Expectations for Applied Kinesiology and Gait

You are expected to be able to:

recall normal ROM and directions of motion for the hip

recall origins, actions, insertions, and innervations of muscles that cross the hip joint

identify postural impairments that result from shortened muscles that cross the hip joint

identify abnormal gait patterns that result from weak muscles that cross the hip joint

recall impact of WB status on gait pattern, type of assistive device, safety, and ability to progress gait

Students are encouraged to review course material from PTA 132/132L to reinforce kinesiology knowledge of the hip joint. For example:

  • What postural compensation in standing and gait will you expect on the affected side if the evaluation includes "+Trendelenberg"?
  • What accessory hip abductor may become overused as a result of primary hip abductor weakness?
  • Hamstrings may progressively dominate as primary hip extensors as a result of hip pathology, pain, or post-surgical weakness.
    • What postural compensations can you expect at the spine when hamstrings dominate hip flexion?
    • How might a new onset of knee pain with sit to stand connect with this pattern of muscle imbalance?
    • Why would hamstrings "cramp" during a bridging activity?
    • How would you try and correct this imbalance through exercise and functional training?

If you do not know the answers to the questions above, start researching and refreshing, check with peers, and use forums to confirm your understanding.

 

Review of Hip Joint Function

The hip is the most proximal joint connecting the leg to the spine. It is mobile, stable joint, and is subject to degenerative, overuse and traumatic forces which can disrupt normal joint and muscle function. Painful weight bearing, painful gait, or instability with gait/falls are the most common impairments that prompt a patient to seek medical attention.

Recall from our fracture lecture that hip and femur fractures are common, and surgical interventions can vary from joint replacements, to open-reduction-internal fixation (ORIF), to external fixation.

The goals of any surgical intervention to the hip joint are to reduce/eliminate pain, create a joint stable enough for functional activities, and restore enough ROM and strength for functional activities. Post-operative weight-bearing restrictions vary greatly and is defined by the surgeon.

 

Functional ROM in the hip joint for ADLs is

120 degrees flexion

20 degrees ER

20 degrees abduction.

Gait requires at least 30 degrees of flexion and 10 degrees of extension.

Hip function is impacted by integrity of spinal nerves (L1, L2, L3, S1, and S2)