Pelvic, Hip-Knee Joints & Rehab

Hip-Knee Joints & Rehab
By
Hossein Khorrami
khorrami4@yahoo.com
http://www.scribd.com/khorrami4
Pelvic bone, lateral view
Anterior View
Pelvic bone, medial view
Lat. View
Male vs. Female Pelvic
• https://www.youtube.com/watch?v=7aH8c2k
ToQo
Sacrum Flexion vs Extension
• Lumbar extension (backward bending) results in
sacral flexion (nutation), while lumbar flexion
(foreward bending) results in sacral extension
(counternutation)
• Anterior nutation (sacral flexion) is a nodding
movement of the sacrum between the
innominates, with the sacral base moving
anteriorly and inferiorly and the sacral apex
moving posteriorly and superiorly
• Posterior nutation (sacral extension) occurs when
the sacral base moves posteriorly and superiorly
and the sacral apex moves anteriorly and inferiorly
Sacro-iliac(SI) joint
• Synovial, anterior
• Syndesmosis(fibrous), posterior
Sacrococcygeal Joint
• Cartilaginous
Pelvic muscles
• Gluteus maximus: extensor
• Gluteus medius & minimus: abductors &
rotator
• Obturator internus & Quadratus femoris:
rotator
Gluteus Muscles
Gluteus Muscles
• Gluteus maximus: L4-S2
• Gluteus medius: L4-S1
• Gluteus minimus: L4-S1
Hip rotators
Piriformis muscle
• External rotation in extension
• Abduction in hip flexion
Piriformis muscle
G. Medius, dual function
External Rotators of Hip
• Gemellus superior
• Gemellus inferior
• Piriformis, S1-S2(L5)
• Quadratus femoris
• Obturator internus
• Obturator externus
https://www.healthline.com/human-body-maps/gemellus-superior#1
Gluteus medius & minnimus
• Abduction in neutral
• Hold level of pelvic in gaiting with assist of
tensor fascia latae
• To prevent pelvic from dropping to the
opposite side
Sciatic Nerve, Innervation
• Lateral rotator group (except piriformis and
quadratus femoris) and the posterior
compartment of thigh
Hip flexor, Psoas muscle
Hip flexor, Psoas muscle
• Origin: T12-L5
• Insertion: lesser
trochanter of femur
• Innervation: L1-L3
Iliacus muscle
• Origin: iliac fossa
• Insertion: base of lesser
trochanter
• Innervation: femoral
nerve
Hip ligaments, anterior
Hip ligaments, posterior
Hip movements
• Flexion
• Extension
• Adduction
• Abduction
• Internal rotation
• External rotation
https://www.youtube.com/watch?v=7BbxUIhYxzA
Hip & knee
Adductor Magnus
• ORIGIN:
Anterior part of pubic bone
(ramus). Adductor magnus
also takes origin from ischial
tuberosity.
• INSERTION:
Whole length of medial side of
femur, from hip to knee.
• ACTION:
Adduct and laterally rotate hip
joint. Adductors longus/brevis
also flex extended femur and
extend flexed femur
Adductors
• NERVE
Magnus: posterior division of obturator nerve L2, 3,
4. Tibial portion of sciatic nerve, L4, 5, S1. Brevis:
anterior division of obturator nerve, (L2–L4), and
sometimes the posterior division
Longus: anterior division of obturator nerve, L2, 3, 4
• BASIC FUNCTIONAL MOVEMENT

bringing second leg in or out of a car
Knee muscles
• Hamstering
– Biceps femoris(2joint)
– Semitendinosus
– Semimembranosus
• Quadriceps
– Rectus femoris
– Vastus medialis
– Vastus lateralis
– Vastus intermedialis
• Sartorius
• Popliteus muscle
Rectus femoris
Quadriceps
• Knee extensors
– Rectus femoris(dual joint)
• Vastus medialis
• Vastus lateralis
• Vastus intermedius
Adductor muscle
Adductors
Sartorius
• Longest muscle
Sartorius Muscle
Hamsterings
• All dual joint

muscles
Knee bones
• Femur
• Tibia
• Fibula
• Patella
Popliteus muscle
• Starts flexion
• Medial meniscus
• Lateral meniscus
• Anterior Cruciate Ligament(ACL)
• Posterior Cruciate Ligament(PCL)
Ligaments & menisci
Ligaments & menisci
Anterior view
“Screw-home Mechanism”
• Medial rotation of the femur on the tibia at end of

knee extension. This action nestles the condyles of
the femur onto the shallow platform of the tibia so
that the knee is “locked”. The posterior cruciate
ligament becomes taut and little muscle activity is
necessary to stand for extended periods of time.
• There is a special muscle, the popliteus, located in the

