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Integrated functional anatomy of the hip joint - Bones, joints, palpation, ligaments, nerves, joint anatomy, joint actions, arthrokinematics, muscles, fascia, and range of motion of the hip joint. Highlighting the behaviors in postural dysfunction, lower cross syndrome, hip pain, hip impingement, low back pain, osteoarthritis, dysplasia, and common interventions for the hip joint.

 Hip Joint Anatomy (Pelvifemoral Joint)

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I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

The H.M.S. is the most valuable certificate I have earned and was a fraction of the the cost of my others. Define the best bang for your buck!

Brookbush is the most efficient Personal Training Certification I have ever come across. All the lessons are well thought out and very straight to the point.

I am getting my Master's degree in Kinesiology, and I would like to say that I have benefited greatly from the rich, comprehensive, well-documented scientific content of Brookbush Institute that links theory to practical applications. Proudly I've got my CPT certificate, and I am on my way to get my HMS certificate.

Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

Totally loving the convenience and affordability of this program with my crazy lifestyle! I feel like I am getting a quality education without a massive cost! My favorite part is the videos I can watch in the courses. I learn so much better that way. Once I really spent more time on the site, I figured out how to maneuver around a lot better! I enjoy the sense of humor, as well as the easy explanation, and short tests. And if I am really tired, I can have the computer read me the lessons. 😁

Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

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Integrated Manual Therapist

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) specific exercises, manual techniques, and interventions for dysfunction, pain, posture, and movement impairment. The hip joint is included in the common compensation patterns known as an anterior 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 muscle specific techniques for enhancing sports performance (e.g. lower body (leg) stability, strength, hypertrophy, agility, and power).

Brookbush Institute's most recommended techniques for the Hip Joint (see videos below):

Tensor Fascia Latae (Hip Flexor) Static Manual Release

The hip (acetabulofemoral) joint with boney landmarks labeled 

Course Description:   Hip Joint Anatomy (Pelvifemoral Joint)

Page 2 from the "Hip Joint Anatomy" study guide. Joint types and bones.

Study Guide: Hip Joint Anatomy (Pelvifemoral Joint)

Introduction

: "part of the human body where pelvis and thigh join," Old English hype "hip," from Proto-Germanic *hupiz (cognates: Dutch heup, Old High German huf, German Hüfte, Swedish höft, Gothic hups "hip"), of uncertain origin." (

joint (n): "c. 1300, "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," from Old French joint "joint of the body" (12c.), from Latin iunctus "united, connected, associated," past participle of iungere "join" (see 

The pelvis, including the iliac crest, ishial tuberosity, and pubis

https://thesebonesofmine.files.wordpress.com/2012/01/basic-hip.jpg

The pelvis is comprised of the pubis, ischium, and ilium. These bones intersect in a "Y" 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.

Lateral view of the pelvis and acetabulum with boney landmarks labeled

Lateral View of Pelvis - By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below)Bartleby.com: Gray's Anatomy, Plate 235, Public Domain, https://commons.wikimedia.org/w/index.php?curid=792148[/caption]

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 posterior to the center of the head of the femur. The hyaline cartilage is thickest in the area anterior and superior to the fovea (1).

Interesting Note: The femoral head and center of the axis of rotation of your hip joint is actually medial to the anterior superior iliac spine (ASIS); inferior to the middle one-third of the inguinal ligament. The average width between hip joints in the adult is only about 7" (2). Makes you reconsider what the cue "hip width" really means.

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° at its inferior poles, creating the "acetabular notch" (1). The acetabulum is made deeper by a fibrocartilaginous labrum which extends beyond the "equator" of the femoral head (2). At the inferior poles, the acetabulum becomes wider and transitions into the transverse acetabular ligament, covering the acetabular notch.

 Three angles are commonly discussed in reference to the acetabulum, and coverage of the femoral head.

Center-Edge Angle: Although this angle varies in the adult population, the average measure is roughly 35° 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 superior 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).

Acetabular Anteversion Angle: This is the angle created by the anterior and posterior rims of the acetabulum, as measured in the horizontal plane. The acetabulum normally tilts anteriorly about 20°, exposing more of the anterior side of the femoral head (15)

Lateral Inclination: This is the angle created between a line from the lateral/superior edge to the media/ inferior edge of the acetabulum and a vertical line (line of gravity). This angle should be roughly 50° (3).

You could think of the acetabulum as tilted so that it "faces" more anterior and inferior.

The acetabular angle of the hip joint highlighting acetabular anteversion

Acetabular Angles (Center-edge Angle & Acetabular Anteversion Angle) - Donald A. Neumann, “Kinesiology of the Musculoskeletal System: Foundations of Rehabilitation – 2nd Edition” © 2012 Mosby, Inc. Pg. 474, Figure 12-13

Two angles are commonly discussed relative to the angle between the femoral neck and femoral shaft.


