![HIP JOINT
DR. PRIYANKA RANAWAT
[PHYSIOTHERAPIST]](https://image.slidesharecdn.com/hipjoint-240608111453-4e62fe3c/85/HIP-JOINT-pptx-slide-share-MMT-ROM-of-hip-1-320.jpg)
![Cont...
• To test :-
• For grade 1 :- palpation [ gluteus maximusdeep finger
pressure over the buttocks ]
• Patient extends hip through entire available ROM .
• Resistance is given straight downward toward the floor
{ no resistance is given in the grade 3 }
• For grade 4 to 5 apply resistance through distal thigh in
the direction opposite to hip extension.
6/8/2024 17](https://image.slidesharecdn.com/hipjoint-240608111453-4e62fe3c/85/HIP-JOINT-pptx-slide-share-MMT-ROM-of-hip-17-320.jpg)
![Cont...
• The therapist will cross their arms to perform test by
placing one hand on the therapist shoulder to stabilize
the trunk and by placing the other hand on the distal
femur to apply force directly against the hip flexors
• grade 1 :- palpation contraction just distal to inguinal
ligamant on the medial side of sartorius .[iliopsoas can be
challenging .]
6/8/2024 20](https://image.slidesharecdn.com/hipjoint-240608111453-4e62fe3c/85/HIP-JOINT-pptx-slide-share-MMT-ROM-of-hip-20-320.jpg)
![Cont...
• Therapist position:-
• Therapist stands behind patient in side lying or on
rest side in supine
• Provide stabilization at the pelvis in side lying
• Palpation over hip abduction in supine at lateral thigh
tensor fibers.[ grade 1]
6/8/2024 22](https://image.slidesharecdn.com/hipjoint-240608111453-4e62fe3c/85/HIP-JOINT-pptx-slide-share-MMT-ROM-of-hip-22-320.jpg)
![Manual muscle testing of hip
adduction
Patient position :-
• Grade 3 to 5 patient in side lying
with top leg [ non test side
] abducted 25 degree.
• Test side is bottom leg in side lying
• Grade 0 to 2 patient in supine { gravity
minimal position } , non- test side leg
abducted 25 degree.
6/8/2024 25](https://image.slidesharecdn.com/hipjoint-240608111453-4e62fe3c/85/HIP-JOINT-pptx-slide-share-MMT-ROM-of-hip-25-320.jpg)
HIP JOINT.pptx slide share / MMT/ ROM of hip
- 1. HIP JOINT DR. PRIYANKA RANAWAT [PHYSIOTHERAPIST]
- 2. HIP JOINT Also known as coxofemoral & femoroacetabular joint Ball and socket variety of synovial joint Multiaxial joint 6/8/2024 2
- 3. Muscles • Hip flexors muscles • Hip extensors muscles • Hip adductors muscles • Hip abductors muscles • Hip medial rotators muscles • Hip lateral rotator muscles 6/8/2024 3
- 4. Hip flexors & extensors muscles • Flexors muscles:- • Iliopsoas • Rectus femoris • Tensor fascia latae • Sartorius • Extensors muscles:- • Gluteus maximus • Semitendinosus • Semimembranosus • Biceps femoris 6/8/2024 4
- 5. Flexors & extensors muscle 6/8/2024 5
- 6. Hip adductors & abductors muscles • Adductors muscles:- • Adductor magnus • Adductor longus • Adductor brevis • Pectineus • Gracilis • Abductors muscles :- • Gluteus medius • Gluteus minimus • Tensor fascia latae • Pirioformis 6/8/2024 6
- 7. Adductors muscles & abductors 6/8/2024 7
- 8. Hip medial & lateral rotators muscles • Medial rotators muscles :- • Tensor fascia latae • Gluteus minimus • Gluteus medius • Lateral rotators muscles :- • Gluteus maximus • Piriformis • Quadratus femoris • Sartorius • Obturator internus & externus 6/8/2024 8
- 9. Medial & lateral rotators 6/8/2024 9
- 10. Range of motion OF HIP flexion • Flexion :- Normal ROM 0 –120 DEGREE • Position :- supine lying • Fulcrum:- lateral aspect of hip joint • Fixed arm :- lateral midline of pelvis • Movable arm :- lateral midline of the femur 6/8/2024 10
- 11. Extension rom of hip • Normal ROM :- 0 – 30 DEGREE • Testing position :- prone lying • Fulcrum :- lateral aspect pf hip joint • Movable arm :- lateral midline of femur • Fixed arm :- lateral midline of the pelvis 6/8/2024 11
- 12. Abduction rom of hip • Normal ROM :- 0 – 45 degree • Testing position :- supine lying • Fulcrum :- anterior superior iliac spine of the extremity • Movable arm :- anterior midline of femur • Fixed arm :- horizontal line extending from one ASIS to other ASIS 6/8/2024 12
- 13. adduction rom of hip • Normal ROM :- 0 – 45 degree • Testing position :- supine lying • Fulcrum :- anterior superior iliac spine of the extremity • Movable arm :- anterior midline of femur • Fixed arm :- horizontal line extending from one ASIS to other ASIS 6/8/2024 13
- 14. Medial & lateral rotation rom of hip • Testing position :- sitting on a supporting surface • Normal ROM :- 0 – 45 DEGREE • Fulcrum of patella • Movable of arm :- anterior midline of lower leg • Fixed arm :- parallel to leg 6/8/2024 14
- 15. Manual muscle testing of hip extension Grade 3 to 5 • Prone . Arms may be overhead or abducted to hold side of table . • Modified for hip flexion tightness patient stand with hips flexed and places torso prone on the table . • Grade 0 to 2 patient is in side lying { gravity minimal position } 6/8/2024 15
