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Hip Extension Is Limited Movement Through These Segments in Order to Reach the by Tension in the Rectus Femoris Muscle of the Quadriceps End Ranges of Motion

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Hip Extension Is Limited Movement Through These Segments in Order to Reach the by Tension in the Rectus Femoris Muscle of the Quadriceps End Ranges of Motion THE JOURNAL The Athletic Hip The hip is essential to elite performance. Dan Hollingsworth explains how this complex joint works. By Dan Hollingsworth November 2010 Body of sternum Xiphoid process Costal cartilages T11 T12 12th rib L1 Transverse processes of lumbar vertebrae L2 Internal lip Sacral promontory L3 Iliac tuberosity Intermediate line L4 Iliac crest External lip Iliac crest L5 Tubercle Wing (ala) of ilium Greater sciatic notch Anterior superior iliac spine Arcuate line Anterior inferior iliac spine Sacrum Ischial spine Iliopubic eminence Lesser sciatic notch Superior pubic ramus Coccyx Greater trochanter of femur Obturator foramen Pecten pubis (pectineal line) Pubic tubercle Pubic symphysis Howell Golson Howell Inferior pubic ramus Ischial tuberosity Pubic arch Lesser trochanter of femur Arcuate pubic ligament An easy case can be made for the hip being the most important anatomic region in all athletic endeavors. Before this argument can be made, we must have a clear picture of the anatomic structure and biomechanics of this complex region. 1 of 8 Copyright © 2010 CrossFit, Inc. All Rights Reserved. Subscription info at http://journal.crossfit.com CrossFit is a registered trademark ® of CrossFit, Inc. Feedback to [email protected] Visit CrossFit.com Athletic Hip ... (continued) A basic understanding of human biomechanics will be Origin of psoas major muscle from helpful in fully comprehending this article. Please refer sides of vertebral bodies, to Dr. Lon Kilgore’s Jan. 29, 2009, CrossFit Journal article intervertebral discs and transverse Movement 101 for a fantastic introduction to human Iliacus muscle processes (T12-L4) movement terminology. Sartorius muscle Piriformis muscle Skeletal Anatomy The true hip joint, otherwise known as the coxofemoral joint, is the articulation between the femur (the long Pectineus bone of the thigh) and the pelvis. Specifically, these two Rectus femoris muscle muscle structures form a union between the head of the femur and the acetabulum of the pelvis, creating a true ball-and- Piriformis Adductor socket joint. The primary skeletal role of the coxofemoral muscle longus joint is to support the weight of the head, arms and trunk. muscle Dynamically, the hip complex is the power-generation and Obturator internus and transfer station that initiates and directs nearly all complex gemellus human movements. muscles Adductor Gluteus brevis minimus muscle muscle Gracilis muscle Dynamically, the hip complex Vastus lateralis muscle is the power-generation and Obturator externus transfer station that initiates Iliopsoas muscle muscle and directs nearly all complex Vastus medialis muscle Adductor magnus human movements. muscle Vastus intermedius muscle Quadratus femoris muscle Articularis genus The femur is the longest bone in the human skeleton. muscle Distally, the femur articulates with the tibia to form the Adductor magnus knee complex. The femoral neck projects off the proximal Iliotibial tract muscle shaft of the femur and angulates approximately 55 degrees Biceps femoris toward the pelvis. In women this angle is a little greater muscle to accommodate the greater width of the female pelvis. The femoral neck tends to be the weakest link in the femur Sartorius and is particularly susceptible to injury. New athletes Quadriceps muscle who complain of hip pain, especially with high-impact femoris muscle activities, should be evaluated to rule out a possible stress (rectus femoris, vastus lateralis, Gracilis muscle fracture. The head of the femur is attached to the proximal vastus intermedius, Golson Howell femoral neck and forms the point of interaction between and vastus medialis the femur and pelvis. The femoral head is circular in shape via patellar ligament) Semitendinosis muscle and covered in smooth articular cartilage. Figure 1: Hip and thigh muscles—bony attachments (anterior view). 