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Biomechanics of Hip and Pelvis

Produced by
 Phil Austin

Phil Austin
Introduction to Hip Joint
 Articulation of the acetabulum of the pelvis and
the head of femur

 The 2 segments form a ball and socket joint with


3° of freedom

 Flex / ext
 Abd / Add
 Med / Lat rotation

Phil Austin
Primary Function

 To Support weight of head, arms and trunk


(HAT) During static erect posture and
dynamic postures (e.g. running).

 Primarily structured to serve its weight


bearing function (supports ⅔ body weight)
 Comprehensive Analysis. 3rd ed 2001
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive

Phil Austin
Structure
 Full ossification occurs at 20 – 25 years

 The acetabulum appears to be a hemisphere, BUT only


the upper margin has a true circular contour.

 The “roundness” decreases with age.

 Only the upper horse shoe shaped area is articular.

Phil Austin
Acetabular Fossa – non articular.
Contains fibro-elastic fat covered
with synovial membrane

Netter F, Atlas of Human Anatomy, 2nd ed.


Proximal Articular Surface
Located at lateral aspect of
innominate.
Bones form the acetabulum
Ilium (2/5)
Ischium (2/5)
Pubis (1/5)

Acetabular notch – spanned by


fibrous band (transverse acetabular
ligament) T.A.L. This connects the
2 ends of the horse shoe.

Netter F, Atlas of Human Anatomy, 2nd ed


Creates a fibro-osseous tunnel
through which blood vessels
can pass to the deepest part
of the acetabulum.
Central Edge Angle (CE)

In Males ≅ 38 °
In Females ≅ 35 °

Smaller CE angle – may


result in diminished coverage
of the head of femur.

∴ ↑ risk of superior dislocation.

CE angle increases with age

∴Children have ↓ coverage


over the head of the femur
= ↓ coverage over the head of
femur compared to adults

Congenital dislocation is most


common at the hip joint due to
↓CE angle.
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001
Acetabular Anteversion.
 Anterior orientation – “Angle of acetabular
anteverision”

 Men – 18.5 °
 Women – 21.5 °

 NB – Kapandji cites values of 30 - 40 °

 ∴ ↑ Anteversion = ↓ joint stability + ↑ chance anterior


dislocation.

Phil Austin
Acetabular Labrum

Covers entire periphery of acetabulum.

Deepens the “socket”

Increases concavity through its


triangular shape

Grasps the head of femur to


maintain contact with acetabulum.

Transverse acetabular ligament –


considered part of the labrum
(BUT contains no cartilage cells)

Netter F, Atlas of Human Anatomy, 2nd ed


Structure of Distal Articular Surface

 Head of femur – fairly rounded hyaline


cartilage covered – slightly larger than a true
hemisphere.

 The radius of the femoral head is smaller in


females when compared to the dimensions of
the pelvis.
 Comprehensive Analysis. 3rd ed
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive
2001

Phil Austin
Ligamentum Teres - Main Function – act as a
channel for secondary blood supply from the
obturator artery and nerves.

Blood supply via this is greater in childhood

Sclerosis of the ligament in elderly. ∴ secondary


supply cannot back up primary retinacular supply

Absence increases risk of avascular necrosis to


head with femoral neck trauma.

Fovea – Inferior to most medial point on femoral


head.

Attachment point of the ligament of head of femur is


attached.(Ligamentum Teres)

Femoral head – attached to femoral neck; the neck is


attached to shaft between the greater and lesser
trochanter.

Netter F, Atlas of Human Anatomy, 2nd ed


Angulation of Femur
 Femoral head faces medially, superiorly
and anteriorly.

 Frontal plane – ∠ of inclination


 Axis of femoral head, neck and longitudinal axis of
shaft

 Transverse plane - ∠ of torsion


 Axis of femoral head and neck and an axis through the
distal femoral condyles.

Phil Austin
Embryonic Development.
 Early stages – both ↑ and
↓ extremity buds project
laterally from body (full
abduction).

