🔹Hip Abduction

🔸Gluteus Medius and minimus nerve supply : superior gluteal nerve.

🔹Acessory muscles :
-Tensor fasciae latae
-Gluteus Maximus (upper fibers)

🔸Notice that :
- The anterior fibers of gluteus medius medially rotate and may assist in hip flexion.
- The posterior fibers of gluteus medius laterally rotate and may assist in hip extension.

🔹ROM :
From med line to full ROM, the hip joint can abduct for 45 degrees.

🔸 This ROM can be limited by :
- Tension of of distal band of iliofemoral ligament and of the pubocapsular ligament.
- Tension of hip adductors.

🔹Notice that in fixation and substitution :
When testing the abductors as a group in side lying position, the stabilization is necessary, but often difficult, As it requires :
🔸Strong fixation by many trunk muscles.
🔸Stabilization given by the PT.
🔸The slight flexion of hip and knee of the under leg aids in stabilizing the pelvis against anterior and posterior tilt.
🔹Any shift in position of pelvis may be result from :
🔸 trunk weakness
🔸Substitute by anterior or posterior hip muscles
🔸Substitute by lateral abdominals.

🔹Hip adduction :

🔸Pectineus

Nerve supply : Femoral and Obturator Nerves.

🔸Adductor Magnus

Nerve supply : Obturator and Sciatic Nerves.

🔸Gracilis, Adductor Brevis and Adductor longus nerve supply : Obturator Nerve.

🔹ROM : from the hip abduction position to the mid line the ROM is 45 degrees.

🔸The ROM can be limited by :
- contact with the other leg
- when hip is flexed, tension of ischio-femoral ligament.

🔹Substitutions :
- Anterior pelvic tilt or flexion of hip allows substitution by the hip flexors.
- Forward rotation of the pelvis with extension of hip shows attempt to hold with lower fibers of gluteus maximus.

🔸Notice that excessive tightness of adductors cause avulsion fracture (like in excessive jumping).

🔹When person has a two striped pirformis, the Sciatic Nerve is between them (1)
🔹Or when sciatic nerve under the pirformis (2)

In (1) or (2) compression on sciatic nerve occurs which leads to inflammation or spasm.

🔸Hip external rotation

🔹Pirformis, Quadratus femoris, Obturator internus and gemellus superior :-
Nerve supply is sacral plexus.

🔹Obturator Externus nerve supply is Obturator Nerve

🔹ROM :
- with knee in flexion the hip lateral rotation is 45 degrees of motion
-with knee in extension the ROM will have tendency to be less amplitude.

🔸The ROM can be limited by :
- Tension of lateral band of iliofemoral ligament.
- Tension in the hip medial rotator muscles.

🔹Weakness of hip lateral rotators causes :-
- Medial rotation of femur
- Pronation of foot
- Tendency toward Knock-knee position

🔸Contracture in lateral rotators of hip :-
- Usually occurs in an abducted position of hip.
- The ROM of medial rotation will then be limited in standing position and toes are outwardly directed.

🔸Hip internal rotation :-

🔹Gluteus minimus and Tensor fasciae latae :-

Nerve supply is superior gluteal nerve.

🔸Acessory muscles :
- Gluteus Medius
- Semitendinosus
- Semimembranosus

🔹ROM like lateral rotation

🔸The ROM can be limited by :-
-Tension in the iliofemoral ligament when the hip is extended.
- Tension in the ischio-capsular ligament when hip is flexed.
- Tension of hip lateral rotator muscles.

🔹Weakness of hip medial rotators :-
result in lateral rotation of the lower extremity in standing and walking.

🔹Trunk flexion :-

🔸Rectus abdominis :

🔹Nerve supply : lower intercostal nerves.

🔹Acessory muscles :
Internal and external oblique muscles.

🔹Factors limiting motion :
- Tension of spinal extensor ms
- Tension of posterior longitudinal ligament, interspinal and supraspinal ligament and legmenta flava m
- opposition of lower lip of vertebral bodies.
- compression of intervertebral fibrocartilages in front.
- contact of lower ribs on abdomen (obesity).

