The Hip Joint

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The Hip Joint

• Exercises and Injuries

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Exercises for the Hip Joint

• Good
• ExRx
• Qustionable
• Bodybuilding

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Terminology

• Compound
• An exercise that involves two or more joint
  movements.
• Isolated
• An exercise that involves just one discernible
  joint movement.

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Terminology
Closed Chain An exercise in which the end segment
of the exercised limb is fixed, or the end is
supporting the weight. Most compound exercises
are closed chain movements. Open Chain An
exercise in which the end segment of the
exercised limb is not fixed, or the end is not
supporting the weight. Most isolated exercise are
open chain movements.
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Gluteus Maximus
Basic/Auxiliary Compound/Isolated Open/Closed
Squats B C C
Deadlift B C C
Lunge A C O
Step up B or A C O
Leg Press B C O
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Gluteus Maximus Squats
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Gluteus Maximus Dead Lift
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Gluteus Maximus Lunge
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Gluteus Maximus Step Up
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Gluteus Maximus Leg Press
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Hip Abductors/Adductors
Basic/Auxiliary Compound/Isolated Open/Closed
Cable A I O
Seated A I O
Lever A I O


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Hip Abductors Cable
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Hip Abductors Seated
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Hip Abductors Lever
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Hip Adductors Seated
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Hip Adductors Lever
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Hip Flexors
Basic/Auxiliary Compound/Isolated Open/Closed
Leg Raise A I O
Lever A I O



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Hip Flexors Leg Raise
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Hip Flexors Lever
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Stretching

• Opposite action of the muscle
• For example, to stretch a hip extensor muscle,
  perform hip flexion.

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Gluteus Maximus - Stretching
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Abductors - Stretching
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Abductors (IT Band) - Stretching
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Hip Flexors - Stretching
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HIP INJURIES
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GROIN INJURIES
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Pathology

• Twisting, running, jumping
• Muscles most often involved
• Adductor longus
• Iliopsoas
• Gracilis
• Sartorius

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Pathology

• Strain pulled muscle
• Tendinitis inflammation of a tendon
• Avulsion fractures
• Stress fracture near the pubic crest or femoral
  neck

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Causes

• Sudden change in direction
• Kicking across your body (What action of the hip
  does this require?)
• Slipping while changing directions
• Overuse

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Treatment

• Ice for 20 to 30 minutes every 3 to 4 hours
• NSAID
• Supportive bandage
• Stretching e.g. butterfly stretch
• Patience. Wait until
• full range of motion
• full strength
• run with no pain
• change direction with no pain

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HIP POINTER

• A hip pointer is a contusion to the iliac crest,
  the surrounding soft tissue structures, or the
  greater trochanter of the femur.
• Typically, the injury is caused by a direct blow
  or fall.
• Hip pointer injuries occur most commonly in
  contact sports (eg, football, hockey), but they
  can also occur in noncontact sports (eg,
  volleyball) as a result of a fall onto the hip or
  side.
• Pain and tenderness in this region can limit an
  athlete's participation in sports.

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Hip Pointer
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Hip Pointer

• Initial treatment consists of icing, compression
  and rest.
• Anti-inflammatory medication and gentle
  stretching should begin at about 48 hours after
  the injury.
• A personalized program of strengthening,
  flexibility and coordination exercises is then
  designed for the patient.
• If the bruising of the muscle and bone from the
  injury is severe, however, return to full
  activity may take several weeks.

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OSTEOARTHRITIS
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Osteoarthritis

• It is a chronic disease in which the cartilage in
  a joint deteriorates or breaks down.
• There are two categories of osteoarthritis,
  primary and secondary.
• Primary osteoarthritis appears without any
  apparent cause, usually as a result of aging.
• Secondary osteoarthritis occurs in joints that
  have sustained injuries, experienced infections
  or fractures.
• Obesity can also cause secondary osteoarthritis
  due to the added pressure on weight bearing
  joints.

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Osteoarthritis

• Depending on the joints involved, swimming,
  walking, and cycling (perhaps on a stationary
  exercise bicycle) are often the best exercises
  for people with osteoarthritis.
• Why these exercises?
• Common sense safety precautions
• Warm up
• Medication?
• Ice arthritic joint for 15 to 20 minutes after a
  workout
• If the joints are more painful that night or the
  next few days, suspend the workouts

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HIP DISLOCATION
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Dislocation

• Any traumatic hip dislocation requires immediate
  treatment, ideally within six hours or less.
• This is because a traumatic hip dislocation
  interrupts the normal blood circulation to the
  top of the femur, depriving the bone of its vital
  oxygen supply.
• Unless the dislocated hip is reduced (replaced in
  its socket) promptly, and normal circulation is
  restored within the hip joint, there can be
  permanent damage to the head of the femur. This
  permanent damage is called avascular necrosis.

