Introduction

Hip Dysfunction 

Signs of Altered Joint Motion

Techniques and Ending Info

Palpation

Capsule and Ligaments

Bursae

Nerves

Joint Actions

Arthrokinematics

Integrated Function

Postural Dysfunction

 Hip Joint Anatomy (Pelvifemoral Joint)

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Hip Joint Anatomy

Hip (Pelvifemoral) Joint

This course describes hip anatomy; the joint developed by the joining of the pelvis at the acetabulum (hip socket) with the femur (thigh bone) at the femoral head. The hip is also known as the acetabulofemoral joint, pelvifemoral joint, and is occasionally referred to in sections including the pubofemoral joint, ischiofemoral joint, and iliofemoral joint. This course includes descriptions of the bones, synovial joints, joint actions, ligaments, joint capsule, bursae, articular cartilage, relative location, hip muscles, and hip movement. Further, this course discusses palpation and introduces hip joint (lower limb) <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> exercises, manual techniques, and interventions for dysfunction, pain, <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a>, and <a id="movement-impairment" data-tip="1575" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairment</a>. The hip joint is included in the common compensation patterns known as an <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt (APT), lower-crossed syndrome (LCS), hyperlordosis, lumbopelvic hip complex dysfunction (LPHCD), and sacroiliac joint dysfunction (SIJD), and Lower Extremity Dysfunction (LED). Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) with advanced knowledge of the hip joint will improve their ability to analyze human movement and develop sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation/physical therapy (e.g. hip pain, hip arthritis, low back pain, lower limb injury, thigh contusion, articular cartilage damage, total hip replacement surgery), the effect the hip joint has on the lower limb and lumbopelvic hip complex alignment (e.g. the relationship between excessive hip flexion and lumbar extension, and hip <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> techniques for enhancing sports performance (e.g. lower body (leg) <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>, strength, hypertrophy, agility, and <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>).
<h4>Brookbush Institute&apos;s most recommended techniques for the Hip Joint (see videos below):</h4>
<ul>
 <li>Assess: 
 <ul>
 <li>Overhead Squat Assessment: <a href="https://brookbushinstitute.com/video/anterior-pelvic-tilt-break-down-workshop-snippet">Anterior Pelvic Tilt</a></li>
 </ul>
 <a href="https://brookbushinstitute.com/video/anterior-pelvic-tilt-break-down-workshop-snippet"> </a>
 </li>
 <li>Self-administered Techniques: 
 <ul>
 <li>Release: <a href="https://brookbushinstitute.com/video/rectus-femoris-sa-static-release">Rectus Femoris Static Release</a></li>
 <li>Stretch: <a href="https://brookbushinstitute.com/video/kneeling-hip-flexor-static-stretch">Kneeling Hip Flexor Stretch</a></li>
 <li>Activation: <a href="https://brookbushinstitute.com/video/quick-glute-activation-circuit">Quick Glute Activation Circuit</a></li>
 </ul>
 <a href="https://brookbushinstitute.com/video/quick-glute-activation-circuit"> </a>
 </li>
 <li>Manual Techniques: 
 <ul>
 <li>Release: <a href="https://brookbushinstitute.com/video/tfl-manual-release">Tensor Fascia Latae (Hip Flexor) Static Manual Release</a></li>
 <li>Mobilization: <a href="https://brookbushinstitute.com/video/hip-joint-lateral-manual-mobilization">Hip Joint </a><a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> Manual Mobilization</li>
 <li>Manipulation: <a href="https://brookbushinstitute.com/video/sacroiliac-joint-chicago-technique">Sacroiliac Joint Chicago Technique</a></li>
 </ul>
 <a href="https://brookbushinstitute.com/video/sacroiliac-joint-chicago-technique"> </a>
 </li>
</ul>
<img alt="The acetabulum and femur connecting to form the hip joint" title="The hip (acetabulofemoral) joint with boney landmarks labeled " src="https://www.datocms-assets.com/25800/1638277550-screen-shot-2016-10-18-at-8-47-31-pm.png">

Course Description:   Hip Joint Anatomy (Pelvifemoral Joint)

<h2>What&apos;s in a name</h2>
<ul>
 <li><a href="http://www.etymonline.com/index.php?allowed_in_frame=0&amp;search=hip" target="_blank" rel="noopener">hip (n)</a>: &quot;part of the human body where pelvis and thigh join,&quot; Old English hype &quot;hip,&quot; from Proto-Germanic *hupiz (cognates: Dutch heup, Old High German huf, German H&#xFC;fte, Swedish h&#xF6;ft, Gothic hups &quot;hip&quot;), of uncertain origin.&quot; (<a href="http://www.etymonline.com/index.php?allowed_in_frame=0&amp;search=hip" target="_blank" rel="noopener">Etymology Online</a>)</li>
 <li>joint (n): &quot;c. 1300, &quot;an (anatomical) joint, a part of a body where two bones meet and move in contact with one another, the structure that holds such bones together,&quot; from Old French joint &quot;joint of the body&quot; (12c.), from Latin iunctus &quot;united, connected, associated,&quot; past participle of iungere &quot;join&quot; (see <a class="crossreference" href="http://www.etymonline.com/index.php?term=jugular&amp;allowed_in_frame=0" target="_blank" rel="noopener">jugular</a>). &quot;</li>
</ul>
<a href="https://www.datocms-assets.com/25800/1642786237-basic-hip.jpeg"><img src="https://www.datocms-assets.com/25800/1642786237-basic-hip.jpeg" title="The pelvis, including the iliac crest, ishial tuberosity, and pubis" alt="An image of the ilium, ischium, and pubis"></a> https://thesebonesofmine.files.wordpress.com/2012/01/basic-hip.jpg

<ul>
 <li>Joint Type:
 <ul>
 <li>Diarthrosis</li>
 <li><a href="https://brookbushinstitute.com/courses/definitions-naming-and-types-of-synovial-joints" target="_blank" rel="noopener">Synovial Joint </a>
 <ul>
 <li><a href="https://brookbushinstitute.com/courses/definitions-naming-and-types-of-synovial-joints" target="_blank" rel="noopener">Ball &amp; Socket joint</a></li>
 </ul>
 </li>
 </ul>
 </li>
 <li>Bones: Femur and Pelvis (1 - 4)
 <ul>
 <li>The pelvis is comprised of the pubis, ischium, and ilium. These bones intersect in a &quot;Y&quot; shape at the acetabulum (1/5th pubis, 2/5th ischium, 2/5th ilium (3)), and although fused and ossified by early adulthood, they are actually separated by hyaline cartilage at birth.</li>
 </ul>
 </li>
</ul>
<a href="https://www.datocms-assets.com/25800/1642786282-pelvis-lateral.png"><img src="https://www.datocms-assets.com/25800/1642786282-pelvis-lateral.png" title="Lateral view of the pelvis and acetabulum with boney landmarks labeled" alt="A lateral view of the pelvis"></a>
<a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> View of Pelvis - By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See &quot;Book&quot; section below)Bartleby.com: Gray&apos;s Anatomy, Plate 235, Public Domain, https://commons.wikimedia.org/w/index.php?curid=792148[/caption]
<ul>
 <li>Articular Surfaces:
 <ul>
 <li>Femoral Head (Ball): Forms about 2/3rds of a sphere, giving way to the femoral neck laterally. The femoral head is covered completely in hyaline cartilage except for a small fovea just <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> to the center of the head of the femur. The hyaline cartilage is thickest in the area <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> and <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> to the fovea (1).
 <ul>
 <li>Interesting Note: The femoral head and center of the axis of rotation of your hip joint is actually <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> to the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> iliac spine (ASIS); <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> to the middle one-third of the inguinal ligament. The average width between hip joints in the adult is only about 7&quot; (2). Makes you reconsider what the cue &quot;hip width&quot; really means.</li>
 </ul>
 </li>
 <li>The acetabulum (Socket): The acetabulum is a deep, hemispheric cup-like socket that accepts the femoral head. The rim of the acetabulum is incomplete, missing about 60 - 70&#xB0; at its <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> poles, creating the &quot;acetabular notch&quot; (1). The acetabulum is made deeper by a fibrocartilaginous labrum which extends beyond the &quot;equator&quot; of the femoral head (2). At the <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> poles, the acetabulum becomes wider and transitions into the transverse acetabular ligament, covering the acetabular notch.</li>
 </ul>
 </li>
</ul>
Acetabular Alignment: Three angles are commonly discussed in reference to the acetabulum, and coverage of the femoral head.
<ul>
 <li>Center-Edge Angle: Although this angle varies in the adult population, the average measure is roughly 35&#xB0; on a radiograph (Andas et al). The angle is created by a line from the center of the femoral head vertically, and a line from the center of the femoral head to the lateral/superior rim of the acetabulum. This angle infers how much of the acetabulum covers the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> portion of the femoral head, resisting the downward force of gravity. A reduction in this angle could increase the likelihood of dislocation, increase the pressure per area on superiorly oriented intra-articular structures, and potentially osteoarthritis (1, 3).</li>
 <li>Acetabular Anteversion Angle: This is the angle created by the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> rims of the acetabulum, as measured in the horizontal plane. The acetabulum normally tilts anteriorly about 20&#xB0;, exposing more of the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> side of the femoral head (15)</li>
 <li><a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> Inclination: This is the angle created between a line from the lateral/superior edge to the media/ <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> edge of the acetabulum and a vertical line (line of gravity). This angle should be roughly 50&#xB0; (3).
 <ul>
 <li>You could think of the acetabulum as tilted so that it &quot;faces&quot; more <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> and <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a>.</li>
 </ul>
 </li>
</ul>
<a href="https://www.datocms-assets.com/25800/1642786341-acetabular-angles.jpeg"><img src="https://www.datocms-assets.com/25800/1642786341-acetabular-angles.jpeg" title="The acetabular angle of the hip joint highlighting acetabular anteversion" alt="The angles of the hip joint "></a>
Acetabular Angles (Center-edge Angle &amp; Acetabular Anteversion Angle) - Donald A. Neumann, &#x201C;Kinesiology of the Musculoskeletal System: Foundations of Rehabilitation &#x2013; 2nd Edition&#x201D; &#xA9; 2012 Mosby, Inc. Pg. 474, Figure 12-13
Femoral Alignment: Two angles are commonly discussed relative to the angle between the femoral neck and femoral shaft. 
<ul>
 <li>Angle of Inclination (Frontal Plane)
 <ul>
 <li>The angle between the femoral neck and <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> side of the femoral shaft in the frontal plane. This angle is roughly 140 - 150&#xB0; at birth but is reduced to an average of 125&#xB0; in adults (primarily due to the force across the femoral neck during walking) (1, 3). Significant deviations may alter biomechanics leading to increased risk of degeneration or in severe cases dislocation and stress-induced degeneration of the joint (1).</li>
 <li>Normal: 125&#xBA;
 <ul>
 <li>Coxa Valga: &gt; 125&#xBA; (structurally &quot;longer leg&quot;)</li>
 <li>Coxa Vara: &lt; 125&#xBA; (structurally &quot;shorter leg&quot;)</li>
 </ul>
 </li>
 </ul>
 </li>
</ul>
<a href="https://www.datocms-assets.com/25800/1642786405-462px-coxa-valga-norma-vara-000.png"><img src="https://www.datocms-assets.com/25800/1642786405-462px-coxa-valga-norma-vara-000.png" title="Angles of the hip joint including coxa valga, coxa norma, and coxa vara" alt="Various angles of the hip joint"></a>
By Addingrefs - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=6952989
<ul>
 <li>Femoral Torsion (transverse plane):
 <ul>
 <li>Formed between the bones shaft (<a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> axis between the femoral condyles) and the femoral neck. 15&#xB0; of anteversion is normal, with more or less representing an abnormal amount of femoral torsion (twisting). Both excessive anteversion and retroversion may lead to changes in biomechanics, secondary dysfunction (for example, osteoarthritis), and changes in one gait pattern (1, 3).</li>
 <li>Normal Range: 8&#xBA;-15&#xBA;
 <ul>
 <li>Anteversion (1, 3): &gt; 15 - 20&#xBA; (may present with &quot;toe-in&quot; <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a>)</li>
 <li>Retroversion (1): &lt; 8&#xBA; (may present with &quot;toe-out&quot; <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a>)</li>
 </ul>
 </li>
 </ul>
 </li>
</ul>
Interesting Note: Despite some variations between adults, the occurrence of anteversion outside of a standard mean is relatively low; less than 7% in a pathological population (41). We may be able to presume lower percentages in an asymptomatic/non-pathological population (41).
<a href="https://www.datocms-assets.com/25800/1642786464-inter_anteversion.jpeg"><img src="https://www.datocms-assets.com/25800/1642786464-inter_anteversion.jpeg" title="Anteversion angle of the femur" alt="An image showing anteversion of the femur"></a>
Anteversion angle of the Left Femur, formed between a line bisecting the femoral neck and a medial/lateral axis through the condyles. http://www.pediatric-orthopedics.com/Topics/Cerebral_Palsy/Intervention/Inter_Anteversion.jpg

