Chapter 19. Hip

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

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.

The hip articulation is a ball-and-socket joint formed between the head of the femur and the acetabulum of the pelvic bone (Fig. 19-1). Structurally, the hip is suited for stability first, then mobility.1 The primary function of the hip is to support the weight of the head, arms, and trunk during the static erect posture and during dynamic activities such as ambulation, running, and stair climbing.2 In addition, the hip joint provides a pathway for the transmission of forces between the pelvis and the lower extremities. The hip joint is a marvel of physics, transmitting truly impressive loads, both tensile and compressive. For example, during walking, the hip supports 1.3–5.8 times the body weight, and 4.5–8 times the body weight while running.3 Finally, the hip joint functions to provide a wide range of lower limb movement.

The hip joint is well designed to provide such an important service, provided that it is permitted to grow and develop normally.

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.4–8

• Absence of a normal femoral head during growth, such as in developmental dysplasia of the hip (DDH), causes the acetabulum to have a flat shape.
• A deformed head stimulates the formation of a correspondingly deformed acetabulum if the deformation occurs at a young enough age.4

Bony Anatomy

The os coxa (hip bone) initially begins life as three individual bones: the ilium, ...