 At 7 / 8 weeks gestation,
adduction of the joints
begin.

 By the end of week 8, the


foetal position has been
achieved.

Phil Austin
150 ° in infancy.
125 ° in adults.
120 ° in the elderly

The ∠ varies among


individuals and sexes

Female = ↓ due to greater


width of female pelvis.
Singleton. HC LeVeau BF: Stability
& Stress, A review. Phys Ther 55,
957-973, 1975

Normal ∠ of inclination – the greater trochanter lies at the level


of the centre of the femoral head.

Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001
A pathological increase between neck and shaft –
COXA VALGA

Decrease –
COXA VARA

Phil Austin
Angle of Torsion of Femur
 Best viewed by looking down the length of the femur.

 This angle reflects the twist in the bone that occurs


during foetal development.

 Normal torsion – anterior. This is due to the knee being


aligned in a frontal plane.

 Allowing the knee to flex and extend in a sagittal plane.

Phil Austin
Angle of Torsion of Femur

 Each structural deviation needs careful consideration as


to the impact on the hip joint AND function of joints both
proximal and distal to it.

 Anteversion can cause significant dysfunction to both


knee and foot.

 Both angles of inclination and torsion are


 Properties of the Femur and exist
independently to the hip joint.
Phil Austin
Pathological Anteversion

Anteversion
Age (y)
(in degrees) Pathological Retroversion
.
Birth - 1 y 30 - 50
2 30
3-5 25
6 -12 20
12 -15 17
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive
16 - 20 11 Analysis. 3rd ed 2001

20 8
Signs & Symptoms

Anteversion Retroversion

Toeing in Toeing out


Squinting patellae
Subtalar pronation Subtalar supination
Medial tibial torsion Lateral tibial torsion
Medial femoral torsion lateral tibial torsion

www.clinicalsportsmedicine.com/chapters/24b.htm

Phil Austin
Articular Congruence
 Considered congruent

 BUT - Significantly more articular surface on the


head of femur than on the acetabulum.

 In standing position – head is exposed


anteriorly and superiorly.

 ∴ Angle of torsion is poorly matched to anterior orientation of


acetabulum.
 Comprehensive Analysis. 3rd ed 2001
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive

Phil Austin
Articular Congruence
 Coxa Valga, anteversion or a shallow acetabulum results
with increased :

 Articular exposure of the femoral head

 Less congruence

 Reduced stability In an a neutral standing position.

 Increased articular contact can be achieved with flexion,


abduction and slight lateral rotation.
Phil Austin
Contact of the femoral head on the acetabulum Increases
during flexion and abduction

b) = maximum articular contact of femoral head

Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001
Articular Congruence
 The Acetabular fossa may set up a partial vacuum – so
atmospheric pressure may contribute to stability.

 Maintaining contact of the 2 articulating surfaces.

 Atmospheric pressure plays a stronger role in


stabilization than the capsuloligamentous structures
 (Wingstrand H et al, Intracapsular and atmospheric pressure in the
the dynamics and stability of the
hip. Acta Orthop Scand, 61: 231-
231-235. 1990)

Phil Austin
Hip Joint Capsule
 Strong and Dense

 Attached to entire periphery of bony acetabulum.

 Covers femoral neck and head

 Gtr / Lssr trochanter – Extra articular.

 2 sets of fibres
 Superficial longitudinal fibres - Retinacular
 Deeper circular fibres – Zona Orbicularis (collar like)

Phil Austin
Iliofemoral lig - Referred to as – Y ligament – stronger /
thickest of all hip ligaments.
Bands of ilio pubo / femoral ligs

Posterior portion
Ischio-femoral ligament –
Outer fibres spiral around femoral neck
Deeper fibres arranged horizontally.

Ligament and capsule allow minimal


joint distraction

Netter F, Atlas of Human Anatomy, 2nd ed


Line of gravity (LOG)
 Normal standing posture – LOG passes posteriorly to the
hip joint. (Kendall; McCreary, & Provence, 1993,p 75)
 Produces a posterior tilt.