🔹Fixation (Prevent Substitution) :
- Hip flexors
- weight of legs and pelvis

🔸Notice that in trunk flexion :-
- Grade 3 is partial range of grade 4 (In scapular motion from plence)
- Grade 2 is static contraction (poor).
- Ambilicus deviation occurs if it :-
- Upward, the upper part is more stronger.
- Downward the lower part is more stronger.
- If there is no deviation, so there is equal tone between upper and lower.

🔹Trunk Extension :

🔸Erector spinae (sacrospinalis) :

1- Iliocostalis dorsi and Spinalis dorsi nerve supply is dorsal rami of spinal nerves.
2- longissimus dorsi
3- iliocostalis lumborum
4- Quadratus lumborum


🔸Acessory muscles :
- semispinalis
- multifidus
- Rotators

🔸ROM :
Lumber extension is more than thoracic extension.

🔸Factors limiting motion :
🔹Tension of anterior longitudinal ligament of spine.
🔹Tension of anterior abdominal muscles.
🔹Contact of spinous processes
🔹Contact of inferior articular margins with laminae.

Fixation :
- Hip extensors
- weight of legs and pelvis

🔹Trunk Rotators :-
نقول تريكايه بسيطه كدا في الأكشن :
Internal ➡️ Same Direction
External ➡️ opposite Direction

يعني أما اقولك بعمل Right rotation بـ ايه تقولي بال
- Right internal oblique (same)
- left external oblique (opposite)

🔸External and internal oblique nerve supply is mainly : lower intercostals.

🔹ROM :
full clearance of scapula from plence in opposite direction.

🔸Factors limiting motion :
1- Antagonist
2- Tension of annulus fibrosis between vertebrae.
3- Tension of costovertebral ligaments in thoracic area.
4- In lumber area, interlocking of articular facets (Rotation negligible).

🔹Fixation:
Reverse action of hip flexor muscles.

🔸Acessory muscles :
- latissimus dorsi
- semispinalis
- Multifidus
- Rotators
- Rectus abdominis (combined trunk rotation and flexion).

🔸Elevation of pelvis :

🔹Quadratus lumborum :

🔸Nerve supply : lumbar plexus

🔸Action :
- Hip hiking
- Elevates the pelvis laterally by producing a lateral rotation of the lumbar spine.

🔹ROM :
In standing position, the pelvis raised on one side until the foot is well clear of floor.

🔸ROM may be limited by :
- Tension of spinal ligaments on the opposite side.
- Contact of iliac crest with thorax.

🔹Sartorius :

🔸Nerve supply : Femoral nerve.

🔹Function : flexion, abduction, external rotation with knee flexed position.

🔹Acessory muscles :
- Hip and knee flexors
- External rotators of hip
- Hip abductors

🔹ROM : combined range

🔹Postion : sitting with thighs on table and legs dangling off desired motion.

🔹Resistance :
- On lateral aspect of knee (resist hip flexors)
- On medial aspect of ankle
(resist external rotation and knee flexion)

🔹Substitution (pure hip flexion):

Iliopsoas and rectus femoris in this movement is evidence by straight hip flexion without abduction and lateral rotation.

🔹Effect of weakness :
Impaired contribution to anteromedial stability of knee joint.

🔹Effect of contracture :
Patient walks with anterior pelvic tilit and hip flexion, abduction, external rotation.

🔸Tensor fasciae latae :

🔸Nerve supply : superior gluteal nerve

🔸Action : flexion, abduction, internal rotation with flexed knee.

🔸ROM is also combined and on asking the patient to abduct the hip, ROM is approximately 30 degrees.

🔸Effect of weakness :
Thrust to the direction of bow leg position and the extremity tends to rotates laterally from hip.

🔸Effect of shortness :
If the tightness :
1- Bilateral : causes anterior pelvic tilt, Sometimes bilateral Knock knee.
2- Unilateral : the abductors and fasciae latae are tight along with tensor and this causes lateral pelvic tilt on side of tight, knee on that side will tend toward a Knock knee position.

🔸Notice that :
If tensor fasciae latae is tight as a hip flexor, this causes anterior pelvic tilt and a medial rotation of femur, as Indicated by patella position.

#Biomechanics #regional

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Cervical Rotation
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Cervical Extension
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