- 16. Cont... • Therapist position :- • Standing at side of limb to be tested at level of pelvis • The hand used to provide resistance is over the posterior thigh just above the knee . • The opposite hand stabilize the pelvis laterally to maintain hip and pelvis posture 6/8/2024 16
- 17. Cont... • To test :- • For grade 1 :- palpation [ gluteus maximusdeep finger pressure over the buttocks ] • Patient extends hip through entire available ROM . • Resistance is given straight downward toward the floor { no resistance is given in the grade 3 } • For grade 4 to 5 apply resistance through distal thigh in the direction opposite to hip extension. 6/8/2024 17
- 18. Manual muscle testing of hip flexion 6/8/2024 18
- 19. Cont... • Patient position :- • Patient seated position for gravity resistance test and if they are able to actively flex the hip • Grade 3 to 5 6/8/2024 19
- 20. Cont... • The therapist will cross their arms to perform test by placing one hand on the therapist shoulder to stabilize the trunk and by placing the other hand on the distal femur to apply force directly against the hip flexors • grade 1 :- palpation contraction just distal to inguinal ligamant on the medial side of sartorius .[iliopsoas can be challenging .] 6/8/2024 20
- 21. Manual muscle testing of hip abduction • Patient positioning :- • Grade 3 to 5 patient in side lying with test side up • Grade 0 to 2 patient in supine { gravity minimal position 6/8/2024 21
- 22. Cont... • Therapist position:- • Therapist stands behind patient in side lying or on rest side in supine • Provide stabilization at the pelvis in side lying • Palpation over hip abduction in supine at lateral thigh tensor fibers.[ grade 1] 6/8/2024 22
- 23. Cont... • Therapist position:- • The therapist will cross their arms to perform test by placing one hand on the therapist shoulder to stabilize the trunk and by placing the other hand on the distal femur to apply force directly against the hip flexors 6/8/2024 23
- 24. Cont... • To test :- • Patient actively abduct the hip • For grades 4 and 5 provide resistance over lateral knee in the direction opposite to abduction. 6/8/2024 24
- 25. Manual muscle testing of hip adduction Patient position :- • Grade 3 to 5 patient in side lying with top leg [ non test side ] abducted 25 degree. • Test side is bottom leg in side lying • Grade 0 to 2 patient in supine { gravity minimal position } , non- test side leg abducted 25 degree. 6/8/2024 25
- 26. Cont.... • Therapist position :- • Therapist stands behind patient in side lying with support given to the non- test side in abduction • Therapist stand on the test side if testing in supine • Provide stabilization at pelvis in side lying • Palpation over hip adductors in supine 6/8/2024 26
- 27. Cont... • To test :- • Patient actively adducts the hip • For grade 4 and 5 provide resistance over the medial femur in the direction opposite to adduction . • Grade 1 :- palpate contraction on proximal medial thigh 6/8/2024 27
- 28. Manual muscle testing of hip medial rotation • Patient position :- • Grade 3 to 5 patient in short sitting on plinth with test side knee flexed 90 degree ideally the foot should be suspended off the floor • Grade 0 to 2 – patient in supine { gravity minimal position} 6/8/2024 28
- 29. Cont... • Therapist position :- • Therapist to knee bedside sitting position and stabilize distal thigh of medially • Therapist to stand on test side if in supine 6/8/2024 29
- 30. Cont... • To test :- • Patient actively internally rotates hip • For grades 4 to 5 apply resistance through the lateral ankle through range in a direction opposite to internal rotation. • Grade 1 :- palpate contraction on gluteus medius but no visible and no movement . 6/8/2024 30
- 31. Manual muscle testing of hip lateral rotation • Patient position :- • Grade 3 to 5 patient is in short sitting on plinth with test side knee flexed to 90 degree , ideally the foot should be suspended off the floor • Grade 0 to 2 patient is in supine with knee flexed to 90 degree { gravity minimal position } 6/8/2024 31
- 32. Cont... • Therapist position :- • Therapist to kneel bedside the patient and stabilize at the distal thigh laterally • Therapist to stand on test side if in prone 6/8/2024 32
- 33. Cont... • To test :- • Patient actively externally rotates the hip • For grades 4 to 5 resistance through the medial ankle through range in direction opposite to external rotation. • Grade 1 :- palpate contraction gluteus maximus . 6/8/2024 33