 In a closed chain, with the femur relatively fixed,


posterior tilt → hip extension.

 What controls gravity’s hip extensor moment ???


 Hip flexor muscle activity ????
 moon.ouhsc.edu/dthompso/NAMICS/hipbmk.htm

Phil Austin
LOG

moon.ouhsc.edu/dthompso/NAMICS/hipbmk.htm
Phil Austin
Gravity’s effect on the hip

We don’t need activate


muscles to stabilise the
hip during neutral
standing.

Anterior ligaments exist


in the same line of
application (LOA)

moon.ouhsc.edu/dthompso/NAMICS/hipbmk.htm

Phil Austin
Gravity’s effect on the hip
 The iliofemoral ligament elongates = very tight spring →
elastic force.

 This force is PASSIVE & not active (muscle force)

 Directed to its point of attachments on the ilium / femur

 The force prevents the attachments being pulled further


apart (PREVENTS EXTENSION)
 moon.ouhsc.edu/dthompso/NAMICS/hipbmk.htm

Phil Austin
Weight-Bearing
 Trabeculae of bone line up along lines of stress.

 Along pubic rami, ischia and the dome of the acetabulae.


(primary wt bearing areas)

 Primary wt bearing area is continuous with the MEDIAL


TRABECULAR SYSTEM. (MTS)

 Trabeculae at the centre of the acetabulum – continuous


with the LATERAL TRABECULAR SYSTEM. (LTS)

Phil Austin
Medial Trabecular System
Oriented along vertical compressive
forces passing through the hip.
Kapandji. I The Physiology of Joints, Vol 2, ed 5, Williams & Wilkins,
Baltimore 1987.

Lateral Trabecular System


Is oblique – may develop in
response to shear stresses created
by HAT pressing on the femoral
head, while the GRF pushes up the
femoral shaft.
Levangie PK, Norkin CC. Joint Structure and Function, Kapandji. I The Physiology of Joints, Vol 2, ed 5, Williams & Wilkins,
a Comprehensive Analysis. 3rd ed 2001 Baltimore 1987.
Trabecular Systems
 Med / Lat systems also aid in resistance of bending stresses
occurring at the femoral neck and shaft from weight from HAT.

 Med system resists bending compression forces medially

 Lat system resists bending tensile forces laterally.

 Zone of weakness – Less reinforcement. Susceptible to


bending forces, May #
 Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001

Phil Austin
Wt bearing causes bending forces
along the shaft of the femur =
Compression forces medially
Tensile forces laterally

Wt bearing through the head of the


femur & contraction of the abductors
cause tensile forces superiorly &
compressive forces inferiorly

Levangie PK, Norkin CC. Joint Structure and Function,


a Comprehensive Analysis. 3rd ed 2001
Primary Weight-bearing Areas
 1) Dome of
acetabulum

 Lies directly over the


centre of rotation of
femoral head.

 Greatest prevalence
of degenerative
change??

Phil Austin
2) Superior portion of femoral head

Degenerative changes occur


around / below the fovea or
peripheral edge of articular
surface.

∴ the primary weight bearing area


is not in the area of greatest
degenerative change.
Bombelli, R, et al: Mechanics of the normal and
osteoarthritic hip: A new perspective, Clin Orthop,
Orthop, 182-
182-69-
69-
78,1984

AP view of the left hip in a patient


with osteoarthritis. The superior
weight-bearing area of the joint
Phil Austin
space is quite narrowed.
Motion of Femur at Hip (Open Chain)

 Typical ROM

 Flex – 90° (knee ext)


 Flex – 120 ° (knee flex)
 Ext – 10 – 30 °
 Abd – 40 – 45 °
 Add – 20 - 30 °
 Lat / Med Rot – 42 - 50 ° (performed with hip at 90 ° flex)

Phil Austin
Osteokinematics

Phil Austin
Motion of femur at the hip (open Chain)

 ROM is influenced if motion is


 a) passive OR active
 b) passive tension in a 2 joint muscle is encountered
or avoided.

