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Anatomy of the Hip

Anterior View

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Posterior View

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Physiologic (Osteokinematic) Motions of the Hip

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Normal ROM OPP CPP Normal End Feel(s) Capsular Pattern

Flex = 100°–120°

Ext = 15°

Abd = 40°–45°

IR = 30°–40°

ER = 40°–50°

30° flex

30° abd & slight ER

Max ext, IR, abd

Flex & add = elastic or tissue approx

SLR = elastic

Ext & abd = elastic/firm

IR & ER = elastic/firm

IR > ext > abd

Accessory (Arthrokinematic) Motions of the Hip

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Arthrology Arthrokinematics

Concave surface:

acetabulum

Convex surface:

femoral head

To facilitate hip flex:

Femur spins posterior

To facilitate hip ext:

Femur spins anterior

To facilitate hip abd:

Femur spins lateral & glides medial on pelvis

To facilitate hip add:

Femur spins medial & glides lateral on pelvis

To facilitate hip IR:

Femur rolls medial & glides posterior & lateral on pelvis

To facilitate hip ER:

Femur rolls lateral & glides anterior & medial on pelvis

Hip Mobilization Techniques

Hip Distraction

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Indications:

  • To improve motion in all directions

Patient:

  • Supine with hip in open-packed position

Clinician:

  • At pt's feet in a tandem stance facing pt

  • Stabilizing contact: Provided by pt's body weight with assistance from a belt around pelvis

  • Mobilizing contact: Both hands grasp pt's distal tibia/fibula just proximal to ankle (or above knee if knee pathology exists); belt may be used to reinforce hand contacts

Accessory Motion Technique:

  • While maintaining all contacts, clinician shifts weight from front to back foot

Accessory With Physiologic Motion Technique:

  • Pt & clinician in same position

  • Pt & clinician move hip in direction of greatest restriction

  • Clinician maintains hand contacts & distraction force t/o ROM

Hip Inferior Glide

Indications:

  • To improve hip flex

Patient:

  • Supine with hip flexed to 90° & lower leg draped over clinician's shoulder (knee flexed); may incorporate abd/add or ER/IR to pre-position at point of restriction

Clinician:

  • Stand to side facing pt with pt's posterior thigh in contact with clinician's shoulder

  • Stabilizing contact: Provided by pt's body weight with assistance from belt around pt's pelvis

  • Mobilizing contact: Clasped hands mobilize by contacting anterior aspect of proximal femur. Mobilization belt may be used around clinician's waist & pt's thigh to reinforce hand contacts

Accessory Motion Technique:

  • Both hands exert inferior mobilizing force; clinician may lean back ...

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