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The National Academy of Sports Medicine

Integrated Function of the Hip Complex

Course Objectives

Explain the interdependent relationship of the


Hip Complex as it works synergistically to
produce force, reduce force and stabilize the
entire kinetic chain during function
movements
Each muscle has a function in all three planes
of motion

Functional Anatomy: Hip Flexors

Psoas
Iliacus
Sartorius
Tensor Fascia Latae
(TFL)
Rectus Femoris
Adductor Longus
Pectineus

Psoas
Origin
Bodies and transverse
processes of the lumbar
spine

Insertion
Lesser trochanter of the
femur

Innervation
Spinal branches of L2-L4

Psoas
Isolated Function
Flexes hip
Synergistically assists in hip external rotation
Extends, laterally flexes, and rotates lumbar spine

Integrated Function
Decelerates femoral internal rotation at heel strike
Assists in stabilization of the lumbar spine during functional
movements
Decelerates hip extension while accelerating hip external
rotation

Psoas

Chain Reaction
Tight psoas inhibits gluteus maximus, increases
compressive forces in the lumbar spine
Tight psoas inhibits the lumbo-pelvic-hip complex
intrinsic stabilization mechanism which increases
translational and rotational stress in the lumbar
spine during dynamic movement

Iliacus
Origin
Iliac Fossa

Insertion
Lesser Trochanter

Innervation
L2-L4

Iliacus
Isolated Function
Hip Flexion
Hip External Rotation

Integrated Function
Decelerates hip
extension and internal
rotation
Dynamic stabilization of
the lumbo-pelvic-hip
complex

Iliacus
Chain Reactions
Compensates for
weakness in the other
hip flexor muscles
Compensates for weak
intrinsic core stabilizers

Sartorius
Origin
ASIS

Insertion
Proximal, medial surface
of the tibia

Innervation
Femoral Nerve

Sartorius
Isolated Function
Hip flexion, abduction,
external rotation
Knee flexion, internal
rotation

Integrated Function
Decelerates hip
extension, adduction,
and internal rotation
Decelerates knee
extension and external
rotation

Sartorius
Chain Reactions
Transverse plane
compensation at the hip
(internal rotation) and
knee (tibial external
rotation) lengthens this
biarticular muscle

Tensor Fascia Latae (TFL)


Origin
Outer surface of the iliac
crest just posterior to
the ASIS

Insertion
Proximal 1/3 of the ITB

Innervation
Superior Gluteal Nerve

Tensor Fascia Latae (TFL)


Isolated Function
Hip Flexion, abduction,
internal rotation

Integrated Function
Eccentrically decelerates
hip extension, adduction,
and external rotation
Dynamically stabilizes
the LPHC

Tensor Fascia Latae (TFL)


Chain Reactions
Compensates for a weak
gluteus medius
Accelerates femoral
adduction via:
Tibial abduction (during
weight bearing)
Femoral IR function

Rectus Femoris
Origin
Anterior inferior iliac
spine
Superior rim of
acetabulum

Insertion
Patella

Innervation
Femoral N. L2-L4

Rectus Femoris
Isolated Function
Knee extension
Hip flexion

Integrated Function
Eccentrically decelerates knee flexion, adduction, and
internal rotation at heel strike
Dynamically stabilizes the knee
Accelerates extension and external rotation during triple
extension
Decelerates hip extension and knee flexion

Rectus Femoris

Chain Reactions
Weak quadriceps increases eccentric load to the
patellar tendon
Tight rectus femoris creates increased anterior
pelvic tilt, which inhibits the gluteus maximus, thus
creating kinetic chain compensations

Functional Anatomy: Hip Adductors

Pectineus
Gracilis
Adductor Brevis
Adductor Longus
Adductor Magnus

Pectineus
Origin
Pectineal line of the
pubic ramus

Insertion
Pectineal line of the
femur

Innervation
Femoral Nerve

Gracilis
Origin
Pubic symphisis

Insertion
Medial tibial plateu (pes
anserine)

Innervation
Obturator N. L2-L4

Adductor Brevis
Origin
Inferior Pubic Ramus

Insertion
Pectineal Line
Linea Aspera

Innervation
Obturator N. L2-L4

Adductor Longus
Origin
Medial portion of the
superior pubic ramus

Insertion
Linea Aspera of the
femur

Innervation
Obturator N. L2-L4

Adductor Magnus
Origin
Ischiopubic ramus
Ischial tuberosity

Insertion
Linea aspera of femur
Adductor tubercle

Innervation
Obturator N. L2-L4,S1

Adductor Complex
Isolated Function
Adducts, Flexes, and Internally Rotates the femur
Magnus: Adducts, Extends, Externally Rotates the femur

Integrated Function
Works synergistically with gluteus medius, tensor fascia
latae, and quadratus lumborum for frontal plane
stabilization during stance phase
Assists in eccentric deceleration of hip extension, external
rotation and abduction
Adductor magnus assists with hip extension and external
rotation

Adductor Complex

Chain Reactions
Tight adductors increase frontal plane stress at
the knee and hip
Tight adductors cause myokinetic inhibition of the
gluteus medius, leading to compensations by the
quadratus and tensor fascia latae/iliotibial band for
frontal plane stabilization, leading to lumbar spine
and sacroiliac joint dysfunctions