Introduction to the  Hip (Pelvifemoral) Joint

The hip joint itself (femoral head and acetabulum) may not be palpated due to the depth of the joint surfaces relative to the thick surrounding musculature. However, several bony landmarks in proximity to the hip joint are important anatomical reference points. Note it is helpful to learn the palpations below in the order listed:
<ol>
 <li>Iliac Crest - The iliac crest is the large bony ridge that holds your pants up and is often referred to as the &quot;hip&quot; in common language (&quot;put your hands on your hips&quot;). The large bony ridge is actually the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> spine of the ilium (pelvis), and an attachment site for many <a href="https://brookbushinstitute.com/article/spine-and-trunk-muscles" target="_blank" rel="noopener">trunk muscles</a>. If you place your hands on your waist and course your finger down and into the soft tissue of the trunk, you should easily identify this landmark. Try to place the span from index fingertip to webspace to thumb fingertip on top of the majority of the iliac crest. Now see if you can run your hands forward (anteriorly) along the crest until your index fingertip reaches the front end of the iliac crest (ASIS). Do the same thing, but this time trace the iliac crest back (posteriorly) until you feel a bony corner where the iliac crest seems to make a nearly 90&#xB0; turn to run inferiorly (PSIS). Now try to identify the iliac crest of your partner.</li>
 <li>Anterior <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> Iliac Spine (ASIS) - Use the iliac crest palpation above. If you trace the iliac crest anteriorly with your fingers, you will come to a bony corner where the iliac crest seems to make a nearly 90&#xB0; turn to run inferiorly. (If you pass the ASIS you will feel only the soft tissue of the abdomen). The bony corner of the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> iliac crest is your <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> Iliac Spine, commonly referred to as your ASIS.</li>
 <li>Anterior <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">Inferior</a> Iliac Spine (AIIS) - To palpate the AIIS you will need to have yourself or a partner lay down with your legs over a bolster so that you are in a relaxed, hip flexed position. Identify the ASIS, using the instruction above. Now <a id="glide" data-tip="1815" target="_blank" href="/glossary-term/glide" class="glossary">slide</a> your fingers deeper into the soft tissue, <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">Inferior</a> and <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> to the ASIS about an inch. Although you will be palpating through some large tendons (<a href="https://brookbushinstitute.com/article/sartorius" target="_blank" rel="noopener">sartorius</a> and <a href="https://brookbushinstitute.com/article/rectus-femoris" target="_blank" rel="noopener">rectus femoris</a>), you should be able to feel a hard bony mound that is your AIIS.</li>
 <li>Posterior <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> Iliac Spine (PSIS) - Using the iliac crest palpation above, use your thumbs to trace the iliac crest to its most <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> edge. You will come to a bony corner where the iliac crest seems to make a nearly 90&#xB0; turn to run inferiorly into the tailbone (sacrum). This corner is the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> iliac spine, commonly referred to as the PSIS. You may note that the two PSIS are much closer to one another than the ASIS are; the PSIS is generally only a couple inches <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> to the spinous process.</li>
 <li>Greater Trochanter - Find the midway point between the ASIS and PSIS on the iliac crest (iliac crest and mid-axillary line). <a id="glide" data-tip="1815" target="_blank" href="/glossary-term/glide" class="glossary">Slide</a> your finger 4 to 6 inches <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> to this point, depressing your fingers into the soft tissue of the thigh. You should run into the apex of the greater trochanter. You can palpate around this large chunk of bone, to feel its rather rough and jagged surfaces.</li>
</ol>
<a href="https://www.datocms-assets.com/25800/1642786173-hip-cadaver.jpeg"><img src="https://www.datocms-assets.com/25800/1642786173-hip-cadaver.jpeg" title="The hip joint with boney landmarks labeled including the acetabulum, head of the femur, and iliac spine" alt="A lateral view of the acetabulofemoral joint "></a>
By <a title="User:Anatomist90" href="//commons.wikimedia.org/wiki/User:Anatomist90" target="_blank" rel="noopener">Anatomist90</a> - Own work, <a title="Creative Commons Attribution-Share Alike 3.0" href="http://creativecommons.org/licenses/by-sa/3.0" target="_blank" rel="noopener">CC BY-SA 3.0</a>, https://commons.wikimedia.org/w/index.php?curid=23768321

 Hip Joint Palpation

<h3>Non-contractile/passive tissue</h3>
<ul>
 <li>Open Pack Position: Flexion 30 &#x2013; 90, abduction to approximately 30&#xB0;, and slight external rotation (1,2)</li>
 <li>Close Pack Position: End range extension, with abduction and internal rotation (1)
 <ul>
 <li>The hip joint is one of the few joints in the body in which the close-packed position is NOT also the position of maximal joint congruence. In the case of the hip, joint surfaces fit most congruently in the &#x201C;open-pack&#x201D; position.</li>
 </ul>
 </li>
</ul>
<table>
 <tbody>
 <tr>
 <td width="187">
 <h3>Name</h3>
 </td>
 <td width="195">
 <h3>Attachments</h3>
 </td>
 <td width="233">
 <h3>Course</h3>
 </td>
 <td width="165">
 <h3>Restricted Motions</h3>
 </td>
 </tr>
 <tr>
 <td colspan="4" width="779">Note: The Iliofemoral, pubofemoral and ischiofemoral ligaments are thickenings of the hip capsule. They should not be thought of as separate structures, but as an integrated group of fibers enveloping the hip joint.</td>
 </tr>
 <tr>
 <td width="187">Iliofemoral ligament (a.k.a &quot;Y ligament of Bertin&quot;)</td>
 <td width="195">
 <ul>
 <li>Pelvic Attachment: Below the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> iliac spine</li>
 <li>Femoral Attachment: The two bands insert superior/lateral (the strongest of the hip joint ligaments) and inferior/medial on the intertrochanteric line</li>
 </ul>
 </td>
 <td width="233">Course: Splits into two bands that course inferiorly, anterior to the femoral head. This ligament has an inverted Y shape.</td>
 <td width="165">ExtensionInternal RotationLateral branch may resist the extremes of External Rotation</td>
 </tr>
 <tr>
 <td width="187">Pubofemoral</td>
 <td width="195">
 <ul>
 <li>Pelvis Attachment: <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> and <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> rim of the acetabulum (pubic portion) and adjacent parts of the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> pubic ramus and obturator membrane.</li>
 <li>Femoral Attachment: Blending with the inferior/medial fibers of the Iliofemoral ligament, attaching to the intertrochanteric line</li>
 </ul>
 </td>
 <td width="233">Course: Courses inferiorly, anterior to the femoral head, and wraps underneath the joint.</td>
 <td width="165">ExtensionInternal RotationAbduction</td>
 </tr>
 <tr>
 <td width="187">Weak Triangular Area in Anterior Capsule</td>
 <td width="195">
 <ul>
 <li>Location: Between Iliofemoral and pubofemoral ligaments (2). Protected by the tendon of the iliopsoas</li>
 </ul>
 </td>
 <td width="233"></td>
 <td width="165">May not be as effective in restricting anterior/superior glide.</td>
 </tr>
 <tr>
 <td width="187">Ischiofemoral Ligament</td>
 <td width="195">
 <ul>
 <li>Pelvic Attachment: Ischial rim of the acetabulum</li>
 <li>Femoral Attachment: Blends with the <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> and <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> capsule, and more superficial fibers spiral upward toward the apex of the greater trochanter</li>
 <li>Note: Less developed than the ischiofemoral and pubofemoral ligaments</li>
 </ul>
 </td>
 <td width="233">Course: Courses laterally (and somewhat superior) to the femoral neck, covering the posterior and inferior regions of the joint.</td>
 <td width="165">ExtensionAdduction (Superior Fibers)Internal Rotation</td>
 </tr>
 <tr>
 <td width="187">Ligamentum Teres</td>
 <td width="195">
 <ul>
 <li>Pelvic Attachment: Non-articular surface of the acetabulum</li>
 <li>Femoral Attachment: Pit on the head of the femur</li>
 </ul>
 </td>
 <td width="233">Course: Lateral from center of acetabulum to near the center of the femoral head</td>
 <td width="165">Should restrict abduction and distraction, but does not become taut enough to restrict either. The primary role of this ligament is to protect the small acetabular artery).</td>
 </tr>
 <tr>
 <td width="187">Transverse Acetabular Ligament</td>
 <td width="195">
 <ul>
 <li>Attachments: From the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> horn to the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> horn (<a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a>) horn of the acetabulum.</li>
 </ul>
 </td>
 <td width="233">Course: This ligament courses horizontally, filling the gap on the inferior portion of the acetabulum.</td>
 <td width="165">Inferior Glide</td>
 </tr>
 <tr>
 <td width="187">Capsule</td>
 <td width="195">
 <ul>
 <li>Pelvic Attachment: Emanating from the acetabular rim from underneath the outer edge of the labrum (and transverse ligament).</li>
 <li>Femoral Attachment: The capsule courses superficially to envelop the joint and insert into the neck of the femur, abutting the intertrochanteric line.</li>
 </ul>
 </td>
 <td width="233">Generally, the capsule is referred to by region:
 <ul>
 <li>Anterior</li>
 <li>Posterior</li>
 <li>Inferior</li>
 <li><a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> (although rarely referred to in practice)</li>
 </ul>
 </td>
 <td width="165">
 <ul>
 <li><a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> Capsule: Flexion and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> glide</li>
 <li><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Capsule: Extension and <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> glide</li>
 <li><a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">Inferior</a> Capsule: Abduction and <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">Inferior</a> glide</li>
 <li>Superior: Does not become taught during normal motion of the hip</li>
 </ul>
 </td>
 </tr>
 <tr>
 <td width="187">Labrum</td>
 <td width="195">
 <ul>
 <li>Pelvic Attachment: The external and internal surfaces of the acetabular rim, fusing with the articular cartilage (1).</li>
 <li>Cross section: In cross-section, the labrum is nearly a perfect triangle, wide at its <a id="base-of-support" data-tip="1196" target="_blank" href="/glossary-term/base-of-support" class="glossary">base</a> and extending to a point.</li>
 </ul>
 </td>
 <td width="233">Course: Extends laterally about 5mm to deepen the hip socket. Resembles the outer edge of a &#x201C;suction cup&#x201D;</td>
 <td width="165">Restricts glide in all directions. May contribute to creating a seal around the femoral head. This may aid in contributing to negative pressure and resistance against distraction (1, 3).</td>
 </tr>
 </tbody>
</table>
<a href="https://www.datocms-assets.com/25800/1642786881-ligementum-teres.jpeg"><img src="https://www.datocms-assets.com/25800/1642786881-ligementum-teres.jpeg" title="The hip joint with cartilage, boney landmarks, and ligaments in a cadaver dissection" alt="A cadaver dissection of the hip joint"></a>&#xA0; Cadaver Dissection of Hip Joint. Note: The Ligamentum Capitis Femoris is also know as Ligamentum Teres - By Anatomist90 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=23768622

Hip Connective Tissues: Capsule, Ligaments, and Labrum

Trochanteric Bursae: The greater trochanteric bursae covers the greater trochanter, providing a smooth surface for muscles and ligaments to pass over. This bursa may be divided into facets (faces) (40):
<ul>
 <li><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Facet: Gluteus minimus invests in this facet</li>
 <li>Subgluteus Minimus Facet: Positioned under the gluteus minimus tendon</li>
 <li><a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">Lateral</a> Facets: Gluteus medius invests in this facet</li>
 <li>Subgluteus Medius Facet: Positioned under the gluteus medius tendon</li>
 <li><a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> Facet: Free from attachments, this facet is presumed to reduce friction between the greater trochanter g<a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">luteus maximus</a> and iliotibial band.</li>
</ul>
Iliopsoas Bursae: Lies between the iliopsoas tendon, quadratus femoris, and lesser trochanter. May be implicated as a source of pain (bursitis) related to a diagnosis of hip impingement syndrome.
Ischiogluteal (gluteal) Bursae: Lies between the ischium and <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>, and is believed to reduce friction between the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and ischium during hip flexion.
<a href="https://www.datocms-assets.com/25800/1642787276-hip-bursitis.jpeg"><img src="https://www.datocms-assets.com/25800/1642787276-hip-bursitis.jpeg" title="Hip bursae including the ischiogluteal, gluteus medius, and iliopsoas bursa" alt="The location of the bursae of the hip"></a> http://www.lockeroomsports.com/wordpress/wp-content/uploads/2014/09/hip-bursitis.jpg

 Hip Joint Bursae

<ul>
 <li>Sensory Innervation: Femoral <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> (either from direct branches or from muscular branches), obturator <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>, accessory obturator <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>, <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> gluteal <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>, and <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> to the quadratus femoris (2). Sensory Innervation of Joint Capsule by Region (14):
 <ul>
 <li>Anteromedial: Branches from the obturator and femoral nerves</li>
 <li>Anterior: Branches from the femoral <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>.</li>
 <li>Posterior: Branches from the sciatic <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> and <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> to the quadratus femoris</li>
 <li>Posterior Medial: Branches from the <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> to the quadratus femoris</li>
 <li>Posterior Lateral: Branches from the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> gluteal nerve</li>
 </ul>
 </li>
</ul>
<table class=" aligncenter">
 <tbody>
 <tr>
 <td width="322">
 <h3 style="text-align: left;">Muscles Crossing the Hip</h3>
 </td>
 <td style="text-align: left;" width="315">
 <h3>Neural Innervation (1-4)</h3>
 </td>
 <td style="text-align: left;" width="170">
 <h3>Nerve Root (1-4)</h3>
 </td>
 </tr>
 <tr>
 <td width="322">Psoas</td>
 <td width="315">Femoral Nerve</td>
 <td width="170">L1 &#x2013; L3</td>
 </tr>
 <tr>
 <td width="322">Iliacus</td>
 <td width="315">Femoral Nerve</td>
 <td width="170">L2 &#x2013; L3</td>
 </tr>
 <tr>
 <td width="322">Sartorius</td>
 <td width="315">Femoral Nerve</td>
 <td width="170">L2 &#x2013; L3</td>
 </tr>
 <tr>
 <td width="322">Rectus Femoris</td>
 <td width="315">Femoral Nerve</td>
 <td width="170">L2 &#x2013; L4</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">Pectineus</a></td>
 <td width="315">Femoral and Obturator Nerve</td>
 <td width="170">L2 &#x2013; L4</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">Adductor Brevis</a></td>
 <td width="315">Obturator Nerve</td>
 <td width="170">L2 &#x2013; L4</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">Adductor Longus</a></td>
 <td width="315">Obturator Nerve</td>
 <td width="170">L2 &#x2013; L4</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">Adductor Magnus</a> (Anterior Fibers)</td>
 <td width="315">Obturator Nerve</td>
 <td width="170">L2 &#x2013; L4</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">Gracilis</a></td>
 <td width="315">Obturator Nerve</td>
 <td width="170">L2 &#x2013; L4</td>
 </tr>
 <tr>
 <td width="322">Obturator Externus</td>
 <td width="315">Obturator Nerve</td>
 <td width="170">L3 &#x2013; L4</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">Tensor Fascia Latae</a></td>
 <td width="315">Superior Gluteal Nerve</td>
 <td width="170">L4 &#x2013; S1</td>
 </tr>
 <tr>
 <td width="322">Gluteus Minimus</td>
 <td width="315">Superior Gluteal Nerve</td>
 <td width="170">L4 &#x2013; S1</td>
 </tr>
 <tr>
 <td width="322">Gluteus Medius</td>
 <td width="315">Superior Gluteal Nerve</td>
 <td width="170">L4 &#x2013; S1</td>
 </tr>
 <tr>
 <td width="322">Quadratus Femoris</td>
 <td width="315">Nerve to the Quadratus Femoris</td>
 <td width="170">L4 &#x2013; S2</td>
 </tr>
 <tr>
 <td width="322">Gemellus Inferior</td>
 <td width="315">Nerve to the Quadratus Femoris</td>
 <td width="170">L5 &#x2013; S2</td>
 </tr>
 <tr>
 <td width="322">Gemellus Superior</td>
 <td width="315">Nerve to the Obturator Internus</td>
 <td width="170">L5 &#x2013; S2</td>
 </tr>
 <tr>
 <td width="322">Obturator Internus</td>
 <td width="315">Nerve to the Obturator Internus</td>
 <td width="170">L5 &#x2013; S2</td>
 </tr>
 <tr>
 <td width="322">Piriformis</td>
 <td width="315">Nerve to the Piriformis</td>
 <td width="170">L5 &#x2013; S2</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">Adductor Magnus (Posterior Fibers)</a></td>
 <td width="315">Tibial branch of Sciatic Nerve</td>
 <td width="170">L4 &#x2013; S1</td>
 </tr>
 <tr>
 <td width="322">Semitendinosus</td>
 <td width="315">Tibial Branch of Sciatic Nerve</td>
 <td width="170">L4 &#x2013; S2</td>
 </tr>
 <tr>
 <td width="322">Semimembranosus</td>
 <td width="315">Tibial Branch of Sciatic Nerve</td>
 <td width="170">L4 &#x2013; S2</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">Biceps Femoris (Long Head)</a></td>
 <td width="315">Tibial Branch of Sciatic Nerve</td>
 <td width="170">L5 &#x2013; S3</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">Bicep Femoris (Short Head)</a></td>
 <td width="315">Fibular Branch of Sciatic Nerve</td>
 <td width="170">L5 &#x2013; S2</td>
 </tr>
 <tr>
 <td width="322"><a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">Gluteus Maximus</a></td>
 <td width="315">Inferior Gluteal Nerve</td>
 <td width="170">L5 &#x2013; S2</td>
 </tr>
 </tbody>
</table>