back of the knee, which initiates knee flexion by
laterally rotating the femur on the tibia. This aligns
the condyles of the femur so that flexion can proceed.
Screw-home
mechanism
Knee tendons & ligaments
Knee tendons & ligaments
• Lateral view
Gastrocnemius muscle
• Knee flexion
Soleus Muscle
Knee problems
• Romatoid Arthritis (RA)
• Osteoarthritis (OA)
• Patellofemoral pain syndrome
– Weakness of vastus medialis
• Ligaments & Meniscus injuries
Osteoarthritis
• Decrease articular space
• Osteophytes
• Bone & cartilage fragment
• Cartilage breaking down
Osteoarthritis(OA), treatment
• Heat, hot pack
• Knee support
• Stationary bike
• Isometric exercises
• SLR
Patellofemoral pain syndrome
• Mostly happens in young females & athletes
• Pain in sitting, jumping & using stairs
• Because of weakness in vastus medialis
• Shortening of vastus lateralis
• Patella shifts to the lateral side
• Wearing down the cartilage under patella
Patellofemoral pain syndrome
• One leg Squat close chain slowly
• Side SLR
• Knee over the roll
• Side lean on the wall
• Strengthening exercises
Heel Cord Stretch
• Stand facing a wall with your unaffected leg
forward with a slight bend at the knee
• Affected leg is straight and behind, with the
heel flat and the toes pointed in slightly
• Keep both heels flat on the floor and press
hips forward toward the wall
• Hold this stretch for 30 seconds and then relax
for 30 seconds
• 2 sets of 4/day
Standing Quadriceps Stretch
• Hold on to the back of a chair or a wall for
balance
• Bend knee and bring heel up toward the buttock
• Grasp ankle with hand and gently pull heel closer
to the body
• Hold this position for 30 to 60 seconds.
• Repeat with the opposite leg
• 2-3 reps
Half Squats
• Stand with feet shoulder distance apart
• Keep your lifted and slowly lower hips about
10 inches
• Plant weight in heels and hold the squat for 5
seconds
• Push through heels and bring body back up to
standing
• 3 sets of 10
Hamstring Curls
• Hold onto the back of a chair or a wall for
balance
• Bend affected knee and raise the heel toward
the ceiling as far as possible without pain
• Hold this position for 5 seconds and then relax
• Repeat
• Can use ankle weight
• 3 sets of 10
Calf raises
• Stand with body weight evenly distributed
over both feet
• Hold onto the back of a chair or a wall for
balance
• Lift unaffected foot off of the floor so that all
of body weight is placed on affected foot
• Raise the heel of the affected foot as high as
possible, then lower
• Repeat 10 times.
Leg extension
• Sit up straight on a chair
• Tighten thigh muscles and slowly straighten
and raise the affected leg as high as possible
• Squeeze thigh muscles and hold this position
for 5 seconds
• Relax and bring foot to the floor
• Repeat
• 3 sets of 10
Straight-leg raise
• Lie on the floor with elbows directly under
shoulders
• Keep affected leg straight and bend the other
leg so that the foot is flat on the floor
• Tighten the thigh muscle of affected leg and
slowly raise it 6 to 10 inches off the floor
• Hold this position for 5 seconds and then relax
and bring the leg to the floor
• 3 sets of 10
Prone SLR
• Lie on the floor on stomach with legs straight
• Tighten gluteus and hamstring muscles of the
affected leg and raise the leg toward the
ceiling as high as possible
• Hold this position for 5 seconds.
• Lower leg and rest it for 2 seconds
• 3 sets of 10
Leg press
• Place the center of the elastic band at the arch of
foot
• Lie on the floor with elbows bent
• Tighten the thigh muscle of affected leg and bring
knee toward the chest
• Flex foot and slowly straighten the leg, pushing
against the elastic band
• Hold this position for 2 seconds. Relax and bring
the leg to the floor
• 3 sets of 10
Ligaments & meniscus injuries
• Ice pack
• Pulse US
• IFC
• Strengthening ex
• CPM
• Heel slide
• SLR
Total Hip Replacement(THR)
• Prevent leg adduction
• Avoid hip flexion over 90o
• Avoid hip extension over 0o
• Avoid hip internal rotation in involved side
THR, exercises
• Ankle pumping
• Heel strike
• Heel sliding
• Squeeze gluteus m.
• Squeeze knee extension

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Hip-Knee Joints & Rehab

• BASIC FUNCTIONAL MOVEMENT

• All dual joint

• Medial rotation of the femur on the tibia at end of

• There is a special muscle, the popliteus, located in the

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