 E.G. - Hip flexion is 90° with extended knee


 “ “ “ 120° with knee flexed

 Release of passive tension on the 2 joint hamstring.


 Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001

Phil Austin
Motion of femur at the hip (open Chain)
 Hip extension = 10 → 30° but is ↓ when knee flexion prompts
passive flexion 2 joint rectus femoris.

 Abduction = 45° ish – limited by gracilis


 Adduction = 25° ish – limited by TFL

 Med / Lat rotation usually measured with 90° of flexion – 45 → 50°.

 NB – Femoral anteversion → ↓ lat rotation, due to the femoral head


is torsioned more anteriorly

 ∴Encounter of capsuloligamentous / muscular restrictions sooner.

Phil Austin
Motion of Pelvis at Hip (Closed Chain)

 Proximal segment moving on a fixed


distal segment.

 Motion is the same as if the distal


segment were the moving part.

Phil Austin
Anterior / Posterior Tilt
 Motion of entire pelvis in a sagittal plane around a frontal
axis

 Ant tilt – hip flex


 Post tilt – hip ext.

 Ant / post tilt results in flex / ext of hip joints together.


 Or at the closed chain joint if the opposite limb is open
(none weight bearing)

Phil Austin
www.pt.ntu.edu.tw/.../KINspine/PelvicGirdle.htm

Phil Austin
Lateral Tilt
 A frontal plane motion of whole pelvis around a A/P
axis.

 If ASIS’s are not horizontal – lateral tilt.

 Lateral tilt – 1 hip Jt is the pivot point (axis) for motion


described on the other side.
 (hip hike or hip drop)

 ∴ None wt bearing hip is OPEN CHAIN


 Wt bearing hip is CLOSED CHAIN
 Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001

Phil Austin
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001

Phil Austin
The pelvis & wt have shifted Rt hip
into adduction & left hip into
abduction.

Returning to neutral requires while


putting weight through both feet
the rt abductor & the left adductor
work synergistically.

Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001
Pelvic Rotation
 Entire pelvis moving in a
transverse plane around a
vertical axis through the middle
of the pelvis in a bilateral
stance
 Levangie, Norkin, Joint Structure and Function. 3rd
edit 2001.

 Fwd rot of pelvis – side of


pelvis opposite to supporting
hip joint moves anteriorly.

 Stand on 1 leg and rotate


pelvis – Feel relative rot.

Phil Austin
Lumbar-Pelvic Motion

 OPEN CHAIN response due to the pelvis


moving without necessitating motion
elsewhere.

 NB – Subtle adjustments by other joints to


assure that LOG remains within base of
support. I.e. – planterflexion of ankles

Phil Austin
Femur, pelvis and LS produce a ↑ ROM than in 1 segment alone.

Fwd bending to the floor – isolated


Flexion at the hip joints

(anteriorly tilting pelvis on femurs)

If the knees stay extended, hips


only flex to 90°

∴Lumbar & thoracic flexion


incline the head & trunk fwd so
Hands can reach the grounds

EG of open chain response in hips


& trunk (from above)

NB – not an eg of how to pick up


An object
Phil Austin
Maximal abduction = 90°°.
If pure hip adduction = 45°

So must include lateral pelvic tilt & lateral flexion of


the lumbar spine
Closed Chain Function
 The 2 ends of the chain have to be fixed.
 Feet are fixed at 1 end.
 Head is functionally fixed at the other.
 NB - Although the head can move in space, it remains upright /
vertically oriented. This is due to the influence of labyrinthine and
optical righting reflexes.

 ∴ Drive to keep head upright over the sacrum –


effectively fixes the head in relative space.
 ∴ Functionally fixed rather than structurally fixed.

Phil Austin
Closed Chain Function
 All the segments between the weight bearing part = 1
closed chain.

 ∴ Movement at 1 joint will create movement in at least 1


other linkage in the chain.

 ∴ Hip flexion cannot occur independently, but must be


accompanied by motion at joints above and below.