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Dislocation

• January 13, 1991, Bo Jackson partially dislocated
  his hip, tearing the blood vessels to the neck
  and head of the femur.
• X-rays revealed a small fracture to the posterior
  of the hip socket.
• Four weeks later, scans of the joint showed the
  beginning of vascular necrosis, in which the bone
  cells die because of deficient blood supply, and
  chondrolysis, in which cartilage degenerates.
• Eventually Jackson would require a total hip
  replacement which relieves him of pain and allows
  him full range of motion.

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HIP REPLACEMENT SURGERY
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Causes

• 1. Osteoarthritis is perhaps the most common
  cause for hip replacement surgery.
• 2. Avascular necrosis is another cause of
  degeneration of the hip joint.

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Causes

• 3. Abnormalities of hip joint function resulting
  from fractures of the hip and some types of hip
  conditions that appear in childhood can also lead
  to degeneration many years after an injury.

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Surgery
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Parts

• Acetabular component metal shell with plastic
  inner socket
• Femoral component metal stem with a metal or
  ceramic head

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Types

• Cemented epoxy cement holds metal to bone

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Types

• Uncemented mesh allows bone to grow into the
  prothesis

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Operation
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Removing the femoral head

• Dislocate the hip joint
• Cut femoral neck with power saw

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Reaming the Acetabulum

• Power drill and special reamer remove the
  cartilage
• Bone is formed to fit the metal shell

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Inserting the Acetabular Component

• Cemented
• Uncemented

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Preparing Femoral Canal
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Inserting the Femoral Stem
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Attaching the Femoral Head
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Completed
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End of Lecture for Fall 2004
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Complications

1. Thrombophlebitis
2. Infection in the joint
3. Dislocation of the joint
4. Loosening of the joint

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Thrombophlebitis

• Thrombophlebitis occurs when the blood in the
  large veins of the leg forms blood clots within
  the veins.
• This may cause the leg to swell and become warm
  to the touch and painful.
• If the blood clots in the veins break apart they
  can travel to the lung.
• Once in the lung they get lodged in the
  capillaries of the lung and cut off the blood
  supply to a portion of the lung.

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Infection

• Infection can be a very serious complication
  following an artificial joint replacement.
• The chance of getting an infection following
  total hip replacement is probably around 1 in 100
  total hip replacements.
• An infection can spread into the artificial joint
  from other infected areas.
• Your surgeon may want to make sure that you take
  antibiotics when you have dental work, or
  surgical procedures on your bladder or colon to
  reduce the risk of spreading germs to your new
  joint.

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Dislocation

• Just like your real hip, an artificial hip can
  dislocate.
• Dislocation is when the ball comes out of the
  socket.
• There is a greater risk of dislocation right
  after surgery, before the muscles and tendons
  around the new joint have healed. However, there
  is always a risk of dislocation.
• A hip that dislocates more than once may have to
  be revised, which means another operation, to
  make the joint more stable.

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Loosening

• The major reason that artificial joints
  eventually fail continues to be loosening of the
  joint where the metal or cement meets the bone.
• Most joints will eventually loosen and require a
  revision.
• Hopefully, you can expect 12-15 years of service
  from your artificial hip.
• Once the pain becomes unbearable, another
  operation will probably be required to replace
  the hip.

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OSTEOPOROSIS
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Background

• 25 million Americans, 80 of them women
• 1.5 million fractures a year
• 500,000 fractures are in the thorasic and lumbar
  vertebrae
• 250,000 fractures are hip fractures
• 15-20 of hip fractures are fatal
• 18 billion annually

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Hip Fractures and Osteoporosis - AAOS

• Hip fracture disease, one of the most serious
  consequences of osteoporosis, is occurring at an
  epidemic rate in North America.
• More than 350,000 Americans fracture a hip each
  year.
• The current annual cost is more than 9.8
  billion.
• Ninety percent of hip fracture patients are 65
  years of age or older.
• Accounts for more hospital days, by far, than any
  other musculoskeletal injury.

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How serious is the problem?

• In the United States, one of every three adults
  65 years old or older falls each year.1,2
• Falls are the leading cause of injury deaths
  among people 65 years and older.3
• In 1998, about 9,600 people over the age of 65
  died from fall-related injuries.4
• Of all fall deaths, more than 60 involve people
  who are 75 years or older.3
• Fall-related death rates are higher among men
  than women and differ by race. White men have the
  highest death rate, followed by white women,
  black men and black women.3

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