Hips and Thighs

Chapter 9 Hips and Thighs

The pelvis, a crucial region of the body, is the area where the lower extremities attach to the axial skeleton through the sacroiliac (SI) joint. The pelvis houses parts of the digestive system and the urinary and reproductive systems. The lower extremities, the trunk, and the spinal column can influence the movements and position of the pelvis, and the positioning of the pelvis can influence the movements and positioning of the lower extremities, the trunk, and the spinal column. Deep postural muscles in this area work hard to maintain spinal stability and proper positioning. This region also contains muscles that can be difficult to access because of the depth at which they are located. Tightness in these muscles can pull the body out of its ideal position. For example, tightness in the gluteal or deep lateral rotator muscles can cause the hip to laterally rotate. This lateral rotation commonly results in a shift of the sacrum, which hikes the hip on the affected side. If there is tightness bilaterally, this may result in a posterior pelvic tilt, which can lead to a flat back or a decrease in the lordotic curvature of the lumbar vertebrae. This flat back syndrome may be a precursor to hyperkyphosis of the thoracic area. Because of this tension in the gluteal and “deep six” musculature, clients may experience low back pain and possibly even headaches.

Muscles of the hip and thigh

Hip flexors

The hip flexors help balance the posterior pelvic muscles. Three key muscles often become tight and shortened as a result of activities of daily living. These are the iliacus, psoas major, and the rectus femoris. The iliacus and the psoas major are often referred to as the iliopsoas because they share the same insertion at the lesser trochanter of the femur. The psoas minor inserts on the superior ramus of the pubis bone and mainly supports the natural lordotic curvature of the spine, but is only found in about 40% of the population. The psoas major originates on the anterior surface of the lumbar vertebrae and runs over the pubis bone and inserts into the lesser trochanter of the femur. This muscle not only helps to flex the hip, but also has an effect on the lordotic curvature of the lumbar vertebrae. The rectus femoris has a proximal attachment at the acetabulum and inserts into the tibial tuberosity. This long muscle plays a role in both hip flexion and leg extension (Figure 9-4).

When these muscles are under constant tension because of ergonomics and habitual postural positioning, they may become tight and shortened. This can result in pulling forward on the lumbar vertebrae, creating hyperlordosis and causing the pelvis to tilt anteriorly. This is commonly seen in people who maintain a seated position for a prolonged period such as office workers, computer programmers, and others who find themselves sitting at a desk for hours every day. It is important to provide education on proper ergonomics, movement, and self-care to these individuals.

Working in the pelvic region is not easy for many therapists and clients. There are cautions and borders that need to be addressed and talked through before addressing these muscles. There are emotional and comfort aspects about working in the lower pelvic region. Some clients find this area too personal or private to allow the therapist’s hands in this area. Other considerations are the internal organs such as the intestines, uterus, kidneys, and bladder. As the iliacus and psoas travel under the inguinal ligament and insert into the lesser trochanter of the femur, there is also the femoral triangle, which needs to be worked around. Body positioning can be useful to help access these muscles in a less invasive way while protecting the comfort of the client.

Jun 4, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Hips and Thighs
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