Phil Austin
Open chain response to tight hip flexors

a) Inclined forward (LOG falls outside


base of support – No adjustment)

Closed chain response to tight hip flexors

b) Spine extends to maintain LOG within


base of support.
Muscle Function in Stance
 BILATERAL STANCE

 LOG – posterior to to axis for Flex / ext at hips


 ∴ ext moment of force → posterior tilt on pelvis and femoral
heads.

 Checked by passive tension in capsuloligamentous structures.

 Ilio-psoas may assist passive structures.

Phil Austin
Flexors
 Function primarily as mobility muscles in open chain.

 Secondarily – resistance to extension forces occurring as


body passes over foot

 Ilio-psoas – primary hip flexion

 Rectus Femoris – only 1 of quad group that crosses hip


and knee joint. (flex of hip, ext of knee)

Phil Austin
Flexors
 Sartorius – flex, abd, and lat rot of the hip + (flex, med rot
of the knee). Most important when knee and hip are
flexed (climbing stairs)
Williams: Gray's Anatomy ed 38, Churchill Livingston 1995

 Ilio-tibial band – flex, abd, med rot of femur on hip.


 Relieves tensile stresses imposed on femur by weight
bearing forces

 TFL – Maintains tension in the ITB

Phil Austin
Hip Joint Musculature

Netter F, Atlas of Human Anatomy, 2nd ed


Adductors

Function, not as prime movers


But by reflex response to gait activities.
Janda / Stara

Adductors may be synergists to


Abductors when both feet are on
ground - ↑ stability.

22.5% of muscle mass of lower


extremity
18.4 % - flexors
14.9 % - abductors

Ito. I.Morphological analysis of human Lower extremity


based on the relative Muscle weight. Okajimas Folia
Anat, 73 – 247-252 1996.
Extensors
One joint gluteus maximus and two joint
hamstrings – primary hip extensors

Secondary assistance – posterior fibres of


gluteus medius and superior fibres of
adductor magnus and from piriformis.

Hip extension via hamstrings – reduced


When the knee is flexed. Extension
forces in the hip increase by 30%
if the knee is extended.

Netter F, Atlas of Human Anatomy, 2nd ed


Abductors – Gluteus medius / minimus
+ assistance from sartorius when abduction
occurs against strong resistance.

Glut med / min off set gravitational adduction


Torque at stance hip (pelvis drop).

Lateral Rotators

Apart from lat rot, these muscles act as


‘compressors’ and act as stabilizers (similar
To rotator cuff at G/H joint.

Lat rot action decreases with hip flexion.

Medial Rotators

No muscles that primarily act as med rot.


Evidence suggest that the adductors are also
Med rotators.

Trend to increased med rot torque during hip


Netter F, Atlas of Human Anatomy, 2nd ed
Flexion (reduced lat rot
Muscle A flexes, internally
rotates, and abducts the hip

Muscle B extends, externally


rotates, and abducts the hip

Acting together, in a synergy,


the two muscles can abduct
the hip while producing little
or no movement in other
planes.

Phil Austin
Muscle Function in Stance

Biomechanics

Phil Austin
Bilateral Stance
 Erect bilateral stance – both hips are neutral or slight
hyperextension & weight is evenly distributed through
both legs.

 LOG – just posterior to axis of flex / ext. (frontal) =


posterior tilt of pelvis on ”fixed” femoral heads.

 Gravitational tension – checked by passive tension of


capsularligamentous structures + slight / intermittent
activity form iliopsoas.
 Levangie, Norkin, Joint Structure and Function. 3rd edit 2001.

Phil Austin
Bilateral Stance
 In a frontal plane the superincumbent BW – transmitted
through the SI´s, along the pelvic trabeculae system to Rt
& Lt femoral heads.

 H.A.T. – (head, abdomen, thorax) ≅ ⅔ BW is distributed


through both femoral heads.

