Hip Muscles
Mazyad Alotaibi
Testing Muscles of the Lower Extremity
1. Hip Flexion.
2. Hip flexion, abduction and external (lateral)
rotation with knee flexion.
3. Hip Extension.
4. Hip abduction.
5. Hip Abduction from flexed position
6. Hip Adduction
7. Hip External Rotation
8. Hip Internal rotation
Hip Muscles
Hip Flexion
1- ANATOMY:
Agonist / Prim mover : Psoas major and iliacus
Origin:
Psoas major: transverse processes of L1-L5 and the vertebral bodies of
T12-L5
Iliacus: anterior 2/3 of iliac fossa
Insertion:
Psoas major: lesser trochanter of the femur
Iliacus: lesser trochanter of the femur
Nerve Supply:
Psoas major: lumbar plexus , nerve root from L2-L4
Iliacus: lumbar plexus, Femoral nerve L2-L3
Action: powerful hip flexion
Synergist / Accessory Muscles:
Rectus Femoris (RF), Sartorius, Tensor fasciae latae (TFL).
2- Range of motion: 0 to 1200
3- Stabilization:
1. contraction of anterior abdominal muscles to fix lumbar spine
and pelvis.
2. weight of trunk.
4- Effect of weakness and contracture:
1- Difficulty in: climbing stair, walking up or down the incline, getting up
from a reclined position.
2- In marked weakness: walking is difficult because the leg must brought
forward by pelvic motion.
3- Effect of contracture: Bilateral– Increased lumbar lordosis.
Unilateral–hip abduction combined with external
rotation.
5- Factor Limiting of motion:
- With knee flexed, contact of thigh on abdomen.
- With knee extended, tension of Hamstring Muscles.
6- Substitution:
*Sartorius: external rotation and abduction of the hip
*Tensor fasciae latae: internal rotation and abduction of the hip.
7-Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of Resistance
c- Test
d- Instruction to patient
The patient is short sitting with thighs
fully supported and legs hanging over
the edge. The therapist stands next to
the test leg. The therapist places one
hand on the distal thigh and proximal
knee, and applies resistance in a
downward direction as the patient
actively flexes at the hip
Hip flexion, abduction, and external
rotation with knee flexion
1- ANATOMY: Agonist / Prim mover : Sartorius
Origin: anterior superior iliac spine (ASIS)
Insertion: upper medial surface of body of tibia
Action: - flexes hip and knee
- With flexed hip, laterally rotates the thigh
Nerve supply: branches of femoral nerve, L2-L3
Synergist / Accessory Muscles:
hip and knee flexors. hip external rotators, and
hip abductor.
3. Nerve supply: Femoral n.(L2-L3)
2- Range of motion:
NO specific ROM because of two-joint muscle.
3- Fixation:
a. Contraction of abdominal muscles to fix pelvis.
b. Weight of trunk.
4-Effect of weakness and contracture:
effect of weakness: loss of antro- medial instability of
the knee joint.
effect of contracture: flexion, abduction and lat. Rot.
Deformity of the hip with knee flexion.
5- Factor Limiting of motion:
Non, because incomplete range of motion.
6- Substitution:
Iliopsoas or the Rectus Femoris results in pure hip flexion
without abduction and external rotation.
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of
Resistance
c- Test
d- Instruction to patient.
The patient is short sitting with thighs
supported on table and legs hanging over
side. The therapist stands lateral to the test
leg while placing one hand on the lateral
side of the knee and using the other hand to
grasp the medial anterior surface of the
distal leg. Hand at knee gives downward
and inward resistance. Hand at ankle gives
upward and outward resistance. Patient
flexes, abducts, and externally rotates the
hip and flexes the knee.
Hip Extension
1. ANATOMY:
Prim mover / agonist: Gluteus maximus and Hamstring
Origin of Gluteus maximus
– outer rim of ilium (medial aspect)
– dorsal surface of sacrum and coccyx
– sacrotuberous ligament
Insertion of Gluteus maximus :
– Illiotibial tract of fascia lata(primary insertion)
– gluteal tuberosity of femur
Action of Gluteus maximus :
– powerful extensor of hip
– laterally rotates thigh
– upper fibers aid in abduction of thigh
– fibers of IT band stabilize a fully extended knee
Nerve supply of Gluteus maximus : inferior gluteal nerve,
L5,S1,S2
Synergist / Accessory Muscles:
Adductor magnus (inferior part), Gluteus medius (post part),
2- Range of motion: 0 to 200 degrees (hyper)
0 to 50
3- Fixation
a. Contraction of ilio costalis lumborum and quadratus lumborum muscle.
b. Weight of trunk.
