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CHAPTER OBJECTIVES

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At the completion of this chapter, the reader will be able to:

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  1. Describe the anatomy of the joint, ligaments, muscles, and blood and nerve supply that comprise the hip joint complex.

  2. Describe the biomechanics of the hip joint, including the open- and close-packed positions, normal and abnormal joint barriers, force couples, and the static and dynamic stabilizers of the joint.

  3. Describe the purpose and components of the examination of the hip joint.

  4. Perform a comprehensive examination of the hip joint, including palpation of the articular and soft tissue structures, specific passive mobility, passive articular mobility tests, and stability stress tests.

  5. Evaluate the total examination data to establish a diagnosis.

  6. Describe the relationship between muscle imbalance and functional performance of the hip.

  7. Summarize the various causes of hip dysfunction.

  8. Develop self-reliant intervention strategies based on clinical findings and established goals.

  9. Develop a working hypothesis.

  10. Describe and demonstrate intervention strategies and techniques based on clinical findings and established goals.

  11. Evaluate the intervention effectiveness in order to progress or modify an intervention.

  12. Plan an effective home program and instruct the patient in same.

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OVERVIEW

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The structure and design of the hip allow for both mobility and stability,1 the latter of which is particularly important for weight bearing and ambulation. In the human body, the center of gravity is located at the second sacral vertebral level, several segments above and medial to the femoral head. Control of the body mass from such a distant fulcrum requires the generation of significant counterbalance forces as well as the ability of the joint to sustain both high compression and tensile strains.2 Thus, a major function of the hip joint is to provide a pathway for the transmission of forces between the pelvis and the lower extremities.

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ANATOMY

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The hip articulation is formed by the head of the femur and the acetabulum of the pelvic bone (Fig. 19-1). This articulation is classified as an unmodified ovoid (or ball and socket) joint. The hip joint which, although similar in nature to the shoulder joint, differs in the fact that the former has a deeper acetabular socket and acts as a weight-bearing joint with a smaller total arc of motion.

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FIGURE 19-1

Bones of the lower extremity. (Reproduced, with permission, from Chapter 34. Overview of the Lower Limb. In: Morton DA, Foreman K, Albertine KH. eds. The Big Picture: Gross Anatomy. New York, NY: McGraw-Hill; 2011.)

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Bony Anatomy

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Normal hip joint growth and development occur because of a genetically determined balance of growth of the acetabulum and the presence of a strategically located spherical femoral head.37

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The os coxa (hip bone), more commonly referred to as the innominate bone initially begins ...

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