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ANATOMY REFRESHER
tendinosis, semi-membranosis (lateral to medial) (fig.8). 3. Adductors - adductor longus, magnus, brevis and minimus and pectineus and gracilis – it’s worth noting that the adductors also tend to act as extensors when the hip is flexed, and flexors when the hip is extended (fig.9). 4. Abductors – gluteus medius and minimus (fig.10). 5. Rotators - piriformis, plus external and internal obturator, superior and inferior gemelli and quadratus femoris (fig.11). Note that this is not a comprehensive
list as many muscles have supplementary roles to their main plane of movement.
Secondary movers The secondary muscles move the pelvis to allow the leg to clear the ground during movement. They include quadratus lumborum (QL), spinal movement muscles such as ilio-costalis, ilio-longissimus and ilio-spinalis (lateral to medial). The muscles contract concentrically to lift the hemi- pelvis on the side of the body on which the leg is lifting, effectively shortening the leg on that side to allow ground clearance. This is particularly true during walking when hip flexion/knee-flexion is less. These muscles also contract eccentrically bilaterally to allow the torso to flex forwards around the
+ KEY POINT:
A recurring theme is that the stabilising muscles
have to work effectively before the prime movers can work
efficiently. If the stabilisers don’t, the prime movers either work inefficiently or may attempt to take on the role of the stabilisers. This invariably leads to pain and reduction of movement, which compounds the initial problem.
hip, for example when bending to brush one’s teeth at a sink. Not surprisingly trigger points (TrP)
may be activated in these secondary movers if joints within the pelvis ring are compromised (1).
Conclusion The hip joints are the most important part of our anatomy when it comes to retaining balance. The pelvic inclination angle, which is the single most important element of human body posture, is adjusted at the hips. As a ball and socket joint the hip can move in many different directions meaning it is able to provide great flexibility and range. However this, in combination with a deep socket and a ball that is strongly held in
place by the many ligaments surrounding it, means this joint can provide significant flexibility while at the same time also providing a strong platform for the other bones and joints that make up the skeleton and through which movement takes place.
THE AUTHOR Dr Simon Kay, MBBS MRCGP DRCOG DIPL and MSc Sports Medicine, is a member of
FSEM, BASEM, BMAS SOC and is Honoury Education Fellow at Exeter University. He is a full-time GP and Sports Physician based in Devon. He teaches students, GPs and Sports Therapists and has been Medical Officer to various rugby clubs. For more information visit www.sports-doctor.co.uk
With thanks to Primal Pictures for allowing us to use their superb animations and graphics. For more information please visit www.primalpictures.com
This article has been adapted from a series of anatomy refreshers published in sportEX medicine for which sportEX was nominated as a finalist in the 2010 Digital Magazine Awards. Visit www.sportex.net
FOR MORE INTERACTIVE ANATOMY ARTICLES VISIT www.sportex.net
SPORT
SPORTEX MEDICINE, our flagship publication is published quarterly and written for sports physicians, physical therapists and other medical professionals working in the rehabilitation of sports-related injuries.
SPORTEX MEDICINE is written to… ■ provide ideas for rehabilitation programmes including the latter sports-specific stages (includes copiable patient advice leaflets)
■ discussion of the clinical reasoning behind specific injury diagnoses, treatments and rehabilitation programmes
■ summarise key research from all the major research journals
■ identify and review worldwide developments in sports medicine practice.
SPORTEX DYNAMICS is published quarterly and is aimed at people working on the sports touchline including sports massage practitioners, therapists and coaches.
SPORTEX DYNAMICS is written to help you… ■ prevent injuries ■ improve sports performance ■ identify potential injury threats ■ analyse techniques and identify ways of increasing efficiency or minimising the risk of injury
■ provide strength, conditioning and stretching programmes to support the above aims.
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