4- Effect of weakness and contracture:
1- Effect of weak. Bilaterally makes walking difficult., difficult in raising the
trunk from foreword-bent position.
2- Patient must push themselves to an upright position by using their arms
during walk.
3- Effect of contracture: walking with Hyper extension deformity.
5-Factor Limiting of motion:
a. Tension of iliofemoral ligament.
b. Tension of hip flexor muscles.
6-Substitution:
by extending lumbar spine.
Therapist must support the pelvis.
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of Resistance
c- Test
d- Instruction to patient
The patient lies prone on the table. The
therapist stands on the side of the test leg, at
pelvis level. One hand stabilizes the pelvis,
and the other hand is placed on the distal calf.
The hand on the distal calf applies resistance
in a downward direction ad the patient
actively extends at the hip.
Hip abduction
1- ANATOMY: Prim mover/ agonist: ( Gluteus medius and
Gluteus minimus)
Gluteus medius: Origin: outer aspect of ilium (between iliac crest
and anterior and posterior gluteal lines)
– upper fascia (AKA gluteal aponeurosis)
Insertion: lateral aspect of greater trochanter of femur
Action: - anterior and lateral fibers abduct and medially rotate the
thigh
– posterior fibers may laterally rotate thigh
– stabilizes the pelvis and prevents free limb from sagging
during gait
Nerve: superior gluteal nerve, L4,5,S1
Gluteus minimus Origin: outer aspect of ilium (between anterior
and inferior gluteal lines)
Insertion:
– greater trochanter (anterior to medius)
– articular capsule of hip joint
Action: - abduct and medially rotate the thigh
– stabilizes the pelvis and prevents free limb from sagging
during gait
Nerve: superior gluteal nerve, L4,5,S1
Hip abduction
Synergist / Accessory Muscles:
Upper fiber of Gluteus maximus, Sartorius, TFL.
2- Range of motion: 0 to 45 degrees
3- Fixation:
a. Contraction of lateral abdominal muscles and latissimus dorsi.
b. Weight of trunk.
4- Effect of weakness and contracture:
Effect of weakness: unilateral: positive (trendlingburgh test)
Bilateral: waddling gate
Effect of contracture: positive Ober’s test
5- Factor Limiting of motion:
–
Tension of distal band of iliofemoral ligament and pubocapsular
ligament.
–
Tension of hip adductor muscle.
6- Substitution:
- Patient may “hike hip” by approximating pelvis to thorax using lateral trunk
muscles.
- hip external rotation with flexion.
- TFL substitution
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand,
Direction of Resistance
c- Test
d- Instruction to patient.
The patient is side lying with test leg uppermost. The
therapist stands behind the patient and stabilizes
with one hand at the hip. This hand is proximal to
the greater trochanter. The other hand applies
resistance across the lateral surface of the knee.
Patient abducts hip against downward resistance.
Hip Abduction from flexed position
1- ANATOMY:
Prim mover /agonist ( Tensor Fascia Latae):
Origin: - anterior aspect of iliac crest
- anterior superior iliac spine (ASIS)
Insertion: anterior aspect of IT band, below greater
trochanter
Action: - hip flexion
– medially rotate & abduct a flexed thigh
– tenses IT tract to support femur on
the tibia during standing
Nerve: superior gluteal nerve, L4,L5,S1
Synergist / Accessory
Gluteus medius, and Gluteus minimus
2- Range of motion:
No specific Rom, because of two-joint muscle.
3-Fixation:
1. Contraction of lateral abdominal muscles and latissimus dorsi
2. weight of trunk.
4- Effect of weakness and contracture:
Effect of weakness : pt walks with Leg with tendency to rotate hip
laterally
Effect of shortness: Bilaterally– results in anterior pelvic tilt and
sometimes bilateral knock-knees,
Unilateral– results in lateral pelvic tilt.