Functional Anatomy: Hip Internal Rotators

Gluteus minimis & Gluteus medius (anterior


fibers)
Tensor fascia latae (TFL)
Adductor longus
Adductor brevis
Pectineus
Hamstrings (medial)

Gluteus Medius
Origin
Posterior ilium b/w the
posterior and anterior
gluteal lines

Insertion
Greater trochanter

Innervation
Superior Gluteal Nerve

Gluteus Medius
Isolated Function
Anterior Fibers
Abduct and internally
rotate the femur

Integrated Function
Dynamically stabilize the
LPHC during single leg
stance
Eccentrically decelerates
frontal plane hip
adduction

Gluteus Minimus
Origin
Ilium b/w the anterior
and inferior gluteal line

Insertion
Greater Trochanter

Innervation
Superior Gluteal Nerve

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Gluteus Minimus
Isolated Function
Abduct and internally
rotates the femur

Integrated Function
Assists in dynamic
stabilization of the LPHC
during single leg stance
Assists in eccentric
deceleration of femoral
adduction

Hip Internal Rotators

Chain Reactions
In the presence of weakness to posterior fibers of
Gluteus Medius:
Anterior fibers of Gluteus Medius compensate
Gluteus Minimus compensates
TFL compensates

Functional Anatomy: Hip Extensors

Gluteus maximus
Hamstrings
Adductor magnus (posterior head vertical
fibers)

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Gluteus Maximus

Origin

Posterior Gluteal line


Posterior Sacrum
Posterior Coccyx
Sacrotuberous lig.

Insertion
Iliotibial tract
Gluteal tuberosity

Innervation
Inferior gluteal N. L5-S2

Gluteus Maximus cont.

Isolated Function
Extends and externally rotates the hip

Integrated Function
Decelerates hip flexion, adduction and internal
rotation during the stance phase
Decelerates tibial internal rotation via the iliotibial
band
Concentrically accelerates hip extension and
external rotation to get triple extension

Gluteus Maximus cont.

Chain Reactions
Tight psoas inhibits the gluteus maximus
Weak gluteus maximus can cause patellar
tendinitis
Weak gluteus maximus can cause posterior tibialis
tendinitis and plantar fascitis
Weak gluteus maximus can cause achilles
tendinitis

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Functional Anatomy: Hip Abductors

Gluteus medius
Gluteus minimis
Tensor fascia latae (TFL)

Hip Abductors
Isolated Function
Abducts the femur
Internally Rotates the femur
TFL
Gluteus Minimus
Anterior Gluteus Medius

Externally Rotates the femur


Posterior Fibers of Gluteus Medius

Integrated Function
Decelerates frontal plane hip adduction
Gluteus medius assists in eccentrically decelerating
transverse plane hip rotation

Hip Abductors

Chain Reactions
Following ankle sprains, it has been demonstrated
(Beckman) that the gluteus medius has decreased
electromyograpy activity.
This leads to synergistic dominance of tensor fascia
latae and gluteus minimus. These muscles internally
rotate the femur, which increases stress in the lower
leg

Tight psoas creates a sacroiliac joint dysfunction


which creates both myokinematic and
arthrokinematic inhibition of the gluteus medius

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Functional Anatomy: Hip External Rotators

Gluteus maximus
Sartorius
Piriformis
Obturator internus
Obturator externus
Gemellus superior
Gemellus inferior
Quadratus femoris

Piriformis
Origin
Anterior surface of the
sacrum (S2-S4)

Insertion
Superior aspect of the
greater trochanter

Innervation
Ventral rami S1-S2

Obturator Internus
Origin
Obturator Foramen

Insertion
Greater Trochanter

Innervation
Nerve to obturator
internus

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Obturator Externus
Origin
Superior and inferior
pubic ramus
External surface of
obturator foramen

Insertion
Trochanteric fossa

Innervation
Obturator N.

Gemellus Superior
Origin
Ischial spine

Insertion
Greater trochanter

Innervation
N. to obturator internus

Gemellus Inferior
Origin
Ischial tuberosity

Insertion
Greater trochanter

Innervation
N. to quadratus femoris

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Quadratus Femoris
Origin
Lateral border of ischial
tuberosity

Insertion
Quadrate line below
intertrochanteric crest

Innervation
Nerve to quadratus
femoris

Hip External Rotators


Isolated Function
Externally rotates femur (all)
Abducts femur (piriformis, obturator internus)

Integrated Function
Eccentrically decelerates hip internal rotation
Concentrically accelerates hip external rotation
Works as a major pelvo-femoral stabilizer during
functional movements to help maintain stability and proper
function of the lumbo-pelvic-hip complex

Hip External Rotators

Chain Reactions
Tight external rotators (piriformis) can create a
sacroiliac joint dysfunction, leading to lumbar
spine dysfunction
External rotators become synergistically dominant
to compensate for a weak gluteus maximus (tight
psoas), weak biceps femoris (anterior pelvic
rotation), weak gastrocnemius and weak gluteus
medius

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Summary

Covers a large group of muscles


Although there may be a primary plane of
motion where a muscle is the strongest, all
muscles function in all planes of motion
All muscles function eccentrically,
isometrically, and concentrically

The National Academy of Sports Medicine

Thank you

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