 Gravitational torque occurs in the opposite direction


 BW on Rt hip drops the pelvis → Lt
 BW on Lt hip drops the pelvis → Rt

Phil Austin
These 2 opposing graviational
moments of equal magnitude
balance each other & the pelvis
maintains equilibrium in a frontal
plane.

Levangie, Norkin, Joint Structure and Function. 3rd edit 2001.


Bilateral Stance
 If bilateral stance is not symetrical frontal plane muscles
are required to control (adds & abds)

 Side to side motion


 Return to symetrical stance.

 In unilateral stance activity of adds in wt bearing or


none wt bearing cannot contribute to stability of the
stance limb.

 Sole domain of abductor function


Phil Austin
Unilateral Stance

 Full weight of HAT through load bearing hip


 E.g. – 90kg subject

 HAT – ⅔ BW (60kg) 1 Lower limb – 1/6 BW (15kg).

 ∴ Supporting hip will endure 75kg (5/6 BW) of


compression.

 Rt hip joint compression = [2/3 x W] + [1/6 x W] = 5/6 x


BW
 Levangie, Norkin, Joint Structure and Function. 3rd edit 2001.

Phil Austin
Hip abds – moment arm of 50mm

The pull of the abds (Fms) on a


horizontal pelvis will resolve the
translatory component (Ft)
50mm
This pulls the acetabulum to the
centre of the femoral head.
100mm

The rotatory component (Fr) pulls


the pelvis down on the superior
aspect of the femoral head
Unilateral Stance
 Force of gravity on HAT and none WB lower limb
(HATLL) – add force to the supporting hip.

 LOG ≅ 100mm (0.1m) from right hip axis [MA = 100mm]

 Actual MA – slightly ↑ due to wt of hanging Lt leg will pull


COG slightly → Lt

 Simple Hypothetical e.g.


 HATLL Torque adduction 75kg x 0.1m = 7.5 N-m

Phil Austin
Unilateral Stance
 Maintenance of single limb support → countertorque
abduction of equivilent force.

 This is produced at glut medius / minimus

 These muscles must generate an equivilent abduction


torque of 7.5 N m

 Torque abduction = 7.5 N m / 50mm (0.05m) = Fms

 Fms = 7.5 N m = 150kg


0.05m

Phil Austin
Unilateral Stance
 ∴ prevention of the pelvis falling → unsupported side

 The abds must generate a force of at least 150 kg.

 Assuming all the muscular force is transmitted through


the femoral head, the 150kg must now be added to the
75 kg of compression due to BW.

 ∴ total hip compression or joint reaction force at the


stance hip

 = 150 kg + 75 kg ≥ 225 kg total hip joint compression


Phil Austin
Unilateral Stance
 Hypothetical figures simplify forces involved.

 Total joint compression / reaction forces = 2.5 -3 x BW


in a unilateral stance.

 Investigations also calculate 4 – 7 x BW respectively at


begining & end of ”stance phase” of gait

 & 7x when climbing the stairs

Phil Austin
Unilateral Stance
 Wt loss may help reduce joint reaction.

 Magnitudes of force differ in different individuals i.e. ∠


of pull & and the ∠ of inclination of the femoral head.

 Physiological / biomechanical factors causing ↑ force


production at hip abds – in time may accelerate joint
deterioration.

Phil Austin
Compensatory Lateral Lean
 Gravitational force can be ↓ by laterally leaning the trunk
over the pelvis toward the side of pain / weakness when
in a unilateral stance.

 May appear to be counterproductive (apparent ↑ BW)

 BUT – swings LOG closer to the hip joint ∴ ↓


graviational MA.

Phil Austin
Compensatory Lateral Lean
 HATLL must pass through regardless ∴ leaning toward
doesn’t increase joint compression.

 ∴ The shorter the gravitational adduction torque = ↓


need for abduction counter torque

 EG – If lateral lean is bought to 25mm of the right hip


the gravitational torque would be.

Phil Austin
HATLL torque adduction =

5/6 BW (75kg) x .025m

HATLL torque adduction = 1.875 N m

If only 1.875 N m were produced by BW


on the Rt hip – the abds force needed
0.05m would be.