<a href="https://www.datocms-assets.com/25800/1642787328-femoral-nerve.jpeg"><img src="https://www.datocms-assets.com/25800/1642787328-femoral-nerve.jpeg" title="The muscles which are innervated by the femoral nerve, which include rectus femoris, sartorius, and adductors" alt="The femoral nerve and the muscles it innervates"></a>
Femoral <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">Nerve</a> - By Anatomist90 - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=44207838

 Hip Nerves

<h3>Osteokinematics</h3>
<h4>Femur on Pelvis</h4>
<ul>
 <li>Flexion
 <ul>
 <li>Flexors: Psoas, iliacus, <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fasciae latae</a>, gluteus minimus, rectus femoris, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">anterior adductors</a> (pectineus in particular)</li>
 <li>Limited by:<a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener"> Biceps femoris</a>, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">posterior head of adductor magnus</a>, piriformis, deep rotators of the hip, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> capsule, gluteal fascia, sacral fascia, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> fascia latae, neural restriction (sacral <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a> and sacral/lumbar plexus)</li>
 <li>Optimal Range of Motion (ROM): 110 - 135&#xB0; (<a href="http://videotree.brookbushinstitute.com/hip-flexion-goniometry/" target="_blank" rel="noopener">Hip Flexion Goniometry</a>)</li>
 </ul>
 </li>
 <li>Extension
 <ul>
 <li>Extensors: <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">Gluteus maximus</a>, <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a>, semitendinosus, semimembranosus, and <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">adductor magnus</a></li>
 <li>Limited by: psoas, iliacus, <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fascia latae</a>, rectus femoris, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">adductors</a>, gluteus minimus, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> capsule, iliofemoral ligament, ischiofemoral ligament, pubofemoral ligament, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> fascia lata, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> fascia lata, neural restriction (femoral <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>)</li>
 <li>Optimal ROM: *0 - 10&#xB0; (<a href="http://videotree.brookbushinstitute.com/hip-extension-goniometry/" target="_blank" rel="noopener">Hip Extension Goniometry</a>)</li>
 </ul>
 </li>
 <li>Abduction
 <ul>
 <li>Abductors: Gluteus medius, gluteus minimus, <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fascia latae</a> and some assistance from the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a></li>
 <li>Limited by: <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">Adductors</a>, <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> capsule, pubofemoral ligament, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> fascia lata, neural restriction (obturator <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>)</li>
 <li>Optimal ROM: 35 - 45&#xB0; (<a href="http://videotree.brookbushinstitute.com/hip-abduction-goniometry/" target="_blank" rel="noopener">Abduction Goniometry</a>)</li>
 </ul>
 </li>
 <li>Adduction:
 <ul>
 <li>Adductors: <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">Adductors</a></li>
 <li>Limited by: Gluteus medius, gluteus minimus, <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fascia latae</a>, iliotibial band and the vastus lateralis, intertrochanteric band of iliofemoral ligament, neural restrictions (<a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> femoral cutaneous)</li>
 <li>Optimal ROM: Approximately 10&#xB0; (Not reliably measured using <a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">goniometry</a>)</li>
 </ul>
 </li>
 <li>Internal Rotation:
 <ul>
 <li>Internal Rotators: Gluteus minimus, <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fascia latae</a>, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">anterior adductors</a>, and piriformis at greater than 90&#xB0; of hip flexion</li>
 <li>Limited by: Piriformis, deep rotators of the hip, <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a>, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">adductor magnus</a>, psoas, iliacus, and rarely of clinical significance gluteus medius and <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>; <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> capsule, <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> capsule, and neural restriction (sciatic <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>)</li>
 <li>Optimal ROM: 40 - 50&#xB0; (<a href="http://videotree.brookbushinstitute.com/goniometry-hip-internal-rotation/" target="_blank" rel="noopener">Hip Internal Rotation </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> in <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">Prone</a>, <a href="http://videotree.brookbushinstitute.com/goniometric-assessment-hip-internal-rotation-at-90-degree-of-hip-flexion-9090-hip-ir/" target="_blank" rel="noopener">90/90&#xB0; Hip Internal Rotation </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> in <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">Supine</a>)</li>
 </ul>
 </li>
 <li>External Rotation:
 <ul>
 <li>External Rotators: <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">Gluteus maximus,</a> gluteus medius, piriformis, deep rotators of the hip, <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a>, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">adductor magnus</a>, psoas, iliacus</li>
 <li>Limited by: Gluteus minimus, <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fascia latae</a>, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">anterior adductors</a>, piriformis at greater than 90&#xB0; of hip flexion, gluteal fascia, and neural restriction (sciatic <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>)</li>
 <li>Optimal ROM: 40 - 50&#xB0; (<a href="http://videotree.brookbushinstitute.com/goniometry-hip-external-rotation-in-prone/" target="_blank" rel="noopener">Hip External Rotation </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> in <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">Prone</a>, <a href="http://videotree.brookbushinstitute.com/goniometric-assessment-hip-external-rotation-at-90-degrees-of-hip-flexion-9090-hip-er/" target="_blank" rel="noopener">90/90&#xB0; Hip Internal Rotation </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> in Supine</li>
 </ul>
 </li>
 <li>Horizontal Abduction:
 <ul>
 <li>Horizontal Abductors: Piriformis, deep rotators of the hip, g<a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">luteus maximus</a>, gluteus medius<a href="https://brookbushinstitute.com/article/deep-rotators-of-the-hip" target="_blank" rel="noopener">, </a></li>
 <li>Limited by: <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">Adductors</a>, <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> capsule, pubofemoral ligament, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> fascia lata, neural restriction (obturator <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>)</li>
 <li>Optimal ROM: 40 - 60&#xB0;? (Not reliably measured using <a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">goniometry</a>)</li>
 </ul>
 </li>
 <li>Horizontal Adduction:
 <ul>
 <li>Horizontal Abductors: <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">Adductors</a></li>
 <li>Limited by: Piriformis, deep rotators of the hip, g<a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">luteus maximus</a>, gluteus medius, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> capsule, gluteal fascia, <a id="medial" data-tip="1568" target="_blank" href="/glossary-term/medial" class="glossary">medial</a> fascia lata, neural restriction (sciatic <a id="nerve-cell" data-tip="1361" target="_blank" href="/glossary-term/nerve-cell" class="glossary">nerve</a>)</li>
 <li>Optimal ROM: 10&#xB0;? (Not reliably measured using <a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">goniometry</a>)</li>
 </ul>
 </li>
 <li>
 <h4> See <a href="https://brookbushinstitute.com/article/kinesiology-of-the-hip" target="_blank" rel="noopener">Kinesiology of the Hip</a> for a list of <a id="prime-mover" data-tip="1662" target="_blank" href="/glossary-term/prime-mover" class="glossary">prime mover</a>, <a id="synergists" data-tip="1650" target="_blank" href="/glossary-term/synergists" class="glossary">synergists</a>, antagonists, neutralizers, stabilizers, and fixators for all joint actions.</h4>
 </li>
</ul>
<h4>Pelvis on Femur:</h4>
Note: It may be helpful to visualize these motions while in a standing position.
<ul>
 <li>Anterior Pelvic Tilt: <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> iliac spine (ASIS) more than a centimeter below the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> iliac spine (PSIS_ on a horizontal axis. This motion is pelvis on hip flexion, and would be affected by, and have the same effect on the tissues described under &quot;Flexion&quot; above.</li>
 <li>Posterior Pelvic Tilt: ASIS higher than PSIS on a horizontal axis. This motion is pelvis on hip extension, and would be affected by, and have the same effect on the tissues described under &quot;Extension&quot; above.</li>
 <li>Frontal Plane Elevation: (Pelvic Hike): One iliac spine higher than the other. This motion is pelvis on hip abduction (of the side opposite the higher iliac crest), and would be affected by, and have the same effect on the tissues described under &quot;Abduction&quot; above.</li>
 <li>Frontal Plane Depression: (Pelvic Drop): One iliac spine lower than the other. This motion is pelvis on hip adduction (of the side opposite the lower iliac crest), and would be affected by, and have the same effect on the tissues described under &quot;Adduction&quot; above.</li>
 <li>Pelvic Internal Rotation: <a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">Contralateral</a> ASIS moving <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> to the ASIS on the side of a fixed lower extremity. This motion is pelvis on hip internal rotation (of the side of the fixed lower extremity), and would be affected by, and have the same effect on the tissues described under &quot;Internal Rotation&quot; above.</li>
 <li>Pelvic External Rotation: <a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">Contralateral</a> ASIS moving <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> to the ASIS on the side of a fixed lower extremity. This motion is pelvis on hip external rotation (of the side of the fixed lower extremity), and would be affected by, and have the same effect on the tissues described under &quot;External Rotation&quot; above.</li>
</ul>
<a href="https://www.datocms-assets.com/25800/1642787410-quadratus-femoris.jpeg"><img src="https://www.datocms-assets.com/25800/1642787410-quadratus-femoris.jpeg" title="The posterior hip capsule in a cadaver dissection with boney landmarks labeled" alt="A cadaver dissection of the deep poserior hip "></a>
Cadaveric Dissection of Deep <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> Hip: By Anatomist90 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=25188053

Hip Joint Actions 

<a id="arthrokinematics" data-tip="1701" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">Arthrokinematic motion</a> refers to the motion between joint surfaces - <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a>, <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a>, <a id="spin" data-tip="1603" target="_blank" href="/glossary-term/spin" class="glossary">spin</a>, <a id="compression" data-tip="1595" target="_blank" href="/glossary-term/compression" class="glossary">compression</a>, and distraction/traction. These <a id="arthrokinematics" data-tip="1702" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">arthrokinematic motions</a> accompany <a id="osteokinematic-motion" data-tip="1796" target="_blank" href="/glossary-term/osteokinematic-motion" class="glossary">osteokinematic motions</a> to maintain joint congruence. You could visualize this pairing of motions as joint surfaces attempting to maintain the femoral head relatively &quot;center&quot; in the acetabulum. <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">Optimal</a> <a id="arthrokinematics" data-tip="1701" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">Arthrokinematic motion</a> of the hip joint generally follows &quot;convex on <a id="concave" data-tip="1281" target="_blank" href="/glossary-term/concave" class="glossary">concave</a> rules&quot;- <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> opposite <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a> (1). For example, forward motion/flexion of the femur should be accompanied by <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a>.
<h3>Arthrokinematic motion and contributing muscles:</h3>
<ul>
 <li>Compressors: All muscles of the hip may contribute to compression</li>
 <li>Anterior Glide: (Attach from <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> pelvis to femur or lower; all flexors of the hip): Psoas, iliacus, <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fasciae latae</a>, gluteus minimus, rectus femoris, and <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">anterior adductors</a></li>
 <li>Posterior Glide: (attach from <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> pelvis to femur or lower, all extensors of the hip): <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">Gluteus maximus</a>, <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a>, semitendinosus, semimembranosus, and <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">adductor magnus</a></li>
 <li>Superior Glide: (Attach from the femur or lower to pelvis): Psoas, iliacus, <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fascia latae,</a> rectus femoris, sartorius, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">adductors</a>, <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a>, semitendinosus, semimembranosus, and the deep rotators of the hip</li>
 <li>Inferior Glide: (Attach from the greater trochanter to Pelvis): Gluteus medius, gluteus minimus, piriformis, and potentially <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a></li>
</ul>
<h4>Glide is also restricted by the labrum, joint capsule, and ligaments:</h4>
<ul>
 <li>Anterior Glide: Restricted by the labrum, <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> capsule, iliofemoral ligament, ischiofemoral ligament, and potentially the psoas tendon</li>
 <li>Posterior Glide: Restricted by the labrum, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> capsule, and pubofemoral ligament. (Note: due to the acetabular anteversion angle, more of the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> surface of the femoral head contacts the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> acetabulum, which may play a significant role in preventing excessive <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a>)</li>
 <li>Inferior Glide: Restricted by the transverse ligament, <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">Inferior</a> capsule, and pubofemoral ligament</li>
 <li>Superior Glide: Primary restriction is the <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> surface acetabulum and labrum, although at extremes of <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> the teres ligament and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> capsule may restrict motion (1).</li>
</ul>
<h4>Roll accompanies the corresponding joint motion:</h4>
<ul>
 <li>Superior <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">Roll</a> and Abduction: Gluteus medius, gluteus minimus, <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fascia latae</a> and some assistance from the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a></li>
 <li>Inferior <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">Roll</a> and Adduction: <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">Adductors</a></li>
 <li>Anterior <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">Roll</a> and Internal Rotation: Gluteus minimus, <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fascia latae</a>, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">anterior adductors</a></li>
 <li>Posterior <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">Roll</a> and External Rotation: <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">Gluteus maximus,</a> gluteus medius, piriformis, deep rotators of the hip, <a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a>, <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">adductor magnus</a>, psoas, iliacus</li>
</ul>
<img src="https://www.datocms-assets.com/25800/1642787481-gluteus-maximus-cross-section-2.png" title="A cross-sectional view of the hip joint showing the muscles surrounding the acetabulum" alt="A cross-section of the hip joint">
By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See &quot;Book&quot; section below)Bartleby.com: Gray&apos;s Anatomy, Plate 344, Public Domain, https://commons.wikimedia.org/w/index.php?curid=108263

Motion of the hip is influenced by muscles, fascia, and the <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> of nerves that cross multiple joints. Further, the motion of <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> joints may influence the position of bones, force vectors, moment arms, and the dissipation of force.
<ul>
 <li>Joints:
 <ul>
 <li>Lumbar spine (35)</li>
 <li>Sacroiliac joint (33 - 35)</li>
 <li>Knee (16-23)</li>
 <li>Ankle/foot (31, 32).</li>
 </ul>
 </li>
 <li>Muscles:
 <ul>
 <li>All muscles of the hip</li>
 <li>All muscles controlling frontal and transverse plane motion of the entire lower extremity (16 - 23)</li>
 <li>All muscles controlling the lumbar spine and trunk that may alter the position of the pelvis (33 - 35)</li>
 </ul>
 </li>
 <li>Fascial Structures:
 <ul>
 <li>Fascia Latae (including iliotibial band) (39)</li>
 <li>Gluteal Fascia</li>
 <li>Thoracolumbar fascia (33, 38)</li>
 </ul>
 </li>
 <li>Neural Structures:
 <ul>
 <li>Femoral Nerve</li>
 <li>Obturator Nerve</li>
 <li>Sciatic Nerve</li>
 </ul>
 </li>
</ul>
<img src="https://www.datocms-assets.com/25800/1642787584-knee-valgus-2.jpeg" title="Three images of functional knee valgus (knee bow in) during squatting, jumping, and running" alt="Examples of knee bow in (functional valgus)">
3 Images of &quot;Functional Knee Valgus&quot; - Excessive adduction and internal rotation of the hip.