Effect of contracture: hip flexion, and knock knees.
5-Factor Limiting of motion:
- Non, ROM incomplete
6-Substitution:
by Hip lateral rotator muscles.
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of
Resistance
c- Test
d- Instruction to patient.
The patient is side lying with test leg
uppermost, and hip flexed to 45 degrees.
The therapist stands behind the patient and
stabilizes with one hand at the hip. This
hand is proximal to the greater trochanter.
The other hand applies resistance across the
lateral surface of the knee. Patient abducts
hip against downward resistance.
Hip Adduction
1- ANATOMY: Prim mover /agonist (Adductors magnus,
Adductors Brevis, Adductors Longus, Pectineus and
Gracilis)
Origin
Insertion
Adductors magnus
Ischial tuberosity (inf-lat)
Femur (linea aspera)
Adductors Brevis
Pubis
Femur (linea aspera)
Adductors Longus
Pubis
Femur (linea aspera)
Pectineus
Pubis
Femur (linea aspera)
Gracilis
Pubis
Femur (linea aspera)
Action: Hip Adduction
Nerve supply: All Adductors are supply by Obturator nerve (L2,3,4)
Pectineus is supplied by Femoral n.(L2-L3)
Synergist / Accessory Muscles:
Obturator externus, Gluteus maximus.
2- Range of motion: 0 to 15- 20
3- Fixation:
by Weight of trunk
4- Effect of weakness and contracture:
- Effect of weakness : patient unable to adduct the leg during walking.
- Effect of shortness: patient walks with adducted legs.
- Effect of contracture: unable to abduct leg during gate cycle.
5- Factor Limiting of motion:
1. Contact with opposite limb.
2. When hip is flexed, tension of ischiofemoral ligament
6- Substitution:
by 1. hip flexor muscles.
2. Hamstring muscle.
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of
Resistance
c- Test
d- Instruction to patient.
The patient is side lying with the test leg
lowermost and resting on the table. The
uppermost leg is abducted to 25 degrees and
supported by the examiner. The therapist
stands behind the patient at the knee level.
The resistance hand is placed on the distal
medial femur of the test leg. Resistance is
applied in a downward motion while the
patient actively adducts.
Hip External Rotation
1- ANATOMY: Prim mover /agonist (Obturators internus and externus, Gemellae
superior and inferior, Piriformis, Quadratus Femoris, Gluteus maximus
“posterior”
Origin
Insertion
Obturators internus
Ischium and Pubis
Femur (trochanteric fossa )
Obturators externus
Ischium and Pubis
Femur (greater trochanter)
Gemellae Superior
Ischium
Femur (greater trochanter)
Gemellae Inferior
Ischial tuberosity
Femur (greater trochanter)
Piriformis
Sacrum
Femur (greater
trochanter)
Quadratus Femoris
Ischial tuberosity
Femur
Gluteus Maximus
Ilium , sacrum
Femur (gluteal tuberosity)
Nerve supply:
Obturators internus:
Nerve to Obturators internus (L5-S1)
Obturators externus:
Nerve to Obturators externus (L3-L4)
Gemellae Superior:
Nerve to Gemellae Superior (L5-S1)
Gemellae Inferior:
Nerve to Gemellae Inferior (L5-S1)
Piriformis:
Nerve to Piriformis (S1-S2)
Quadratus Femoris:
Nerve to Quadratus Femoris (L5-S1)
Gluteus Maximus:
Inferior gluteal n.(L5-S2)
Action: Hip lateral rotation
Synergist / Accessory Muscles:
Sartorius, Biceps femoris, Adductors magnus and longus
2- Range of motion:
3- Fixation:
0 to 45
by Weight of trunk
4- Effect of weakness and contracture:
- Effect of weak : result in medial rot. accompaied by foot pronation with knockknees.
- Effect of contracture: result in abduction position with limited medial rot. Of the hip
accompained by outward position of the toes in standing position
5- Factor Limiting of motion:
1. Tension of lateral band of iliofemoral ligament.
2. Tension of hip medial rotator muscles.
6- Substitution:
- Sartorius ( Hip flex,abd, and ext rot.)
