At the conclusion of this chapter, the reader will be able to:
Identify the key anatomical and biomechanical features of the hip, their relationship to the lumbo-pelvic-hip complex (LPHC), and their impact on physical therapy examination and intervention.
List and perform key procedures used in the orthopaedic manual physical therapy (OMPT) examination of the hip.
Demonstrate sound clinical decision-making in evaluating the results of the OMPT examination.
Use pertinent examination findings to reach a differential diagnosis and prognosis.
Discuss issues related to the safe performance of OMPT interventions for the hip.
Demonstrate a basic level of proficiency in the performance of an essential skill set of joint mobilization techniques for the hip.
FUNCTIONAL ANATOMY AND KINEMATICS
The hip joint is best defined as a diarthrodial joint that forms the articulation between the acetabulum of the pelvis and the head of the femur. The hip joint possesses three degrees of freedom and provides an important link between the axial skeleton and the lower extremity. Unlike the shoulder, the hip possesses the additional responsibility of bearing superincumbent forces from the head, arm, and trunk (HAT) as well as accommodating for ground reaction forces from the lower extremities. In this chapter, we will focus on the important kinematic and functional connections between the hip and the adjacent structures of the lower kinetic chain. As an integral part of the lumbo-pelvic-hip complex (LPHC), the hip joint plays an important role in dictating the function of the trunk and lower quarter.
The acetabulum is formed by the fusion of the ilium, ishium, and pubis, which do not become fully ossified until the age of 25.1 On the periphery of the acetabulum, the horseshoeshaped lunate surface, which is covered with hyaline cartilage, serves as the primary articulating surface for the head of the femur.2 The inferior gap of the lunate is bridged by the transverse acetabular ligament. The acetabular labrum serves to increase the depth and enhance congruency between the acetabulum and the femur, thus adding to its overall stability. The acetabular fossa, which serves as a deep, fibrous tunnel for the passage of blood vessels, is located medially and represents the non-weight-bearing surface of the acetabulum.
The femur is the largest long bone in the body. The head of the femur is more regularly shaped than its acetabular counterpart, comprising nearly two-thirds of a complete sphere. The entire head is covered with articular cartilage, with the exception of a region at the posteromedial aspect, identified as the fovea capitis, which serves as the attachment site for the teres ligament, also known as the ligament to the head of the femur.
Stability of the Hip Joint
Critical to understanding stability of the hip is an ...