The hip has a propensity toward excessive internal rotation, adduction, and flexion during functional tasks, as well as excessive <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a>, <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a>, and stiffness. This may result in, or be the result of altered length and activity of one, or many of the muscles crossing the hip joint, and maladaptive changes in length and/or <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a> of passive soft tissues (capsule, ligaments, and fascial structures). It should be noted that additional compensatory patterns exist and are <a id="relevance" data-tip="1505" target="_blank" href="/glossary-term/relevance" class="glossary">relevant</a> to practice; however, in this article, the focus will be given to this pattern, which is presumed to be &quot;most common.&quot;
<ul>
 <li>Common <a id="osteokinematic-motion" data-tip="1881" target="_blank" href="/glossary-term/osteokinematic-motion" class="glossary">Osteokinematic</a> Dysfunction: Excessive hip internal rotation, adduction, and flexion</li>
 <li>Common <a id="arthrokinematics" data-tip="1863" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">Arthrokinematic</a> Dysfunction: Excessive <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> and <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a>, and increased stiffness</li>
</ul>
<h3>Hip Compensatory Pattern Summary (<a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">LLD</a> and <a href="https://brookbushinstitute.com/courses/lumbo-pelvic-hip-complex-dysfunction-lphcd" target="_blank" rel="noopener">LPHCD</a>)</h3>
<ul>
 <li>Maladaptive Decrease In Length/Extensibility (Mobilize):
 <ul>
 <li>Posterior Capsule</li>
 <li>Inferior Capsule</li>
 <li>Ischiofemoral, iliofemoral and pubofemoral ligaments?
 <ul>
 <li>Are these ligaments short and stiff reducing hip extension, or have they been lengthened by the excessive <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> <a id="glide" data-tip="1598" target="_blank" href="/glossary-term/glide" class="glossary">glide</a> of the femoral head?</li>
 </ul>
 </li>
 </ul>
 </li>
 <li>Short/Over-active (<a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> and Lengthen) 
 <ul>
 <li>Psoas</li>
 <li>Iliacus</li>
 <li><a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">Tensor Fascia Latae (TFL)</a></li>
 <li>Gluteus Minimus</li>
 <li>Rectus Femoris</li>
 <li><a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">Anterior adductor Complex</a></li>
 <li>Sartorius</li>
 </ul>
 </li>
 <li>Long/Over-active (<a id="synergistic-dominance" data-tip="1649" target="_blank" href="/glossary-term/synergistic-dominance" class="glossary">Synergistically Dominant</a> - <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> Only)
 <ul>
 <li><a href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">Biceps Femoris</a></li>
 <li><a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">Adductor Magnus</a></li>
 <li>Piriformis</li>
 <li>Deep Rotators of the Hip</li>
 </ul>
 </li>
 <li>Long/Under-active (Activate and <a id="integration" data-tip="1476" target="_blank" href="/glossary-term/integration" class="glossary">Integrate</a>) 
 <ul>
 <li><a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">Gluteus Maximus</a></li>
 <li>Gluteus Medius</li>
 <li>Semitendinosus and Semimembranosus</li>
 </ul>
 </li>
 <li>Short/Under-active (<a id="prime-mover" data-tip="1662" target="_blank" href="/glossary-term/prime-mover" class="glossary">Prime Mover</a> Inhibition - Condition via <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">Integrated</a> Patterns)
 <ul>
 <li>Potentially the Psoas</li>
 </ul>
 </li>
</ul>

Postural Dysfunction and the Hip Joint

<ul>
 <li>In <a title="UBD" href="https://brookbushinstitute.com/courses/upper-body-dysfunction-ubd" target="_blank" rel="noopener">Upper Body Dysfunction (UBD)</a> the hip is rarely involved. Occasionally, a loss of shoulder range of motion is related to over-activity and adaptive shortening of the <a title="Latissimus Dorsi" href="https://brookbushinstitute.com/courses/latissimus-dorsi" target="_blank" rel="noopener">latissimus dorsi</a>, emanating from Sacroiliac Joint Dysfunction (SIJD) or <a title="Lumbo Pelvic Hip Complex Dysfunction (LPHCD)" href="https://brookbushinstitute.com/courses/lumbo-pelvic-hip-complex-dysfunction-lphcd" target="_blank" rel="noopener">Lumbo Pelvic Hip Complex Dysfunction (LPHCD)</a>. In this case, the hip may be related to the loss of shoulder range of motion; however, in these individuals, intervention should be focused on improving <a title="Lumbo Pelvic Hip Complex Dysfunction (LPHCD)" href="https://brookbushinstitute.com/courses/lumbo-pelvic-hip-complex-dysfunction-lphcd" target="_blank" rel="noopener">LPHCD</a> and SIJD.</li>
 <li>In <a title="LLD" href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">Lower Leg Dysfunction (LLD)</a>, dysfunction of the hip is secondary to dysfunction at the foot/ankle complex; however, it is unlikely that a complete resolution from dysfunction/symptoms will occur until the foot/ankle, hip and knee have been addressed. <a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction" target="_blank" rel="noopener">LLD</a> may be characterized by a loss of dorsiflexion, excessive pronation (eversion), and a functional knee valgus (excessive tibia on femur external rotation, femoral internal rotation and hip adduction)(6, 7, 9, 16 - 23, 31 - 32). Several studies have noted a functional knee valgus (knees bow in) is correlated with excessive hip internal rotation and adduction, <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and gluteus medius weakness, as well as, a loss of external rotation strength (16 -23).</li>
 <li>In <a title="LPHCD" href="https://brookbushinstitute.com/courses/lumbo-pelvic-hip-complex-dysfunction-lphcd" target="_blank" rel="noopener">Lumbo Pelvic Hip Complex Dysfunction (LPHCD),</a> hip joint dysfunction is the primary concern. A simplified version of this <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> could be described as an <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt - or, excessive pelvis on femur flexion. This may be the result of low back pain, a loss of hip extension, decreased <a id="extensibility-2" data-tip="1308" target="_blank" href="/glossary-term/extensibility-2" class="glossary">extensibility</a> and increased activity of the hip flexors, and/or decreased <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity (27-30, 36-37). In the most common presentations of these dysfunctional patterns, we could include most, if not all of the dysfunction noted above, as <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> and <a id="inferior" data-tip="1569" target="_blank" href="/glossary-term/inferior" class="glossary">inferior</a> capsule restriction may also contribute to a loss of hip extension, and many of the hip flexors will also contribute to hip internal rotation and/or adduction.</li>
</ul>
Note: Much of the hip compensatory pattern noted above is derived from research related to changes in joint motion, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity, range of motion, and strength in those exhibiting signs of <a href="https://brookbushinstitute.com/courses/lower-leg-dysfunction/" target="_blank" rel="noopener">LLD</a> or <a href="https://brookbushinstitute.com/courses/lumbo-pelvic-hip-complex-dysfunction-lphcd" target="_blank" rel="noopener">LPHCD</a>, just as the predictive <a id="model" data-tip="1471" target="_blank" href="/glossary-term/model" class="glossary">models</a> of dysfunction are influenced by the common patterns noted relative to joint pathology.
<ul>
 <li>In Sacroiliac Joint Dysfunction (SIJD) an asymmetrical weight shift results in two patterns of hip dysfunction. Generally, on the side opposite the sacroiliac joint stiffness (SIJ), the pelvis rotates anteriorly, the sacrum often counter-nutates, and the femur is relatively flexed, adducted, and internally rotated, matching the common hip compensatory pattern. In a variation of the commonly seen functional knee valgus, the hip dysfunction on the side of the sacroiliac joint stiffness often contributes to a &quot;functional varus&quot; - excessive external rotation and abduction. The knees bowing-out is likely the result of <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> capsule restriction, <span class="glossaryLink " data-tooltip="An increase in synergistic muscle activity due to a weak or inhibited prime mover.&lt;br /&gt;Example: Inhibition of the glute complex may lead to &lt;a id=" synergistic-dominance" data-tip="1643" target="_blank" href="/glossary-term/synergistic-dominance">synergistic dominance of the biceps femoris during hip extension.&quot;&gt;synergistic dominance of the piriformis, <a title="Adductors" href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">adductor magnus</a>, and <a title="Biceps Femoris" href="https://brookbushinstitute.com/courses/biceps-femoris" target="_blank" rel="noopener">biceps femoris</a>, and post-release and lengthening techniques for these over-active structures, the inhibition of the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> and medius will still require attention.</li>
</ul>
<a href="https://www.datocms-assets.com/25800/1642788710-screen-shot-2022-01-21-at-12-10-16-pm.png"><img src="https://www.datocms-assets.com/25800/1642788710-screen-shot-2022-01-21-at-12-10-16-pm.png" title="Dr. Brent Brookbush demonstrating a breakdown of the knee bow in sign during an overhead squat" alt="Overhead squat &lt;a id=" assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">Assessment</a> break down of the sign knees bow in&quot;&gt; Overhead Squat <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">Assessment</a> Break Down of the sign &quot;Knees Bow In&quot;

Hip Dysfunction Relative to Predictive Models of Dysfunction

<ul>
 <li><a href="https://brookbushinstitute.com/courses/solutions-table-overhead-squat-assessment" target="_blank" rel="noopener">Overhead Squat</a>:
 <ul>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-15-sign-clusters-asymmetrical-weight-shift">Asymmetrical Weight Shift</a></li>
 <li><a href="http://videotree.brookbushinstitute.com/overhead-squat-assessment-6-knees-bow-in-breakdown/" target="_blank" rel="noopener">Knees Bow In</a></li>
 <li><a href="http://videotree.brookbushinstitute.com/overhead-squat-assessment-7-knees-bow-out/" target="_blank" rel="noopener">Knees Bow Out</a></li>
 <li><a href="http://videotree.brookbushinstitute.com/overhead-squat-assessment-9-anterior-pelvic-tilt-excessive-lordosis/" target="_blank" rel="noopener">Anterior Pelvic Tilt</a></li>
 <li><a href="http://videotree.brookbushinstitute.com/overhead-squat-assessment-8-excessive-forward-lean/" target="_blank" rel="noopener">Excessive Forward Lean</a></li>
 </ul>
 </li>
</ul>
<ul>
 <li>Goniometry (5):
 <ul>
 <li><a href="http://videotree.brookbushinstitute.com/hip-flexion-goniometry/" target="_blank" rel="noopener">Hip Flexion Goniometry</a> &lt; 110 - 135&#xB0;</li>
 <li><a href="http://videotree.brookbushinstitute.com/hip-extension-goniometry/" target="_blank" rel="noopener">Hip Extension Goniometry</a> &lt; 0 - 10&#xB0;</li>
 <li><a href="http://videotree.brookbushinstitute.com/hip-abduction-goniometry/" target="_blank" rel="noopener">Abduction Goniometry</a> &lt; 35 - 45&#xB0;</li>
 <li><a href="https://brookbushinstitute.com/video/goniometry-hip-internal-rotation-in-prone" target="_blank" rel="noopener">Hip Internal Rotation </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> in <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">Prone</a>, <a href="https://brookbushinstitute.com/video/goniometry-hip-internal-rotation-at-90-degree-of-hip-flexion-9090-hip-ir" target="_blank" rel="noopener">90/90&#xB0; Hip Internal Rotation </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> in <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">Supine</a> &lt; 40 - 50&#xB0;</li>
 <li><a href="http://videotree.brookbushinstitute.com/goniometry-hip-external-rotation-in-prone/" target="_blank" rel="noopener">Hip External Rotation </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> in <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">Prone</a>, <a href="https://brookbushinstitute.com/video/goniometry-hip-external-rotation-at-90-degrees-of-hip-flexion-9090-hip-er" target="_blank" rel="noopener">90/90&#xB0; Hip External Rotation </a><a id="goniometry" data-tip="1523" target="_blank" href="/glossary-term/goniometry" class="glossary">Goniometry</a> in <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">Supine</a> &lt; 40 - 50&#xB0;</li>
 </ul>
 </li>
</ul>
<ul>
 <li>Muscle <a id="muscle-length-test" data-tip="1494" target="_blank" href="/glossary-term/muscle-length-test" class="glossary">Length Tests</a> (5) 
 <ul>
 <li><a href="http://videotree.brookbushinstitute.com/obers-test-tfl-flexibility-assessment/" target="_blank" rel="noopener">Ober&apos;s Test</a></li>
 <li><a href="http://videotree.brookbushinstitute.com/elys-test-rectus-femoris-flexibility-assessment/" target="_blank" rel="noopener">Ely&apos;s Test</a></li>
 <li><a href="http://videotree.brookbushinstitute.com/modified-thomas-test/" target="_blank" rel="noopener">Thomas Test</a></li>
 </ul>
 </li>
</ul>
<ul>
 <li>Manual <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing (4):
 <ul>
 <li><a href="http://videotree.brookbushinstitute.com/gluteus-maximus-manual-muscle-testing-mmt-for-an-active-population/" target="_blank" rel="noopener">Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing (MMT) of the Gluteus Maximus - Weak or With Compensation</li>
 <li><a href="http://videotree.brookbushinstitute.com/gluteus-medius-manual-muscle-testing-mmt-for-an-active-population/" target="_blank" rel="noopener">Manual </a><a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing (MMT) of the Gluteus Medius - Weak or With Compensation</li>
 </ul>
 </li>
</ul>
<h3>Clinical Issues:</h3>
<ul>
 <li>Osteoarthritis</li>
 <li>Hip Impingement</li>
 <li>Labral Tear</li>
 <li>Dysplasia (abnormal shape or growth)</li>
 <li>Sciatica (secondary to changes in piriformis activity/length)</li>
 <li>Low Back Pain</li>
 <li>Altered length and activity of any <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> crossing the hip
 <ul>
 <li>Tendonitis</li>
 <li>Strain</li>
 <li>Trigger-points</li>
 <li>Soreness/inflammation</li>
 </ul>
 </li>
</ul>
<div>
 <h4>Hip Pathology Referral Pain Pattern:</h4>
 Osteoarthritis, osteochondritic lesions, damage to the labrum, <a id="effusion" data-tip="1459" target="_blank" href="/glossary-term/effusion" class="glossary">effusion</a>, and other pathology involving the intra-articular surfaces and structures of the hip present with a diffuse, disjointed <a id="referred-trigger-point-pain" data-tip="1709" target="_blank" href="/glossary-term/referred-trigger-point-pain" class="glossary">referral pain</a> pattern that is often mistaken for muscular <a id="trigger-point" data-tip="1634" target="_blank" href="/glossary-term/trigger-point" class="glossary">trigger points</a>, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> pain, or pain emanating from the lumbosacral joints and the pubic symphysis. Note: The <a id="referred-trigger-point-pain" data-tip="1709" target="_blank" href="/glossary-term/referred-trigger-point-pain" class="glossary">referral pain</a> pattern for the hip does not follow the path of any one <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a>, group of muscles, or a common compensatory pattern, and in practice, this pattern would be reproducible by hip motion and not reproducible via soft tissue palpation.
 <a href="https://www.datocms-assets.com/25800/1642788782-hip-pain-referral-pattern.jpeg"><img src="https://www.datocms-assets.com/25800/1642788782-hip-pain-referral-pattern.jpeg" title="Referral pain patterns for lumbopelvic hip joint dysfunction" alt="Common pain locations for hip dysfunction"></a>
</div>
<div>Referral Pattern for Hip Joint Dysfunction - David G. Simons, Janet Travell, Lois S. Simons, Travell &amp; Simmons&#x2019; Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,&#xA9; 1999 Williams and Wilkens</div>