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of
Resistance
c- Test
d- Instruction to patient.
The patient is short sitting. The therapist
sits on a stool or kneels beside patient.
The therapist places one hand at the
lateral aspect of the distal thigh and
applies resistance in a medial direction.
The other hand grasps the medial ankle
just above the malleolus, and applies
resistance in a lateral direction. The patient
is actively externally rotating at the hip.
Hip Internal Rotation
1- ANATOMY:
Prim mover /agonist ( Gletei minimus and medius, Tensor fascia
latae):
Origin
Gluteus Minimus
Ilium (outer surface)
Action: Hip medial rotation
Nerve supply:
Gluteus Minimus: Superior gluteal n.(L4-S1)
Action : Hip medial rotation
Synergist / Accessory Muscles:
Tensor fascia latae, Gluteus minimus and medius.
Insertion
Femur (greater trochanter)
2- Range of motion: 0 to 45
3- Fixation:
- Weight of trunk
4- Effect of weakness and contracture:
- walking with lat. Rot.
5- Factor Limiting of motion:
1. when hip is extended, tension of iliofemoral Ligament.
2. when hip is flexed, tension of ischiocapsular ligament.
3. tension of hip lateral rotator muscles.
6- Substitution:
by lifting the pelvis on the tested side.
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand, Direction of
Resistance
c- Test
d- Instruction to patient.
The patient is short sitting. The therapist
sits on a stool or kneels beside patient.
The therapist places one hand at the
medial aspect of the distal thigh and
applies resistance in a lateral direction.
The other hand grasps the lateral ankle
just above the malleolus, and applies
resistance in a medial direction. The
patient is actively internally rotating at the
hip.
FLEXIBILITY TESTS
TRENDELENBURG SIGN
• Procedure: subject assumes unilateral stance
without upper extremity assistance. Examiner
observes patient from behind.
• Interpretation:
– Normal: Hip on opposite side should rise slightly
– Abnormal
• Dropping of pelvis on the opposite side
• Shifting center of gravity over stance leg
*These findings indicate abductor weakness of stance
leg
• Thomas Test:
FLEXIBILITY
– Procedure: Patient in supine, both knees brought
to chest. Patient holds unaffected leg, keeping
their back flat against the table. The tests leg is
allowed to drop into extension. Next the knee is
allowed to drop into flexion
– Interpretation:
• Hip should extend to 0 degrees; if this is not achieved,
tightness of one-joint hip flexors is indicated
• If able to achieve full hip extension, but note 80
degrees of knee flexion, then tightness of the two joint
hip flexors (rectus femoris) is indicated
• Abduction of the hip and/or external rotation of the
tibia indicate ITB tightness
THOMAS TEST: NORMAL ILIOPSOAS AND
RECTUS FEMORIS
THOMAS TEST: TIGHT ILIOPSOAS AND RECTUS
FEMORIS
FLEXIBILITY
• Ober’s Test:
– Procedure: Patient in side-lying with test side
up. The knee may extended or flexed to 90 or
30 degrees. The hip is maintained in slight
extension. The test leg is abducted, then
allowed to lower toward the table with the
pelvis stabilized
– Interpretation:
• Normal: able to abduct parallel to the examining
surface
• Inability to adduct to parallel indicates tightness of
the ITB
OBER’S TEST: NORMAL ITB/TFL
OBER’S TEST: TIGHT ITB/TFL
FLEXIBILITY
• Hamstring Flexibility
1. Passive Straight Leg Raise
– Normal: should achieve at least 80 degrees of hip flexion
– Reproduction at 45 degrees or less may indicate lumbar
radiculopathy
2. Popliteal Angle
• Patient is supine with test leg’s hip flexed to 90
degrees
• The knee is passively extended
• Interpretation
– Normal: Angle of flexion should be 15 to 20 degrees or
less
– Abnormal: If angle of flexion is greater than 15 to 20
degrees, this is indicative of hamstring tightness
ELY’S TEST
• Procedure: Patient in prone. The knee of
tested leg is flexed by the examiner
• Interpretation:
– Normal: Able to fully flex the knee without
creating hip flexion
– Abnormal: Flexion of the hip prior to full knee
flexion indicates Rectus Femoris tightness