The angle between the femoral neck and medial side of the femoral shaft in the frontal plane. This angle is roughly 140 - 150° at birth but is reduced to an average of 125° 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).

Coxa Valga: > 125º (structurally "longer leg")

Coxa Vara: < 125º (structurally "shorter leg")

Angles of the hip joint including coxa valga, coxa norma, and coxa vara

By Addingrefs - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=6952989

Formed between the bones shaft (lateral axis between the femoral condyles) and the femoral neck. 15° 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).

Anteversion (1, 3): > 15 - 20º (may present with "toe-in" posture)

Retroversion (1): < 8º (may present with "toe-out" posture)

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).

Anteversion angle of the femur

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

Palpation

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:

 - The iliac crest is the large bony ridge that holds your pants up and is often referred to as the "hip" in common language ("put your hands on your hips"). The large bony ridge is actually the superior spine of the ilium (pelvis), and an attachment site for many 

. 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° turn to run inferiorly (PSIS). Now try to identify the iliac crest of your partner.

 - 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° turn to run inferiorly. (If you pass the ASIS you will feel only the soft tissue of the abdomen). The bony corner of the anterior iliac crest is your Anterior Superior Iliac Spine, commonly referred to as your ASIS.

 - 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 slide your fingers deeper into the soft tissue, inferior and medial to the ASIS about an inch. Although you will be palpating through some large tendons (

), you should be able to feel a hard bony mound that is your AIIS.

 - Using the iliac crest palpation above, use your thumbs to trace the iliac crest to its most posterior edge. You will come to a bony corner where the iliac crest seems to make a nearly 90° turn to run inferiorly into the tailbone (sacrum). This corner is the posterior superior 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 lateral to the spinous process.

 - Find the midway point between the ASIS and PSIS on the iliac crest (iliac crest and mid-axillary line). Slide your finger 4 to 6 inches inferior 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.

The hip joint with boney landmarks labeled including the acetabulum, head of the femur, and iliac spine

, https://commons.wikimedia.org/w/index.php?curid=23768321

 Hip Joint Palpation

Capsule and Ligaments

 Flexion 30 – 90, abduction to approximately 30°, and slight external rotation (1,2)

 End range extension, with abduction and internal rotation (1)

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 “open-pack” position.

The hip joint with cartilage, boney landmarks, and ligaments in a cadaver dissection

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

Bursae

Hip bursae including the ischiogluteal, gluteus medius, and iliopsoas bursa

 Hip Joint Bursae

Hip Connective Tissues: Capsule, Ligaments, and Labrum

Nerves

 Femoral nerve (either from direct branches or from muscular branches), obturator nerve, accessory obturator nerve, superior gluteal nerve, and nerve to the quadratus femoris (2). Sensory Innervation of Joint Capsule by Region (14):  

Anteromedial: Branches from the obturator and femoral nerves

Anterior: Branches from the femoral nerve.

Posterior: Branches from the sciatic nerve and nerve to the quadratus femoris

Posterior Medial: Branches from the nerve to the quadratus femoris

Posterior Lateral: Branches from the superior gluteal nerve

The muscles which are innervated by the femoral nerve, which include rectus femoris, sartorius, and adductors

Femoral Nerve - By Anatomist90 - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=44207838

 Hip Nerves

Joint Actions

, piriformis, deep rotators of the hip, posterior capsule, gluteal fascia, sacral fascia, posterior fascia latae, neural restriction (sacral nerve and sacral/lumbar plexus)

Optimal Range of Motion (ROM): 110 - 135° (

, gluteus minimus, anterior capsule, iliofemoral ligament, ischiofemoral ligament, pubofemoral ligament, anterior fascia lata, lateral fascia lata, neural restriction (femoral nerve)

Abductors: Gluteus medius, gluteus minimus, 

, inferior capsule, pubofemoral ligament, medial fascia lata, neural restriction (obturator nerve)

Limited by: Gluteus medius, gluteus minimus, 

, iliotibial band and the vastus lateralis, intertrochanteric band of iliofemoral ligament, neural restrictions (superior and lateral femoral cutaneous)

Optimal ROM: Approximately 10° (Not reliably measured using goniometry)

, and piriformis at greater than 90° of hip flexion

Limited by: Piriformis, deep rotators of the hip, 

, psoas, iliacus, and rarely of clinical significance gluteus medius and 

; posterior capsule, inferior capsule, and neural restriction (sciatic nerve)

Hip Internal Rotation Goniometry in Prone

90/90° Hip Internal Rotation Goniometry in Supine

 gluteus medius, piriformis, deep rotators of the hip, 

, piriformis at greater than 90° of hip flexion, gluteal fascia, and neural restriction (sciatic nerve)

Hip External Rotation Goniometry in Prone

Horizontal Abductors: Piriformis, deep rotators of the hip, g

Optimal ROM: 40 - 60° (Not reliably measured using goniometry)

Limited by: Piriformis, deep rotators of the hip, g

, gluteus medius, posterior capsule, gluteal fascia, medial fascia lata, neural restriction (sciatic nerve)

Optimal ROM: 10° (Not reliably measured using goniometry)

 for a list of prime mover, synergists, antagonists, neutralizers, stabilizers, and fixators for all joint actions.

