumbar spine. What assessment steps should Noelle take to evaluate the underlying cause of this gait pattern? What should she recommend to Mr. Reyes, and why?

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INTRODUCTION

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Similar to the shoulder region, the pelvic and hip region integrally intertwine their structure and function. However, in contrast to the shoulder area, this region's primary responsibility is not mobility during open chain activities; rather, it is power production during closed chain functions. Just as there is a direct relationship between the trunk and scapula and the scapula and glenohumeral joint, there is also an association between the trunk and pelvis and the pelvis and hip.

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In anatomical terms, "girdle" signifies an anatomical structure that acts as a functional brace or girder from which a segment moves. The shoulder complex is an incomplete girdle whereas the pelvic girdle forms a complete girdle. The pelvic girdle includes the right and left pelvic bones that are joined to the axial skeleton via the sacrum and fifth lumbar vertebra posteriorly, with the left and right hemipelvis meeting at the pubic symphysis anteriorly. Similar to how the humeral head articulates with the glenoid fossa, the femoral head articulates with the pelvic ...

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