Torque abduction = 1.875 N m / 0.05m = Fms


0.025m
Fms = 1.875 N m = 37.5kg
.05m

37.5 kg of muscular joint compression


+ 75 kg of BW compression
Total hip joint compression ≥ 112.5kg

Phil Austin
Sacral Articulating Surface
 Auricular (c) shaped,
 Foetal – prepuberty – surfaces are flat and smooth

 Postpubertal – surface is marked by a central groove or surface


depression that extends the length of the articulating surface

 Sacral cartilage is 1.5 : 1 to 3 : 1 thicker than iliac cartilage.

 ↑ thickness in females : males.


 sacroiliac from embryonic life until 8th decade. Spine, 6
Bowen,Cassidy. Macroscopic and microscopic anatomy of sacroiliac
620-
620-627. 1981

Phil Austin
Articulating Surface of the Ilia
 Also C-shaped

 Smooth / flat to prepuberty

 Postpuberty – central ridge along length. Corresponds


with groove at sacral surface.

 Both surfaces lined with type II collagen (hyaline)

Phil Austin
Iliac Articulations
 In Childhood – permits glide in all ranges (synovial joint).

 Postpuberty – joint surfaces change configuration and translation and


rotation is restricted to a few mm’s (open to controversy)
 Walker.JM. The sacroiliac joint, A critical review. Phys Ther 72,
72, 903, 1992.

 Nutation – Anterior motion of sacral promontory.


 ↓ A/P dia at pelvic brim
 ↑ A/P dia at pelvic outlet.
 Important during pregnancy especially under influence of RELAXIN.
Ligamentous structures are softened.

Phil Austin
Symphysis Pubis Articulation
 Cartilaginous joint.

 Each end of the pubis bone – covered with articular


cartilage.

 Joint formed by fibrocartilaginous disc – joins hyaline


covered ends.

 The disc has a thin central cleft (in females may extend
along the length.
 Kapandji IA. Physiology of joints 3, ed 2 Churchill Livingstone, Edinburgh, 1974

Phil Austin
Symphysis Pubis Articulation
 3 Ligaments associated with pubis joint

 Superior pubic lig – thick / dense fibrous band attaching to pubic


crest and tubercles – support of superior aspect of joint.

 Inferior pubic lig – Arches from ramus to ramus.


 Posterior pubic lig – Continuous with the periosteum of the pubic
bones.
 Anterior Pubis – re-enforced by aponeuroses from muscles
crossing the joint.

Phil Austin
Function of Sacral Region
 HAT creates a nutation torque on the sacrum.

 Ground Force (GF) creates posterior torsion on


the ilia.

 Nutation / counternutation & posterior torsion of


the ilia are prevented by ligamentous tension
and adjacent muscles.

Phil Austin
Function
 SI’s and pubis – linked by closed kinematic chain

 ∴ any motion occurring at the pubis WILL be accompanied by


motion at the SI’s and vice versa.

 SI’s / pubis – functionally related to hips. ∴ effect and affected


by motion from trunk and ↓ extremity.

 ∴ Shifting weight from 1 leg to another WILL induce motion at


the SI’s.

 Fusion of lower lumbars have been found to increase motion at


the SI’s
 Grieve, GP, The sacro-
sacro-iliac joint. Physiotherapy 62.8. 1979

Phil Austin
Function

 Shearing forces created at the pubis


during single leg support phase of walking
due to lateral pelvic tilting.

 If pubis is dislocated = instability. ∴ ↑


stress on SI’s, hips and vertebral column.

Phil Austin
Pelvic Floor Muscles
 Voluntary contraction of levator ani helps constrict openings of
urethra and anus.

 Involuntary contraction occur during coughing or holding breath etc -


↑ intra-abdominal pressure.

 In women, these muscles surround the vagina and help support the
uterus.

 The coccygeus muscle assists the levator ani in supporting pelvic


viscera + maintain intra- abdominal pressure.

Phil Austin