Note: It may be helpful to visualize these motions while in a standing position.

: Anterior superior iliac spine (ASIS) more than a centimeter below the posterior superior iliac spine (PSIS_ on a horizontal axis. This motion is pelvis on hip 

, and would be affected by, and have the same effect on the tissues described under "Flexion" above.

: ASIS higher than PSIS on a horizontal axis. This motion is pelvis on hip 

, and would be affected by, and have the same effect on the tissues described under "Extension" above.

 (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 "Abduction" above.

 (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 "Adduction" above.

 Contralateral ASIS moving anterior 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 "Internal Rotation" above.

 Contralateral ASIS moving posterior 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 "External Rotation" above.

The posterior hip capsule in a cadaver dissection with boney landmarks and muscles labeled

Cadaveric Dissection of Deep Posterior Hip: By Anatomist90 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=25188053

Arthrokinematics

A cross-sectional view of the hip joint showing the muscles surrounding the acetabulum

Integrated Function

Three images of functional knee valgus (knee bow in) during squatting, jumping, and running

Hip Joint Actions 

Postural Dysfunction

excessive internal rotation, adduction, and flexion

excessive anterior glide, superior glide, 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 extensibility of passive soft tissues (capsule, ligaments, and fascial structures). It should be noted that additional compensatory patterns exist and are relevant to practice; however, in this article, the focus will be given to this pattern, which is presumed to be "most common."

 Excessive hip internal rotation, adduction, and flexion

 Excessive anterior and superior glide, and increased stiffness

Maladaptive Decrease In Length/Extensibility 

Ischiofemoral, iliofemoral and pubofemoral ligaments?

Are these ligaments short and stiff reducing hip extension, or have they been lengthened by the excessive anterior glide of the femoral head?

(Synergistically Dominant - Release Only) 

(Prime Mover Inhibition - Condition via Integrated Patterns)

Hip Dysfunction 

Dr. Brent Brookbush demonstrating a breakdown of the knee bow in sign during an overhead squat

Hip Dysfunction Relative to Predictive Models of Dysfunction

Signs of Altered Joint Motion

Referral pain patterns for lumbopelvic hip joint dysfunction

Signs of Dysfunction

Postural Dysfunction and the Hip Joint

Techniques and Ending Info

Self-administered Hip Mobilization (Lateral Distraction)

Self-administered Hip Mobilization (Anterior to Posterior)

Manual Hip Mobilization

Videos

Levangie, P. K., Norkin, C. C. & Lewek, M.D (2019). Joint Structure and Function; A Comprehensive Analysis. 6th Edition. Philadelphia: FA. Davis Company

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

Phillip Page, Clare Frank, Robert Lardner, 

Assessment and Treatment of Muscle Imbalance: The Janda Approach 

NASM Essentials of Corrective Exercise Training

Hip Joint Anatomy (Pelvifemoral Joint)

Related Courses:

Course Description: Hip Joint Anatomy (Pelvifemoral Joint)

Study Guide: Hip Joint Anatomy (Pelvifemoral Joint)

Introduction to the Hip (Pelvifemoral) Joint

Hip Joint Palpation

Hip Connective Tissues: Capsule, Ligaments, and Labrum
1 Sub Section

Hip Nerves

Hip Joint Actions
2 Sub Sections

Postural Dysfunction and the Hip Joint
2 Sub Sections

Videos
3 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Hip Joint Anatomy (Pelvifemoral Joint)

Related Courses:

Course Description: Hip Joint Anatomy (Pelvifemoral Joint)

Study Guide: Hip Joint Anatomy (Pelvifemoral Joint)

Introduction to the Hip (Pelvifemoral) Joint

Hip Joint Palpation

Hip Connective Tissues: Capsule, Ligaments, and Labrum1 Sub Section

Hip Nerves

Hip Joint Actions 2 Sub Sections

Postural Dysfunction and the Hip Joint2 Sub Sections

Videos3 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Hip Connective Tissues: Capsule, Ligaments, and Labrum
1 Sub Section

Hip Joint Actions
2 Sub Sections

Postural Dysfunction and the Hip Joint
2 Sub Sections

Videos
3 Sub Sections