Origin:Hip Mmt page 1
Origin:
· Psoas major: transverse processes of L1-L5 and the vertebral bodies of T12-L5
· Iliacus: anterior 2/3 of iliac fossa
Insertion:
· Psoas major: lesser trochanter of the femur
· Iliacus: lesser trochanter of the femur
Nerve
Innervation:
· Psoas major: lumbar plexus
· Iliacus: lumbar plexus
Patient Position:
· Sitting, the thighs should be supported on the table and the legs hanging off the edge. The patient should have his/her knee raised off the table. Hands can be at sides or holding onto the edge of the table for balance.
Therapist and Patient Instructions:
· The therapist should be next to the limb being tested. The resistance hand is placed over the thigh just proximal to the knee, and resistance is given downward toward the floor. The stablilizing hand should be placed at the hip to maintain trunk alignment. Ask the patient to, “lift your leg off the table, don’t let me push it down.”
Patient Position:
· Patient will be lying on their side with the limb not being tested on the table (this limb can be flexed for stability), and the tested limb being cradled in the therapist’s arm.
Therapist and Patient Instructions:
· Palpate the psoas major and iliacus while the patient tries to flex at the hip. Ask the patient to, “lift your knee up toward your chest.”
Origin:
· Sartorius: Anterior superior spine of the ilium
Insertion:
· Sartorius: medial surface of the tibia
Nerve Innervation:
· Sartorius: femoral
Patient
Position:
· Sitting with thighs supported on the table and legs dangling off, the patient can place their hands down for support. The patient should flex, abduct, and externally rotate at the hip, and flex at the knee. It may be easiest to demonstrate the motion for the patient.
Therapist and Patient Instructions:
· The therapist will be using both hands for resistance. One hand will be placed on the lateral surface of the knee, and the other will be placed on the medial aspect of the ankle. The hand at the knee will resist hip flexion and abduction and the resistance will be given in a down and inward direction. The hand at the ankle will be resisting external rotation and knee flexion and the resistance is in an up and outward direction. Ask the patient to, “slide your heel up the shin of your other leg, don’t let me move your leg or straighten your knee.”
Patient
Position:
· Supine, with the therapist supporting the limb. The heel should be on the shin of the opposite leg.
Therapist and Patient Instructions:
· While palpating the sartorius ask the patient to slide their heel up to their knee.
Origin:
· Gluteus maximus: posterior gluteal line of ilium, posterior sacrum, posterior coccyx, and the sacrotuberous ligament.
· Biceps femoris: long head: tuberosity of the ischium and sacrotuberous ligament, short head: linea aspera and lateral condyle of the femur
· Semitendinosus: ischial tuberosity
· Semimembranosus: ischial tuberosity
Insertion:
· Gluteus maximus: gluteal tuberosity of the femur and the iliotibial band
· Biceps femoris: longhead and short head: lateral head of the fibula and lateral condyle of the tibia
· Semitendinosus: proximal shaft of the tibia and pes anserine
· Semimembranosus: medial condyle of the tibia and the lateral condyle of the femur
Nerve Innervation:
· Gluteus maximus: inferior gluteal
· Biceps femoris: longhead: tibial, shorthead: common fibular
· Semitendinosus: tibial
· Semimembranosus: tibial
Patient
Position:
· Prone on table with the hip in extension.
Therapist and Patient Instructions:
· The therapist is standing aside the limb being tested at the level of the pelvis. The hand providing resistance is placed at the thigh just above the knee. If an insufficient amount of resistance is given in this position the hand can be placed at the ankle (first rule out any injuries of the knee or ankle). Also, make sure your testing manner is consistent and performed bilaterally. The stabilizing hand can be placed on the posterior superior iliac spine to maintain hip alignment. Ask the patient to, “lift your leg off the table, don’t let me push it back down.”
· The test is done in the same manner as above except the patient should now have 90° of knee flexion. This will isolate the gluteus maximus.
Patient
Position:
· Patient is lying on his/her side with the therapist cradling the test limb.
Therapist and Patient Position:
· Palpate the gluteus maximus while asking the patient to, “bring your leg back towards me.”
Origin:
· Gluteus medius: outer surface between the crest and posterior gluteal line of the ilium.
· Gluteus minimus: outer surface between the anterior and inferior gluteal lines of the ilium and the greater sciatic notch.
Insertion:
· Gluteus medius: greater trochanter of the femur
· Gluteus minimus: greater trochanter of the femur
Nerve Innervation:
· Gluteus medius: superior gluteal
· Gluteus minimus: superior gluteal
Patient
Position:
· Patient is lying on side with slight extension at the hip and the pelvis shifted forward slightly, it is then abducted. The leg on the table is flexed for stability.
Therapist and Patient Instructions:
· The therapist will be standing behind the patient. Resistance will be given in a downward direction on the lateral aspect of the thigh just above the knee. The stabilizing hand will be placed just proximal to the greater trochanter. Ask the patient to, “lift your leg up and don’t let me push it back down.”
Patient Position:
· Supine
Therapist and Patient Instructions:
· The therapist should hold the limb being tested at the ankle and lift this leg up off the table just enough to decrease friction. Use the other hand to palpate gluteus medius and gluteus minimus just proximal to the greater trochanter. Ask the patient to try and slide their leg out off the table while keeping their knee pointed to the ceiling.