Signs of Dysfunction

Videos

Self-administered Hip Mobilization (Lateral Distraction)

Self-administered Hip Mobilization (Anterior to Posterior)

Manual Hip Mobilization

<ol>
 <li>Donald A. Neumann, &ldquo;Kinesiology of the Musculoskeletal System: Foundations of Rehabilitation &ndash; 2nd Edition&rdquo; &copy; 2012 Mosby, Inc.</li>
 <li>David B. Jenkins, Hollinshead&rsquo;s Functional Anatomy of the Limbs and Back: Eighth Edition &copy; 2002 Saunders</li>
 <li>Levangie, P. K., Norkin, C. C. &amp; Lewek, M.D (2019). Joint Structure and Function; A Comprehensive Analysis. 6th Edition. Philadelphia: FA. Davis Company</li>
 <li>Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani, Muscles: Testing and Function with <span class="glossaryLink " data-tooltip="Posture refers to the optimal alignment of bones and joints both statically and dynamically. &ldquo;Good form&rdquo; could be defined as optimal posture during exercise.">Posture and Pain: Fifth Edition &copy; 2005 Lippincott Williams &amp; Wilkins</li>
 <li>Cynthia C. Norkin, D. Joyce White, Measurement of Joint Motion: A Guide to Goniometry &ndash; Third Edition. &copy; 2003 by F.A. Davis Company</li>
 <li>Phillip Page, Clare Frank, Robert Lardner, Assessment and Treatment of Muscle Imbalance: The Janda Approach &copy; 2010 Benchmark Physical Therapy, Inc., Clare C. Frank, and Robert Lardner</li>
 <li>Dr. Mike Clark &amp; Scott Lucette, &ldquo;NASM Essentials of Corrective Exercise Training&rdquo; &copy; 2011 Lippincott Williams &amp; Wilkins</li>
 <li>Leon Chaitow, Muscle Energy Techniques: Third Edition, &copy; Pearson Professional Limited 2007</li>
 <li>Shirley A Sahrmann, Diagnoses and Treatment of Movement Impairment Syndromes, &copy; 2002 Mosby Inc.</li>
 <li>Karel Lewit. Manipulative Therapy: Musuloskeletal Medicine &copy; 2007 Elsevier</li>
 <li>Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization &ndash; A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004</li>
 <li>Tom Myers, Anatomy Trains: Second Edition. &copy; Elsevier Limited 2009</li>
 <li>Andrew Biel, Trail Guide to the Human Body: 4th Edition, &copy; 2010
 <ul>
 <li>Anatomy</li>
 </ul>
 
 </li>
 <li>Birnbaum K1, Prescher A, Hessler S, Heller KD. The sensory innervation of the hip joint--an anatomical study. Surg Radiol Anat. 1997;19(6):371-5.</li>
 <li>Cooper, H., Walters, B., Rodriguez, J. (2015). Anatomy of the Hip Capsule and Pericapsular Structures: A Cadaveric Study. Clinical Anatomy 28: 665-671.
 <ul>
 <li>Functional Valgus:</li>
 </ul>
 
 </li>
 <li>Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., &amp; Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. The American journal of sports medicine, 33(4), 492-501.</li>
 <li>Dos Reis, A. C., Correa, J. C. F., Bley, A. S., Rabelo, N. D. D. A., Fukuda, T. Y., &amp; Lucareli, P. R. G. (2015). Kinematic and Kinetic Analysis of the Single-Leg Triple Hop Test in Women With and Without Patellofemoral Pain. journal of orthopaedic &amp; sports physical therapy, 45(10), 799-807.</li>
 <li>Noehren, B., Scholz, J., Davis, I. (2011) The effects of real-time gait retraining on hip kinematics, pain, and function in subjects with patellofemoral pain syndrome. Br Journal of Sports Medicine. 45:691-696</li>
 <li>Ireland, ML., Wilson, JD., Ballantyne, BT., Davis, IM. (2003). Hip Strength in Females With and Without Patellofemoral Pain. J Orthop Sports Phys Ther 2003. 33: 671-676</li>
 <li>Noehren B, Hamill J, Davis I. Prospective Evidence for a Hip Etiology in Patellofemoral Pain. Medicine &amp; Science in Sports &amp; Exercise. 2013;45(6):1120&ndash;1124.</li>
 <li>Smith, J. A., Popovich, J. M., &amp; Kulig, K. (2014). The influence of hip strength on lower limb, pelvis, and trunk kinematics and coordination patterns during walking and hopping in healthy women. Journal of Orthopaedic &amp; Sports Physical Therapy, (Early Access), 1-23.</li>
 <li>Mauntel, T., Begalle, R., Cram, T., Frank, B., Hirth, C., Blackburn, T., &amp; Padua, D. (2013). The effects of lower extremity muscle activation and passive range of motion on single leg squat performance. Journal Of Strength And Conditioning Research / National Strength &amp; Conditioning Association, 27(7), 1813-1823.</li>
 <li>Padua, D. A., Bell, D. R., &amp; Clark, M. A. (2012). Neuromuscular characteristics of individuals displaying excessive medial knee displacement. Journal of athletic training, 47(5), 525
 <ul>
 <li>Exercise Helps Functional Valgus</li>
 </ul>
 
 </li>
 <li>Bell, D. R., Oates, D. C., Clark, M. A., &amp; Padua, D. A. (2013). Two-and 3-dimensional knee valgus are reduced after an exercise intervention in young adults with demonstrable valgus during squatting. Journal of athletic training,48(4), 442-449.</li>
 <li>Ramskov, D., Barton, C., Nielsen, R. O., &amp; Rasmussen, S. (2015). High Eccentric Hip Abduction Strength Reduces the Risk of Developing Patellofemoral Pain Among Novice Runners Initiating a Self-Structured Running Program: A 1-Year Observational Study. journal of orthopaedic &amp; sports physical therapy, 45(3), 153-161</li>
 <li>Snyder, K. R., Earl, J. E., O&rsquo;Connor, K. M., &amp; Ebersole, K. T. (2009). Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running. Clinical Biomechanics, 24(1), 26-34
 <ul>
 <li>Low Back Pain (LPHCD)</li>
 </ul>
 
 </li>
 <li>Ellison, JB., Rose, S., Sahrmann, S. (1990). Patterns of Hip Rotation Range of Motion: A Comparison Between Healthy Subjects and Patients with Low Back Pain. Phys Ther 1990. 70: 537-541</li>
 <li>Cooper, N., Scavo, K., Strickland, K., Tipayamongkol, N., Nicholson, J., Bewyer, D., Sluka, K. Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. J Euro Spine. 26 May 2015
 <ul>
 <li>Loss of Hip Extension:</li>
 </ul>
 
 </li>
 <li>Lewis CL, Sahrmann. 2005 Timing of muscle activation during prone hip extension. Abstract. J Orhop Sports Phys Ther 35(1): A56.</li>
 <li>Tateuchi, H., Taniguchi, M., Mori, N., Ichihashi, N. Balance of hip and trunk muscle activity is associated with increased anterior pelvic tilt during prone hip extension (2013) Journal of Electromyography and Kinesiology 22 (3). 391-397
 <ul>
 <li>Regional Interdependence (Other than Functional Valgus):</li>
 </ul>
 
 </li>
 <li>Souza, T. R., Pinto, R. Z., Trede, R. G., Kirkwood, R. N., &amp; Fonseca, S. T. (2010). Temporal couplings between rearfoot&ndash;shank complex and hip joint during walking. Clinical biomechanics, 25(7), 745-748.</li>
 <li>Franettovich, S. M., Honeywill, C. O. N. O. R., Wyndow, N., Crossley, K. M., &amp; Creaby, M. W. (2014). Neuromotor control of gluteal muscles in runners with achilles tendinopathy. Medicine and science in sports and exercise, 46(3), 594-599.</li>
 <li>Barker, PJ., Hapuarachchi, K.S., Ross, J.A., Sambaiew, E., Ranger, T.A., and Briggs, C.A. (2013). Anatomy and biomechanics of gluteus maximus and the thoracolumbar fascia at the sacroiliac joint. Wiley Online Library. DOI: 10.1002/ca.22233</li>
 <li>Gibbons, S.G.T. (2004) The anatomy of the deep sacral part of the gluteus maximus and the psoas muscle: A clinical perspective. Proceeds of: The 5th Interdiciplinary World Congress on Low Back Pain. November 7-11, Melbourne, Australia.</li>
 <li>Hungerford, B., Gilleard, W., Hodges, P. (2003) Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac <span class="glossaryLink " data-tooltip="Where two or more bones meet.&lt;br /&gt;Etymology: joint (n.) late 13c., &ldquo;a part of a body where two bones meet and move in contact with one another,&rdquo; from Old French joint &ldquo;joint of the body&rdquo; (12c.), from Latin iunctus &ldquo;united, connected, associated,&rdquo; past participle ofiungere &ldquo;join&rdquo; (see &lt;a href=&quot;http://www.etymonline.com/index.php?term=jugular&amp;allowed_in_frame=0&quot;&gt;jugular&lt;/a&gt;). (&lt;a href=&quot;http://www.etymonline.com/index.php?term=joint&quot;&gt;Etymology Online&lt;/a&gt;)">joint pain. Spine 28(14), 1593-1600
 <ul>
 <li>Pathology and Muscle Change:</li>
 </ul>
 
 </li>
 <li>Grimaldi, A, Richardson, C, Stanton, W., Durbridge, G, Donnelly, W. and Hides, J. (2009) The association between degenerative hip joint pathology and size of the gluteus medius, gluteus minimus and piriformis muscles. (2009). Manual Therapy 14. 605-610.</li>
 <li>Grimaldi, A., Richardson, C., Durbridge, G., Donnelly, W., Darnell, R., Hides, J. (2009). The association between degenerative hip joint pathology and size of the gluteus maximus and tensor fascia latae muscles. Manual Therapy. 14. 611-617
 <ul>
 <li>Fascia</li>
 </ul>
 
 </li>
 <li>Carvalhais, VO., Ocarino, Jde M., Ara&uacute;jo, VL., Souza, TR., Silva, PL., Fonseca, ST. (2012). Myofascial force transmission between the latissimus dorsi and gluteus maximus muscles: An in vivo experiment. Journal of Biomechanics 46. 1003-1007</li>
 <li>Stecco, A., Gilliar, W., Hill, R., Fullerton, B., Stecco, Carla. (2013). The anatomical and functional relation between gluteus maximus and fascia lata. Journal of Bodywork &amp; Movement Therapies. 17. 512-517</li>
 <li>Pfirmman CW, Chung CB, Theumann NH, et al.: Greater Trochanter of the Hip: Attachment of the Abduuctor Mechanism and a Complex of Three Bursae - MR Imaging and MR Bursography in Cadavers and MR Imaging in Asymptomatic Volunteers. Radiology 221:469, 2001
 <ul>
 <li>Additional Research</li>
 </ul>
 </li>
 <li>Ezoe, M., Naito, M., Inque, T. (2006). The prevalence of acetabular retroversion among various disorders of the hip. The Journal of Bone and Joint Surgery. 88A (2). 372-379</li>
</ol>

Bibliography

<html><head></head><body>© 2016 Brent Brookbush
Questions, comments and criticisms welcome and encouraged</body></html>

Copyright

A-Band - Refers to the part of the muscle cell that looks darker under a microscope.  This area of the cell is darker due to parallel arrangement of thicker filaments (myosin) and overlap with the thinner filaments (actin).
<ul>
 	<li>As a muscle contracts, the A-band is where actin and myosin interact.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Accuracy - the proportion of individuals correctly identified by the test results.
<ul>
 	<li>For example, a special test with perfect accuracy would imply a test has 100% specificity, 100% sensitivity, 100% positive predictive value and 100% negative predictive values.</li>
</ul>

Action Potential - A rapid change in voltage, resulting in a wave of excitation, that may result in stimulation of a nerve or muscle cell.
<ul>
 	<li>In order for an action potential to be initiated, the resting membrane voltage must exceed the excitation threshold, which then results in a cascade of depolarization and the "wave of excitation." Any stimulus below that threshold will not result in an action potential, and a stimulus greater than the threshold will not increase a single action potential, but may result in additional action potentials.  In this way, the action potential functions more like an on/off switch (all or none), and less like a dimmer switch.</li>
</ul>

A single-joint movement pattern (most often) designed to load a specific under-active muscle(s), while minimizing the contribution of over-active synergists via specific cues/joint motions.
<ul>
 	<li style="text-align: left;">Activation techniques/exercises are performed with the intent of addressing a muscle exhibiting a reduction in activity (tone) as a result of, or contributing to postural dysfunction.</li>
 	<li style="text-align: left;">Activation techniques/exercises cannot be multi-joint movement patterns due to relative flexibility, altered reciprocal inhibition, and synergistic dominance resulting in compensation patterns.</li>
</ul>
Example, <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/activation/gluteus-medius-activation-progression/" target="_blank">gluteus medius activation</a> involves resisted hip abduction while minimizing the contribution of the TFL via hip extension.

