HIP flex ext abd manual MUSCLE TESTING.pdf
- 1. 1 HIP MANUAL MUSCLE TESTING (MMT) Hip Motions 1- Flexion. 2- Extension. 3- Abduction. 4- Adduction. 5- External rotation. 6- Internal rotation. 7- Flexion, Abduction and External rotation with knee flexion (Sartorius). 8- Abduction from flexed position (Tensor Fasciae Latae).
- 2. 2 Hip flexion - Range of motion (ROM): - 0 – 115 degrees (with the knee extended) - 0 – 125 degrees (with the knee flexed) - Prime Movers 1) Psoas major - Origin: Transverse processes of all lumbar vertebrae (L1-L5). - Insertion: Lesser trochanter of femur - Nerve supply: Lumbar plexus (L1 –L3). - Palpation site: Just distal to the inguinal ligament on the medial side of the sartorius.
- 3. 3 2) Iliacus - Origin: Iliac fossa and Iliac crest. - Insertion: Lesser trochanter of femur - Nerve supply: Femoral nerve (L2 –L4).
- 4. 4 - Secondary Movers - Rectus femoris – Sartorius – Tensor Fascisa Latae – Pectineus. - Factors Limiting Motion: 1- Contact of the thigh with the abdomen (when knee in flexion). 2- Tension of hamstring (when knee in extension). - Substitution: 1- Abduction & External rotation (Sartorius). 2- Abduction & Internal rotation (Tensor Fasciae Latae). - Effect of weakness: - Decrease the ability to flex the hip joint with difficulties in some activities as : 1- Stair climbing 2- Walking up or down the incline 3- Bringing the trunk forward in the sitting position to raise from a chair. 4- Praying. - Bilateral hip flexor deformity will be accompanied with increased lumbar lordosis leading to low back pain. N.B:
- 5. 5 Hip extension - Range of motion (ROM): - 115 - 125 degrees to 0 degrees (extension) - 0 - 15 degrees (hyperextension) - Prime Movers 1- Gluteus maximus (The most powerful extensor of the hip) - Origin: - Posterior surface of ilium - Posterior surface of sacrum - Iliac crest and coccyx - Insertion: - Gluteal tuberosity of the femur and iliotibial tract. - Nerve supply: - Inferior gluteal nerve (L5 - S2). - Palpation site : - Deep over the center of the buttocks (between ischial tuberosity and sacrum).
- 6. 6 2- Semitendinosus & semimembranosus (Medial Hamstring) - Origin: - Ischial tuberosity - Insertion: - Medial shaft of tibia (Semitendinosus). - Medial tibial condyle (Semimembranosus). - Nerve supply: - Sciatic nerve (L5 – S2). - Palpation site: - Just proximal to the posterior aspect of the knee joint (on the medial side).
- 7. 7 3- Biceps femoris (Lateral Hamstring) - Origin: - Ischial tuberosity - Insertion: - Lateral tibial condyle. - Head of fibula. - Nerve supply: - Sciatic nerve (L5 – S2). - Palpation site: - Just proximal to the posterior aspect of the knee joint (on the lateral side). - Palpation point for Hamstring: - At the ischial tuberosity - Or just proximal to the posterior aspect of the knee joint N.B:
- 8. 8 - Secondary Movers - Adductor magnus (inferior fibers) - Gluteus medius (posterior fibers) - Factors Limiting Motion: 1- Tension of iliofemoral ligament 2- Tension of hip flexor muscles (psoas major, iliacus, rectus femoris, sartorius, trensor fasciae latae and pectineus). - Substitution: - Extension of lumbar spine - Effect of weakness: Difficulties in some activities as: 1- Stair climbing. 2- Rising from sitting or squatting to standing position. 3- Gluteus maximus lurching gait. - The hamstrings are significant in maintaining hip extension when in standing. - To isolate the gluteus maximus, all tests must be performed with the knee in flexion. N.B:
- 9. 9 Hip abduction - Range of motion (ROM): 0 – 45 degrees - Prime Movers - Gluteus medius & Gluteus mininmus - Origin: - External surface of ilium - Insertion: - Greater trochanter - Nerve supply: - Superior gluteal nerve (L4 – S1). - Palpation site: - Gluteus medius : Just proximal to the greater trochanter (lateral and distal to the iliac crest.
- 10. 10 - Secondary Movers - Upper fibers of the gluteus maximus - Tensor fasciae latae – Sartorius - Obturator internus - Gemellus superior and inferior - Factors Limiting Motion: 1- Tension of pubocapsular ligament 2- Tension of hip adductor muscles (pectineus, gracilis, adductor longus, magnus and brevis - Substitution: 1- Elevation of pelvis (Hip hiking). 2- Hip flexion 3- Hip external rotation - Weakness of gluteus medius result in Trendelenburg Gait N.B: