One of the primary functions of the hip joint is to stabilize the body
The hip joint is formed by the head of the femur and the acetabulum of the pelvis.
The surfaces of the femur head and the acetabulum are covered with a thin layer of hyaline cartilage which acts to allow smooth movement of the joint.
Ligaments of the hip joint :
- Iliofemoral ligament: This is a strong ligament which connects the pelvis to the femur at the front of the joint. It resembles a Y in shape and stabilises the hip by limiting hyperextension
- Pubofemoral ligament: The pubofemoral ligament attaches the part of the pelvis known as the pubis (most forward part, either side of the pubic symphesis) to the femur
- Ischiofemoral ligament: This is a ligament which reinforces the posterior aspect of the capsule, attaching to the ischium and between the two trochanters of the femur
The most important muscles are:
- Gluteals (m. gluteus maximus, m. gluteus medius, m. gluteus minimus) . musculus gluteus medius and musculus gluteus minimus are responsible for abducting and medially rotating the hip joint, as well as stabilising the pelvis, musculus gluteus maximus extends and laterally rotates the hip joint.
- The four quadricep muscles :vastus lateralis, medialis, intermedius and rectus femoris. Rectus femoris acts to flex the hip. The vastus lateralis, medialis, and inermedialis muscles do not cross the hip joint, and attach around the greater trochanter and just below it.
- Iliopsoas: The is the main hip flexor.
- The Hamstrings are three muscles (m. semitendinosus, m. semimembranosus and m. biceps femoris) They all attach superiorly to the ischial tuberosity and cause hip extension.
- Groin muscles (adductor muscles: m. adductor magnus, adductor longus , adductor brevis, m. pectineus, m.gracilis): The adductors are fan-like muscles in the upper thigh that pull the legs together when they contract. They also help stabilize the hip joint. Their action is hip adduction.
Hip Movements – in the standing position
- Flexion – move the leg forwards.
- Extension – move the leg backwards.
- Abduction – move the leg away from your side.
- Adduction – move the leg towards to other leg.
- Internal Rotation – rotate the foot towards the other (toes pointing towards each other).
- External Rotation – rotate the foot away from the other (toes pointing outwards).
Coxarthrosis is an degenerative disease of the hip joint which usually appears in late middle or older age. It is characterized by growth or maturational disturbances in the femoral neck and head, as well as acetabular dysplasia.The dominant symptom is pain on weight-bearing or motion. Hip pain can make simple activities painful; it may not felt exactly in the hip, sometimes it happens in upper part of the thigh and in the groin. The joints can become deformed and ultimately become completely ossified. Arthrosis is generally a slowly progressing process.
Osteoarthritis is the commonest cause of hip pain. Primary is due to articular cartilage problems (wear and tear), whereas secondary is caused when the joint has been damaged by some other disease process:
- Congenital Dislocation of the Hip
- Acetabular dysplasia (malformation of the acetabulum)
- Perthes disease (Slipped femoral epiphysis)
- Septic Arthritis (infection)
Changes the shape of the joint so that it does not function smoothly.
- Causes fragments of bone and cartilage to float in the joint causing irritation and pain.
- Causes bony fragments to develop.
- Results in inflammation.
- Changes the property of the joint fluid.
X-rays, CT, MRI may show joint wear of the upper joint surface where the femoral head lies in contact with the acetabulum. The wear may be commonly superior, supero-lateral or supero-medial.
- Wrong straining,
- Endocriene factors (hormone problems)
- Genetic influences
Physical therapy plays a crucial role in the nonsurgical treatment of hip coxarthrosis. A primary goal is to help you learn how to control symptoms and maximize the health of your hip. You will learn ways to calm pain and symptoms, which might include the use of rest, heat, or topical rubs.
Range-of-motion and stretching exercises will be used to improve hip motion. You will be shown strengthening exercises for the hip to steady the joint and protect it from shock and stress. Your therapist can suggest tips for getting your tasks done with less strain on the joint. Physical therapy is tailored to the patient’s condition and health issues. A common goal of physical therapy is to increase how the patient functions at home and at work
Physical therapy exercise may result in:
- stabilitation of joint
- increase in range of motion
- reduction of atrophy (muscles)
- development of muscular enhancement
- reduction of spasm of muscles
- reduction of destruction, deformity
- posture correction