Active stretching is a term used to describe a stretch that involves an active contraction of opposing musculature to lengthen a muscle to its end range. Generally these stretches are held for 2-5 seconds and repeated for 8-15 repetitions.

Adenosine triphosphatase (ATPase): is the enzyme responsible for catalyzing (initiating and accelerating) the decomposition of ATP to ADP.
<ul>
 	<li>This dephosphorylation (breakdown) reaction releases energy for processes like muscular contraction.</li>
</ul>

Adenosine triphosphate (ATP): The molecule that functions as a universal energy-transfer molecule, providing most of the energy associated with muscular contraction and human movement. ATP is composed of an adenine group, a ribose group, and three molecules of inorganic phosphates.
<ul>
 	<li>Energy is provided when hydrolysis results in the cleaving of a phophate group; resulting in adenosine diphosphate, an inorganigic phosphate group, and energy.</li>
</ul>

Algometry - measuring the amount of pressure to result in sensitivity or pain, using an algometer.
<ul>
 	<li>Generally, research uses algometry to establish a minimum pain pressure threshold (PPT), in which a lower PPT implies more sensitivity and pain, and a higher PPT implies less sensitivity and pain. PPT is a common outcome measure in trigger point research.</li>
</ul>
<a href="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg"><img class="aligncenter wp-image-140177" src="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg" alt="Image of an Algometer" width="500" height="333" /></a>

All-or-none principle - a nerve or muscle cell's response to a stimulus is independent of the strength of the stimulus. If that stimulus exceeds the threshold potential (threshold of an action potential), the nerve or muscle fiber will respond completely; otherwise, there is no response.

Example, when a motor unit in the biceps brachii is stimulated it contracts the same way whether a 10 lb or 50 lb dumbbell is lifted.  It is actually the number of muscle cells and the size of the motor unit that determines force output.

&nbsp;

The transition period between eccentric load and concentric contraction during a repetition of an exercise.  This term is most often used in reference to power/plyometric exercises, in which a shorter amortization phase is believed to be beneficial.  The shorter amortization phase may better use the stored energy from the elastic deformation of connective tissue and enhance synchronization of myotatic (stretch) reflex with maximum voluntary contraction.

Example, the athlete was cued to spend as little time as possible in the bottom of their squat stance (the amortization phase) during a set of box jumps.

Muscles that oppose the prime mover and synergists for a given joint action.

That is, all the muscles that can perform the opposing joint action.

Example: The triceps and anconeus are antagonists during elbow flexion.

An anatomical direction; toward the front

Example, the face is on the anterior aspect of the head

Appendicular Skeleton - referring to the bones the bones of the arms and legs, as well as the bones that support them. This includes the pelvis, clavicle and scapula. There are approximately 126 bones in the appendicular skeleton.
<ul>
 	<li>Etymology - Appendicular, as in appendage, "that which is appended to something as a proper part," 1640s, from <a class="crossreference" href="https://www.etymonline.com/word/append?ref=etymonline_crossreference">append</a> + <a class="crossreference" href="https://www.etymonline.com/word/-age?ref=etymonline_crossreference">-age</a>. - <a href="https://www.etymonline.com/word/appendage" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Appendicular skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/axial-skeleton/" target="_blank" rel="noopener">axial skeleton</a>".

A reflexive decrease in muscle activity due to joint dyskinesis.
For example, a reduction in deep cervical flexor activity as a result of cervical spine dyskinesis.

Arthrokinematic Motion - Small amplitude motions between bone surfaces at a joint.  The arthrokinematic motions are roll, glide (slide or translation), spin, compression and distraction (traction). Arthrokinematic motions accompany osteokinematic motions to maintain joint congruence.
<ul>
 	<li>Example, arthrokinematic motion of the talus includes posterior glide on the tibia during ankle dorsiflexion.</li>
</ul>
Synonyms include: arthrokinematics, passive accessory motion, joint play and component motion

&nbsp;

Assessment - is the act of assessing, i.e. determining the importance, size, or value of -

In most cases, the results of an assessment are compared to normative data. If the individual exhibits values that are within normal parameters, it may be assumed that the aspect of health or motion assessed is not contributing to the patient's complaint, symptoms or movement impairment. If the results fall outside of normal parameters, it may indicate that the aspect of health or motion assessed is contributing to, or being affected by the patient/client's complaint, symptoms, or movement impairment. In some cases, the results of an assessment are compared to an "ideal model." In this case, deviations from the ideal are noted as potential issues. For example, deviations noted in the <a title="Introduction to the Overhead Squat Assessment" href="https://brentbrookbush.com/online-courses/articles/assessment/introduction-overhead-squat-assessment/" target="_blank">Overhead Squat Assessment</a> are compared to an "ideal model" of posture and motion.

Assessments used by human movement professionals can be divided into three broad categories:
<ul>
 	<li>"Clear" the Patient/Client for Intervention - These are tests, assessments and evaluations used to determine if a patient/client's issue may improve given the assessing professional's scope, skills, abilities and willingness to treat that individual.
<ul>
 	<li>For example, many of the special tests used in orthopedic medicine assist in determining the level of pathology or likelihood of a particular diagnosis. Certain issues and diagnoses are beyond the scope of the human movement professional, and are better treated by diagnostic professionals in the medical community (physicians, podiatrists, surgeons, etc.). A Calf Squeeze (Thompson) Test is one example, in which a positive sign may indicate a rupture of the Achilles tendon that may be better treated via surgical intervention.</li>
</ul>
</li>
 	<li>Highlight Contraindications - Tests, assessments and evaluations used to stratify risk or preclude a professional from addressing certain tissues, motions or using a particular technique.
<ul>
 	<li>For example, the Vertebral Artery Test (VBI) is often used to determine if high velocity thrust mobilizations (manipulations) are safe for a patient with cervical dysfunction.</li>
</ul>
</li>
 	<li>Refine Exercise/Intervention Selection: Tests, assessments and evaluations used to assist the professional in determining which techniques, modalities and exercises will best address a patient/client's complaints or desired goals.
<ul>
 	<li>Most movement assessments fall into this category. For example, a positive <a href="https://brentbrookbush.com/vimeo_videos/elys-test-rectus-femoris-flexibility-assessment/" target="_blank">Ely's Test</a> may indicate a need to release and/or lengthen the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/rectus-femoris/" target="_blank">rectus femoris</a>.</li>
</ul>
</li>
</ul>
Note: An assessment, or assessment result, may fall into more than one category. For example, although goniometry is an assessment most often used to Refine Exercise/Intervention Selection, if a range of motion is significantly altered, with an abnormal end-feel, and/or causes the patient or client/pain, the individual may need to be referred to a physician for further testing and Clearance to resume rehab activities.  Further, that same patient may return to the human movement professional with a list of Contraindicated Activities from the physician. - "When in doubt, refer out!"

Axial Skeleton - referring to the bones of the head, neck, trunk and spinal column (does not include pelvis). There are approximately 80 bones in the axial skeleton.
<ul>
 	<li>Etymology - Axial, as in "axis", referring to "imaginary motionless straight line around which a body (such as the Earth) rotates," from Latin axis "axle, pivot, axis of the earth or sky" - <a href="https://www.etymonline.com/word/axis" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Axial skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/appendicular-skeleton/" target="_blank" rel="noopener">appendicular skeleton</a>".

Balance - The ability to maintain a body’s center of mass over its base of support. Balance can be static or dynamic.
<ul>
 	<li>For example, maintaining balance is harder on one leg because the center of mass must stay over a much smaller base of support.</li>
</ul>

A ball and socket joint (also called a spheroid joint or spheroidal joint) is a synovial joint in which the rounded or spherical end of one bone fits into a cup-like depression of another bone. The distal bone is capable of motion around an indefinite number of axes, which have one common center. Examples include the hip and shoulder (glenohumeral joint)

Base of support (BoS) - refers to the area beneath an object or person, and the area within the perimeter created by every point of contact that the object or person makes with the supporting surface. This may include the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/gluteus-maximus/" target="_blank" rel="noopener">glutes</a> of someone sitting on a chair, or the back of someone leaning against a wall.
<ul>
 	<li>For example, during a single leg balance the BoS is the area of the foot in contact with the surface; however, when a person is standing on two feet, the BoS is the area of both feet and the surface between them.</li>
</ul>

Pertaining to both sides

Example, bilateral rows are performed with both arms at the same time.

Case-control Study - a particular form of retrospective study that samples a matched group of people who have, and do not have the outcome being studied. A case-control study is a quasi-experimental design, often used in medicine to aid in determining potential contributing factors (cannot determine causality). In this study type exposure is the dependent variable and outcome is independent.
<ul>
 	<li>Example, in this retrospective case-control, medical records were investigated for trends correlated with cervical pain (1).
<ol>
 	<li>Mäkela, M., Heliövaara, M., Sievers, K., Impivaara, O., Knekt, P., &amp; Aromaa, A. (1991). Prevalence, determinants, and consequences of chronic neck pain in Finland. American journal of epidemiology, 134(11), 1356-1367.</li>
</ol>
</li>
</ul>

An anatomical direction; toward the tail, relative to humans this term is often used to refer to "in the direction of the tale (toward the feet)".

Example, to release the trapezius muscle the therapist used a force directed caudally.

Center of mass (CoM) - an object's mean position of mass; that is, a point that is perfectly surrounded by an equal amount mass in all directions.

Center of gravity (CoG) - point where gravity appears to act. Since the human body is so small compared to the earth, we can assume gravity acts uniformly on the body, and that CoG and CoM are the same.
<ul>
 	<li>Example, the CoM of the human body while lying down or standing straight up is close to our navel. However, it is possible that during a resistance exercise, the combination of the body's weight and the weight of the resistance will place the combined CoM outside the body. For example, during the mid-portion of a <a href="https://brentbrookbush.com/vimeo_videos/back-squat/" target="_blank" rel="noopener">back squat</a> the CoM would be several anterior to the naval.</li>
</ul>

An anatomical direction; toward the head (synonym: cranial)

Example, hip pain was felt with any force directed cephalad.

Cohort Study - a particular form of longitudinal study that samples a cohort (a group of people who share a defining characteristic), performing a cross-section at intervals through-out a period of time. A cohort study is a quasi-experimental design often used in medicine to aid in determining etiology or a cause-and-effect relationship. In this study type exposure is the independent variable and outcome is dependent.
<ul>
 	<li>Example, the study by Cholewicki et al. (1) investigated Yale Varsity Athletes (the cohort) with 2 and 3 year follow up (longitudinal design) and found that trunk muscle response time to off-loading was predictive of future low back injury.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/core/increased-trunk-muscle-latency-may-cause-rather-than-result-from-low-back-pain/" target="_blank" rel="noopener noreferrer">Cholewicki, J., Silfies, S., Shah, R., Greene, H., Reeves, N. Alvi, K., Goldberg, B. (2005). Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 30(23), 2614-2620</a></li>
</ol>

Comparable Sign: A combination of pain, stiffness and/or spasm during examination that is comparable to the patients symptoms.
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

An alternative movement pattern that has been adopted to compensate for dysfunction/impairment in the human movement system.
Example: A lack of calf extensibility may limit dorsiflexion, leading to the knees bowing inward (functional valgus) and excessive forward lean of the torso during a squat.

An arthrokinematic motion - the approximation of joint surfaces; that is, a force that directs one bone surface into another resulting in a reduction in intra-articular volume. Although widely thought of as a "destructive force", it is likely best to consider compression as a naturally occurring, stabilizing force. Any arthrokinematic force in excess (spin, glide, roll, traction) may be viewed as potentially deleterious.

For example, during a squat the femoral head is compressed into the acetabulum by muscular forces, bodyweight and any additional external load.

Concave (Concavity) - Having an outline or surface curved like the interior surface of a bowl or sphere - to cave-in or curve inward.
<ul>
 	<li>Example, the internal surfaces of the pelvis is concave, holding some of the bodies viscera.</li>
</ul>

Concordant Sign - The patient's specific pain, symptom or complaint. 
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

Conductivity: Stimulation results in more than a local effect (1).
<ul>
 	<li>For example, in a muscle cell the stimulation of a motor endplate results in a change in cell membrane polarity that rapidly propagates (is conducted) along the entire length of the muscle cell, stimulating all sacromere.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

A condyloid joint (also called condylar, bicondylar, ellipsoid, or ellipsoidal) is an ovoid articular surface, or condyle, that is received into an elliptical cavity.  These joints permit movement in two planes.  Examples include the knee, metacarpophalangeal joints and metatarsophalangeal joints.

Connective Tissue Cell - One of the four basic types of animal tissue, consisting mostly fibers and ground substance.  These cells are specialized to binds organs together, holds them in place, protect them from external forces, and may fill space in the body's cavities.

Example, the body's muscles are enclosed in durable connective tissue sheets known as the "epimysium", "perimysium", and "endomysium," which and in support and transmitting force.
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Contractility: The ability to shorten (1).
<ul>
 	<li>Contractility: Muscle cells are unique in the amount they can shorten when stimulated; this is this largerly due to the highly organized and unique arrangement of myofilaments (actin and myosin).</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Pertaining to the opposite side

Example, the external oblique muscle performs contralateral rotation; rotation to the opposite side.

Convex (Convexity) - Having an outline or surface curved like the exterior of a circle or sphere - to bulge or curve outward.
<ul>
 	<li>Example, the top of your head is shaped by the convex exterior surface of your skull.</li>
</ul>

Correlational Research - Non-experimental <a href="https://www.questionpro.com/blog/what-is-research/">research</a> method in which the statistical relationship between two variables is investigated.
<ul>
 	<li>In this research by Kwon et al., a correlation was noted between a decrease in extensibility during a hamstring length test (goniometry) and current knee pain (1).</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/correlation-patellofemoral-pain-syndrome-pfps-hamstring-activity/" target="_blank" rel="noopener">Kwon O, Yun M, and Lee W. (2014). Correlation between intrinsic patellofemoral pain syndrome in young adults and lower extremity biomechanics. J. Phys. Ther. Sci. 26: 961-964</a></li>
</ol>

Counter-nutation - posterior rotation of sacrum relative to ilium, and/or anterior rotation of ilium relative to sacrum.
<ul>
 	<li>The pelvic floor muscles are examples of muscle that may counter-nutate the sacrum.</li>
</ul>
[caption id="attachment_126335" align="aligncenter" width="400"]<a href="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png"><img class=" wp-image-126335" src="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png" alt="Nutation and Counter-nutation of the Sacroiliac Joint" width="400" height="967" /></a> Nutation and Counter-nutation of the Sacroiliac Joint[/caption]

&nbsp;

Crossover (Study) Design - A type of longitudinal, repeated measures quasi-experimental design in which each group receives both treatments, but at different times. It is named "crossover" due to the patients "crossing-over" to the other treatment or sham group after a specified period of time.
<ul>
 	<li>This type of study has the advantage of every individual serving as their own control, which may reduce the influence of confounding variables.</li>
 	<li>Unfortunately, the design itself introduces the chances that anyone receiving the experimental variable in the first period will continue to be effected in the second period.</li>
</ul>
In a study by Senna et al., a cross-over design was used to investigate the difference load made on inter-set rest intervals (1).
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/strength-training-research-corner/heavy-vs-light-load-single-joint-exercise-performance-with-different-rest-periods/" target="_blank" rel="noopener">Senna, G.W., Rodrigues, B.M., Sandy, Scudese, Bianco, A, &amp; Dantas, E.H.M. (2017). Heavy vs light load single-joint exercise performance with different intervals. Journal of Human Kinetics, 58, 197-206. </a></li>
</ol>

Cross-sectional Study - a research design that involves gathering data from a population or representative subset at a specific point in time.
<ul>
 	<li>Example, the study by Karimi-Mobarake et al.(1) investigated the prevalence of genu varum and genu valgum among school children 7-11 years old in Iran.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/low-prevalence-of-genu-varum-and-valgum-among-elementary-school-children/" target="_blank" rel="noopener noreferrer">Karimi-Mobarake, M., Kashefipour, A., Yousfnejad, Z. The prevalence of genu varum and genu valgum in primary school children in Iran 2003-2004. (2005) Journal of Medical Science 5(1). 52-54</a></li>
</ol>

Cytokine - A broad and loose category of small proteins that act through receptors, and are especially important to immune function (inflammation).
<ul>
 	<li>Cytokines include substances such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells. Their definite distinction from hormones is a topic of continued research.</li>
</ul>
&nbsp;

Dependent variable - in research, this is the variable that is changed by the independent variable, most often this is the "outcome" of the study.
<ul>
 	<li>Example, in the study by Cleland et al. (1), the independent variable is "thoracic manipulation," and the dependent variable is "lower trapezius muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/short-term-effects-lower-thoracic-manipulation-lower-trapezius-muscle-strength/" target="_blank" rel="noopener noreferrer">Cleland J, Selleck B, Stowell T, Brown L, Alberini S, St. Cyr H, Caron T. Short-term Effects of Thoracic Manipulation on Lower Trapezius Muscle Strength.  Journal of Manual &amp; Manipulative Therapy. 2004; 12(2): 82-90</a></li>
</ol>

An anatomical direction; further from the trunk or center of the body

Example, the foot is at the distal end of the leg.

An arthrokinematic motion - a force applied to a body part that may result in the separation of joint surfaces, a reduction in intra-articular pressure, and/or an increase in intra-articlar space.

For example, to hang from one's hands (i.g. in preparation for a pull-up) results in a traction force on the glenohumeral joint (shoulder).

An anatomical term of location; back or upper surface

Example, shoe laces may compress tissues on the dorsal surface of the foot

The "drawing-in" maneuver is a common cue used during exercise and rehabilitation programs. A light contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abominis</a> (and potentially the entire <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/core-subsystems/intrinsic-stabilization-subsystem/" target="_blank" rel="noopener">intrinsic stabilization subsystem</a>) achieved by gently pulling the lower abdominal region away from one's waist band. This should have minimal effect on breathing, and should not be confused with a maximal contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abdominis</a> resulting in a "vacuum pose".
<ul>
 	<li>Research often refers to this maneuver as the "abdominal drawing-in maneuver"; abbreviated ADIM.</li>
</ul>
Development and introduction of this cue into practice is based on the pivotal research and resulting text:
<ol>
 	<li>Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004</li>
</ol>

Faulty or abnormal movement; an alteration of normal kinematics.

For example, joint stiffness or a reduction in arthrokinematics motion that results in limited osteokinematic range of motion - inadequate inferior glide of the femoral head resulting in limited abduction of the hip.

The seeping into, or abnormal collection of fluid in a body cavity.

For example, knee effusion describes swelling within the knee joint.

Note: the word "effusion" is used differently in medicine than it is used in reference to the movement (seeping out) of liquids and gases, for example in chemistry.

&nbsp;

A trait of body tissues that allows a tissue to return to its resting length or state after deformation or stretch.
Example:  Muscle is elastic tissue; many muscles will return to their resting length after being stretched to 150% of that length without any appreciable change in tissue quality.

Elasticity: Elasticity refers to the ability of a cell to return to its resting length after being stretched/lengthened.
<ul>
 	<li>Note: this term is often confused with extensibility. Elasticity is not the ability to stretch; it is the ability to return to normal length after being stretched. Muscle tissue, connective tissue and even nerve tissue have varying levels of elasticity.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Epithelial cell - One of the four basic cell types, found lining the body's cavities, blood vessels, organs and constitutes most gland tissue.  These cells are specialized to aid with absorption, secretion, or act as a barrier from foreign objects.
<ol>
 	<li>Saladin, K. S., &amp; Miller, L. (1998). Anatomy &amp; physiology. New York (NY): WCB/McGraw-Hill.</li>
</ol>

Equilibrium - a state in which opposing forces or influences are balanced.
<ul>
 	<li>For example, to maintain a neutral trunk while pushing or pulling a weight in one hand, your core musculature must balance the force by creating an equal amount of force in the opposite direction.</li>
</ul>

The study of causation, or origination. The word is commonly used in the medical professions, where it may refer to the study of why things occur, or the reason behind why things act a certain way.

For example, the etiology of low back pain is a complex subject, with multiple contributing factors and various structures implicated.

<div class="gs_citr" tabindex="0">Evidence-based medicine (practice) is the integration of best research evidence with clinical expertise and patient(client) values (2)."</div>
<ul>
 	<li class="gs_citr" tabindex="0">...the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (clients).  It involves the integration of at least (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve (1).</li>
</ul>
&nbsp;
<ol>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., &amp; Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. Bmj, 312(7023), 71-72.</li>
 	<li class="gs_citr" tabindex="0">Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1</li>
</ol>

Excitability: The ability of a cell to change in membrane conductance as a response to stimulation.

<ul>
 	<li>For example, muscle cells are specialized to react to a change in membrane potential with contraction, where as nerve cells are specialized to propagate a change in membrane potential along there axons and communicate that message to other tissues via neurotransmitters.
</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Excitation threshold: The level that a depolarization must reach for an action potential to occur.
<ul>
 	<li>The excitation threshold is a contributing factor to the "all-or-none" response of muscle and nerves cells to a stimulus.</li>
</ul>

Exercise Progression - Modification of an exercise with the intent of promoting adaptation by increasing demand. This can be accomplished by increasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise progression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise, or series of exercises that make it harder to maintain stability with good form.
<ul>
 	<li>Sample Exercise Progression: <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a></li>
</ul>
</li>
</ul>

Exercise regression - The opposite of progression; that is, modification of an exercise with the intent of reducing demand. This can be accomplished by decreasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability. Generally, regressions are used to modify an exercise to the client's current level of ability, with the intent of improving form, motor learning and retention.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise regression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise or series of exercises that make it easier to maintain stability with good form.
<ul>
 	<li>Sample Exercise Regression: <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a></li>
</ul>
</li>
</ul>

Experimental Research - Studies in which the researchers introduce the variable to be studied, with the intent of observing the outcome. This is different than observational research which observes the effect of a variable already present. Many texts also assert that experimental research should include randomization and ideally a control group, as is seen in Randomized Control Trials. Studies in which the variable is introduced by the researchers, but participants are not randomized may be considered Quasi-experimental research.
<ul>
 	<li>In this study by Esformes, the experimental variable was squat depth and the outcome measures observed were various performance measures related to power (1).</li>
</ul>
<ol>
 	<li><a href="https://brookbushinstitute.com/article/back-squat-depth-lower-body-post-activation-potentiation/" target="_blank" rel="noopener">Esformes, J., &amp; Bampouras, T. (2013). Effect of back squat depth on lower-body postactivation potentiation. Journal of Strength and Conditioning Research, 27(11), 2997-3000.</a></li>
</ol>
&nbsp;

Extensibility: The ability of a cell to be stretched or lengthened without damage (1).
<ul>
 	<li>For example, most cells would rupture with even a modest stretch, but muscles can stretch up to 3 times their contracted length.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

False Negative - the proportion of negatives in a group that were assessed incorrectly (assessed as negative when the patient was actually positive)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

False Positive - the proportion of positives in a group that were assessed incorrectly (assessed as positive when the patient was actually negative)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

The function of fascia is to transmit force, provide support, and protect tissues. Fascia can effect motion by:
Transmitting force from one or more muscles (example: the thoracolumbar fascia)
Restricting motion in cases of adaptive shortening and/or adhesion to proximal structures (example: iliotibial band in cases of lower-leg dysfunction)
Elastic recoil after stretching can contribute to force production (example: plyometric exercise)

Note: There is evidence that fascia may house more receptors related to human movement than other tissues. In this way fascia may act as a motherboard for the nervous system

The fascial system does not contract or develop trigger points, and its capacity to adapt to stretching and or strengthening exercise is limited, especially when compared to the adaptive capacity of muscle tissue.

Fibromyalgia - A loosely defined diagnosis that is associated with a combination of widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. Consideration may also be given to the presence of psychosocial stressors and inflammatory disease in the patients history. Newer research suggests that fibromyalgia may be at least in part due to central sensitization of myofascial pain, often associated with trigger points (1 - 4).
<ol>
 	<li>Wolfe, F. (2018). Fibromyalgia Syndrome and Fibromyalgia Syndrome Criteria: Problems in Definition and Validity. Fibromyalgia Syndrome and Widespread Pain: From Construction to Relevant Recognition.</li>
 	<li>Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., ... &amp; Fam, A. G. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis &amp; Rheumatism: Official Journal of the American College of Rheumatology, 33(2), 160-172.</li>
 	<li>Alonso-Blanco, C., Fernandez-de-las-Penas, C., Morales-Cabezas, M., Zarco-Moreno, P., Ge, H. Y., &amp; Florez-García, M. (2011). Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. The Clinical journal of pain, 27(5), 405-413.</li>
 	<li>Staud, R., Nagel, S., Robinson, M. E., &amp; Price, D. D. (2009). Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. PAIN®, 145(1-2), 96-104.</li>
</ol>
&nbsp;

Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.
Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.

An increase in joint stability via compressive forces resulting from muscular contraction and increased tension in fascial structures (1,2).
<ul>
 	<li>This term is most often used in reference to core intrinsic stabilizers, the thoracolumbar fascia and the sacroiliac joint; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Form closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

The relative contribution of joint shape and structure to the stability of a joint (1,2).
<ul>
 	<li>This term is most often used in reference to the "rough" articulating surfaces of the sacroiliac joint and the wedge shape of the sacrum; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Force closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

An arthrokinematic motion - linear motion across a joint surface parallel to the plane of the adjacent joint surface, just as your posterior moves relative to a "slide" in a park.

For example, the glide of facet joint in the spine during spinal flexion and extension, or the posterior glide of the humeral head that must accompany anterior roll to maintain congruence with glenoid fossa during shoulder horizontal adduction.

A plane joint (also called an arthrodial joint, gliding joint or plane articulation) is a synovial joint which allows only gliding movement in the plane of the articular surfaces. The opposed surfaces of the bones are flat or almost flat, with movement generally limited by tight capsules and ligaments. Plane joints are numerous, are most often small, and allow very little motion.  Examples include the carpal joints of the wrist, the tarsal joints of the ankle, and the facet joints of the spine.

"...refers to the measurement of angles, in particular the measurement of angles created at human joints by the bones of the body (1).

&nbsp;
<ol>
 	<li>Cynthia C. Norkin, D. Joyce White. Measurement of Joint Motion: A Guide to Goniometry 3rd Edition. Copyright (C) 2003 by F.A. Davis Company</li>
</ol>

Ground reaction force (GRF) - The force exerted by the ground on the body in contact with it.

For example, when a runner's foot strikes the ground with a force equal to the mass of the individual times their acceleration due to gravity, momentum and muscular exertion, the ground exerts an equal and opposite force on the runner's foot.
<ul>
 	<li>GRF is often measured in research studies using force plates as a means of quantitatively measuring the force generated by an individual.</li>
</ul>

H-Band - Refers to the central zone of a sarcomere that looks lighter under a microscope.  This area of the sarcomere is a lighter portion of the A-band where there is no overlap between the thinner filaments (actin), and the thicker filaments (myosin).
<ul>
 	<li>Example, when a muscle contracts, actin and myosin cross-bridging occurs in the region of the A-band until the H-band is reached where no overlap occurs.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

A hinge joint (also called a ginglymus) is a synovial joint in which the articular surfaces fit one another in a way that only permits motion in one plane. Examples include the elbow, the knee (unless considered a condyloid joint) and the interphalangeal joints.

Holism (holistic) (biological holism) - (from Greek holos "all, whole, entire") is the idea that systems and their properties should be viewed as wholes, not just as a collection of parts.
<ul>
 	<li>Summarized by Aristotle in his "Metaphysics": "The whole is more than the sum of its parts". However, the term "holism" was introduced into language by the South African statesman Jan Smuts as recently as 1926. (Smuts J. C. 1987 [1926]. Holism and evolution. Cape Town: N &amp; S Press.)</li>
</ul>
Example: The Brookbush Institute promotes a holistic approach to human movement science, in which the muscular, fascial, articular and neural systems are not viewed as separable and all proximal segments are considered.

Hormone: Chemical messengers produced by the endocrine system, transported via tissue fluids such as blood, to stimulate cells to "act."
<ul>
 	<li>Example: Growth hormone is secreted by the pituitary gland in the brain; stimulating growth, cell reproduction and cell regeneration in certain types of cells</li>
</ul>
The English physician E. H. Starling discovered in collaboration with the physiologist W. M. Bayliss secretin, the first hormone, in 1902. (1).
<ol>
 	<li>Henriksen, J. H., &amp; de Muckadell, O. S. (2000). Secretin, its discovery, and the introduction of the hormone concept. Scandinavian journal of clinical and laboratory investigation, 60(6), 463-472.</li>
</ol>

A range of motion achieved by the patient/client that is more than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If an individual can place their forehead on their knees they are likely hypermobile at one, if not several joints

Example 2: 110° of shoulder external rotation would be considered hyper-mobile.

Hyperplasia is an increase in organic tissue size due to an adaptive increase in the number of cells per organ.
<ul>
 	<li>Although muscle hyperplasia has been noted in some animals, human muscle tissue does not seem to have this adaptive ability.</li>
</ul>

A condition of excessive tone of the skeletal muscles; increased resistance of muscle to passive stretching.  May be related to increased neural drive, synergistic dominance, trigger points, reflexive over-activity, and/or muscle length.
Example:  Individuals who exhibit ankle eversion and abduction during an overhead squat assessment likely have hypertonic fibularis (peroneal) muscles.

Muscular hypertrophy is an increase in muscle mass/size due to increase in the volume and cross-sectional area (CSA) of individual muscle cells. The increase in cross-sectional area can be attributed to an an increase in contractile proteins and structural elements (myofibrillar hypertophy), as well as an increase in glycogen storage and elements related to metabolism (sarcoplasmic hypertophy). Hypertrophy is an adaptation of both cardiac and skeletal muscle fibers in response to progressive increases in workload.
<ul>
 	<li>Note: Hypertrophy is not hyperplasia. Hyperplasia is an increase in muscle size due to an adaptive increase in the number of muscle fibers/cells per muscle. This type of adaptation does not occur in human muscle tissue.</li>
</ul>

A range of motion achieved by a patient/client that is less than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If the end range of shoulder external rotation is reached and measured as 75° during goniometric assessment, the client/patient is exhibiting hypomobility of the glenohumeral joint (shoulder).

Hypothesis - a proposed explanation for a phenomenon; "scientific hypotheses" are generally constructed in a way that is testable or falsifiable.
<ul>
 	<li>Example: The hypothesis, "excessive knee valgus may be correlated with future knee pain and injury," has been the subject of several studies published over the last decade.</li>
</ul>

Diminished tone of skeletal muscles; diminished resistance of muscles to passive stretching.   May be related to inhibition, reciprocal inhibition, arthrokinematics inhibition and/or  increased resting length of muscle.
Example:  If your knees cave (hip adduction) during a squat or leg-press it is likely that your gluteus medius is hypotonic.

I-Band - Refers to the part of the muscle cell that looks lighter under a microscope.  This area of the cell is lighter due to parallel arrangement of thinner filaments (actin), and no overlap with the thicker filaments (myosin).
<ul>
 	<li>As a muscle contracts, the I-bands will decrease in width and move closer to one another.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Independent variable - in research, this is the variable or phenomenon being manipulated in the study.
<ul>
 	<li>Example, in the study by Ghanbari et al. (1), the independent variable is "knee joint mobilization", the dependent variable is "quadriceps muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/effect-knee-joint-mobilization-quadriceps-muscle-strength/" target="_blank" rel="noopener noreferrer">Ghanbari A. and Kamalgharibi S. (2013). Effect of knee joint mobilization on quadriceps muscle strength. International Journal of Health and Rehabilitation Sciences. 2(4): 186-191</a></li>
</ol>

An anatomical direction; toward the bottom (below)

Example, the mouth is inferior to the eyes

A reduction in neural drive, muscular activity, and or force output due to altered neuromuscular reflex.  Alterations in neuromuscular reflex may occur due to increases in muscle length (hypothesis: increased excitation threshold), altered reciprocal inhibition in response to increased antagonist tone, and or alterations in joint motion (arthrokinematics inhibition).

Making a whole of parts.

Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.

Intermuscular Coordination - Optimal timing and motor unit recruitment of agonists, antagonists, synergists, neutralizers, stabilizers and fixators.

Example: Role of Muscles during Hip Extension
<ul>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Prime Mover" href="https://brentbrookbush.com/glossary/prime-mover/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Prime Mover&lt;/div&gt;The muscle most responsible for a joint action under load -&lt;br /&gt;&lt;br /&gt;That is, the muscle that can produce the most force for a given joint action. Often this term is used synonymously with the term agonist. The prime mover as defined above, may or may not be the most active muscle for a joint action during activities of daily living.&lt;br /&gt;&lt;br /&gt;Example: the gluteus maximus is the most powerful hip extensor and therefore the prime mover; however, the hamstrings are likely the most active hip extensors during low level activities like walking or standing.">Prime Mover</a>:  <a href="https://player.vimeo.com/external/82855344.hd.mp4?s=54c3e7d98fb9d4e0af8d282c85ba9b3e">Gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Synergists" href="https://brentbrookbush.com/glossary/synergists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Synergists&lt;/div&gt;Muscles that assist the prime mover in performing a joint action.&lt;br /&gt;&lt;br /&gt;That is, all muscles that can perform a joint action that are not the prime mover, are termed synergists.&lt;br /&gt;Example: The rectus abdominis is the prime mover of spinal flexion. All other muscles that can perform spinal flexion are synergists including – external obliques, internal obliques and psoas.">Synergists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/biceps-femoris/">Biceps femoris (long head)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/semitendinosus-and-semimembranosus/">semitendinosus, semimembranosus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">posterior head of adductor magnus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Antagonist" href="https://brentbrookbush.com/glossary/antagonists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Antagonist&lt;/div&gt;Muscles that oppose the prime mover and synergists for a given joint action.&lt;br /&gt;&lt;br /&gt;That is, all the muscles that can perform the opposing joint action.&lt;br /&gt;&lt;br /&gt;Example: The triceps and anconeus are antagonists during elbow flexion.">Antagonists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/psoas/">Psoas</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/iliacus/">iliacus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/tensor-fascia-latae-tfl/">tensor fascia latae</a> (TFL),<a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-femoris/"> rectus femoris</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">anterior adductors (especially pectineus)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/sartorius/">sartorius</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Neutralizer" href="https://brentbrookbush.com/glossary/neutralizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Neutralizer&lt;/div&gt;Muscles that oppose unwanted joint motions created by the prime mover and/or synergists, and/or muscles that prevent unwanted ancillary motion.&lt;br /&gt;Example: The teres minor and infraspinatus neutralize the internal rotation force created by the pectoralis major during horizontal adduction of the shoulder.">Neutralizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-minimus/">Gluteus minimus</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-medius/">anterior fibers of gluteus medius</a> neutralize external rotation force of <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-maximus/">gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Stabilizer" href="https://brentbrookbush.com/glossary/stabilizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Stabilizer&lt;/div&gt;Muscles whose primary role is to improve arthrokinematics by maintaining optimal alignment of joint surfaces.&lt;br /&gt;&lt;br /&gt;Most often these muscles are the most intrinsic muscles of a joint, have a larger percentage of Type I muscle fibers and are rich in proprioceptors.&lt;br /&gt;Example: The muscles of the rotator cuff act as stabilizers for most shoulder motions.">Stabilizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/deep-rotators-of-the-hip/">Deep rotators of hip</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Fixator" href="https://brentbrookbush.com/glossary/fixators/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Fixator&lt;/div&gt;Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.&lt;br /&gt;Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.">Fixators</a>: <a href="https://brentbrookbush.com/articles/core-subsystems/intrinsic-stabilization-subsystem/">Intrinsic stabilization subsystem</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-abdominis/">rectus abdominis</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/internal-obliques/">internal</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/external-obliques/">external obliques</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/quadratus-lumborum/">quadratus lumborum</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/erector-spinae/">erector spinae</a></li>
</ul>
&nbsp;

Example from: <a href="https://brentbrookbush.com/articles/anatomy-articles/introduction-to-functional-anatomy/kinesiology-of-the-hip/" target="_blank" rel="noopener">Introduction to Functional Anatomy: Kinesiology of the Hip</a>

Intramuscular coordination refers to the coordinated recruitment of motor units within a single muscle. This concept is used to explain increases in maximal strength and power; however, the coordinated and sequential recruitment of motor units is also essential to strength endurance and smooth coordinated motion.  Related terminology may include; motor unit recruitment, preferential recruitment, rate coding, sequence, etc..

Example: It is hypothesized that the "shaking" noted during a novice exercisers attempt at an activity like the <a href="https://brentbrookbush.com/vimeo_videos/ball-crunch-and-progressions/" target="_blank">stability ball crunch</a> may be due to relatively poor intramuscular coordination. Rather than smooth, sequential firing of rectus abdominis motor units, groups of motor units turn on and off in an uncoordinated manner.

Pertaining to the same side

Example, the quadratus lumborum performs ipsilateral flexion; lateral flexion toward the same side as the muscle.

An isoform, or variant, is a member of a set of similar proteins, that originate from the same gene, or gene family.
<ul>
 	<li>Example, the variations in myosin heavy chain proteins (MHC I, MHC IIA, MHC IIB/X) that contribute to the characteristic differences between muscle fiber types.</li>
</ul>

“The Prime Assumption”
Everything crossing a joint will influence joint motion during every joint action.

A concept that has expanded over the past several decades to describe the integration of 4 body systems (muscle, joints, fascia and nerves), as well as, the coordinated function of various body segments (e.g. hip, knee and ankle) to produce motion. Kinetic referring to motion, and chain being an analogy for the interdependent link between systems.

Example, the posterior kinetic chain, refers to the integrated function of nerves, muscles, fascia and joints on the posterior side of the body.

The concept of the kinetic chain was originally adapted from the work of a mechanical engineer named Franz Reuleaux (Kinematics of Machinery (1875)) by Dr. Arthur Steindler in 1955 (Steindler A: Kinesiology of the Human Body. Springfield, IL, Charles C. Thomas Co.. 1955).

Latent Trigger Point - A myofascial trigger point that is not painful at rest, only painful when palpated, and may or may not exhibit a characteristic referral pain pattern when palpated.  Latent trigger points do result in an acute point of sensitivity, in a taut band of muscle, and may restrict range of motion (1).

Note: Based on the clinical experience, the Brookbush Institute suggests that latent trigger points (sometimes refereed to as Tender Points) are more common than active trigger points. Further, they are likely addressed more often than trigger points; being the intended target of many soft-tissue mobility techniques.
<ol>
 	<li>David G. Simons, Janet Travell, Lois S. Simons, Travell &amp; Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens</li>
</ol>

An anatomical direction; further from the midline

Example, the anterior deltoid is lateral to the pectoralis major

Length/Tension Relationship - The amount of force generated by a muscle is dependent on sarcomere length.
<ul>
 	<li>The ability of sarcomere to maximally produce force occurs when sarcomere length results in optimal overlap between actin and myosin. Stretching a sarcomere decreases overlap between actin and myosin filaments and reduces force production (1-3). When length is less than optimal, actin from opposite ends overlap and interfere with cross-bridging, and myosin filament are compressed as they contact the the Z-disk also reducing force (4)</li>
</ul>
<ol>
 	<li>Gordon, A. M., Huxley, A. F., &amp; Julian, F. J. (1966). The variation in isometric tension with sarcomere length in vertebrate muscle fibres. The Journal of physiology, 184(1), 170-192.</li>
 	<li>Edman, K. A. P. (1966). The relation between sarcomere length and active tension in isolated semitendinosus fibres of the frog. The Journal of Physiology, 183(2), 407-417.</li>
 	<li>Lieber, R. L., Loren, G. J., &amp; Friden, J. (1994). In vivo measurement of human wrist extensor muscle sarcomere length changes. Journal of neurophysiology, 71(3), 874-881.</li>
 	<li>Lieber, R. L. (2002). Skeletal muscle structure, function, and plasticity. Lippincott Williams &amp; Wilkins.</li>
</ol>
&nbsp;

Levels of Evidence - Relative to evidence-based practice, levels of evidence are an attempt to describe the strength of the results measured in a clinical trial or research study.  Note: levels of evidence do not supersede the critical evaluation of an experienced professional, and should be viewed as guidelines - a meta-analysis may be poorly constructed (Level IA), and a comparative study (Level III) may employ new technologies and a strong methodology.


The Levels of Evidence used by the Brookbush Institute, as described by Shekelle et al.(1):
<ul>
 	<li class="p1">IA - Evidence from meta-analysis of randomized controlled trials</li>
 	<li class="p1">IB - Evidence from at least one randomized controlled trial</li>
 	<li class="p1">IIA - Evidence from at least one controlled study without randomization</li>
 	<li class="p1">IIB - Evidence from at least one other type of quasi-experimental study</li>
 	<li class="p1">III - Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case-control studies</li>
 	<li class="p1">IV - Evidence from expert committee reports or opinions or clinical experience of respected authorities, or both</li>
</ul>
<ol>
 	<li>Shekelle, P. G., Woolf, S. H., Eccles, M., &amp; Grimshaw, J. (1999). Developing clinical guidelines. Western Journal of Medicine, 170(6), 348.</li>
</ol>

Likelihood Ratios - Likilihood ratios are used for assessing the value of performing a diagnostic test. They use sensitivity and specificity to determine whether a test result usefully changes the practitioner's chance (probability) of reaching the correct assessment. Calculation of likelihood ratios is based on Baye's theorem.
<ul>
 	<li>Positive Likelihood Ratio (LR+) - The ratio of a positive test result in people with the pathology to a positive test result in people without the pathology.</li>
 	<li>Negative Likelihood Ratio (LR-) - The ratio of a negative test result in people with the pathology to a negative test result in people without the pathology.</li>
</ul>

Longitudinal Study - a research design that involves observing the same variables, several times over a period of time.
<ul>
 	<li>Example, the study by Hewett et al. (1) is a type of longitudinal study called a "cohort study." This study investigated whether excessive knee valgus during landing was a predictor of knee injury risk in adolescent females over the course of a season.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/research-review-increased-valgus-during-landing-predicts-acl-injury-in-adolescent-female-athletes/" target="_blank" rel="noopener noreferrer">Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., &amp; Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. The American journal of sports medicine, 33(4), 492-501</a></li>
</ol>

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