2 of 8 Copyright © 2010 CrossFit, Inc. All Rights Reserved. Subscription info at http://journal.crossfit.com CrossFit is a registered trademark ® of CrossFit, Inc. Feedback to [email protected] Visit CrossFit.com Athletic Hip ... (continued) Superficial dissection Deeper dissection Iliac crest Fascia (gluteal aponeurosis) over Gluteus medius muscle Gluteus minimus muscle Gluteus maximus muscle Piriformis muscle Sciatic nerve Sacrospinous ligament Superior gemellus muscle Sacrotuberous ligament Obturator internus muscle Inferior gemellus muscle Ischial tuberosity Quadratus femoris muscle Greater trochanter Semitendinosus muscle Biceps femoris muscle (long head) Adductor minimus part of Adductor magnus muscle Semimembranosus muscle Iliotibial tract Gracilis muscle Biceps femoris muscle Short head Long head Semimembranosus muscle Semitendinosus muscle Popliteal vessels and tibial nerve Common peroneal nerve Plantaris muscle Popliteus Gastrocnemius muscle muscle Medial head Lateral head Sartorius muscle Soleus muscle Howell Golson Howell Figure 2: Muscles of the hip, thigh and calves. The pelvis is the transition area between the spine and The hip joint is supported by a thick and strong capsule the lower extremities. The pelvis comprises three bones: of ligaments. This dense capsule is a major contributor the ilium, the ischium and the pubis. The pelvic ring is to the stability of the hip joint. The capsule extends well completed by the distal end of the spinal column, the beyond the head of the femur and actually encapsulates sacrum. Interaction between the head of the femur and the femoral neck. Several areas of thickening within the pelvis occurs at the cup-like structure known as the capsule add greater strength to areas that are exposed acetabulum. All three bones of the pelvis contribute to to significant stress during weight-bearing activities, with the structure of the acetabulum. Interestingly, it is only the the thickest area being the anterosuperior portion. The upper portion of the acetabulum that is lined with smooth acetabular labrum is a wedge-shaped ring of cartilage that articular cartilage. This is due to the weight-bearing pattern further adds to the stability of the hip joint. The labrum of the joint. encircles the entire acetabulum and not only increases the depth of the acetabulum but also provides a physical barrier that improves stability much the same was as a wheel chock prevents a car from rolling downhill. 3 of 8 Copyright © 2010 CrossFit, Inc. All Rights Reserved. Subscription info at http://journal.crossfit.com CrossFit is a registered trademark ® of CrossFit, Inc. Feedback to [email protected] Visit CrossFit.com Athletic Hip ... (continued) Vena caval foramen Diaphragm Central tendon of diaphragm Esophagus and vagus nerves Right crus of diaphragm Left crus of diaphragm Median arcuate ligament Aorta and thoracic duct Thoracic splachnic nerves and azygos vein Medial arcuate ligament (lateral lumbocostal arch) Lateral arcuate ligament (medial lumbocostal arch) L1 Sympathetic trunk Anterior longitudinal ligament L2 Quadratus lumborum muscle L3 Psoas minor muscle L4 Psoas major muscle Transversus abdominis muscle L5 Internal abdominal oblique muscle External abdominal oblique muscle Iliacus muscle Anterior sacrococcygeal ligament Anterior Anterior superior iliac spine inferior iliac spine Piriformis muscle Coccygeus muscle Ischial spine Inguinal (Poupart’s) ligament Obturator internus muscle Rectococcygeus muscle Obturator membrane Pubic symphysis Tendinous arch of levator ani muscle Opening for femoral vessels Pecten pubis (pectineal line) Superior fascia of urogenital diaphragm Pectineal (Cooper’s) ligament Howell Golson Howell Pubic tubercle Urethra and rectourethralis muscle Lacunar (Gimbernat’s) ligament Rectum Levator ani muscle Lesser trochanter of femur Figure 3: Posterior abdominal wall (internal view). Hip-Joint Kinematics In order to have a discussion of joint motion, it is critical Can you imagine to have a frame of reference. In most discussions of hip- joint motion, including this one, the primary frame of how challenging landing a reference is that of the femur moving on the pelvis at the 1-rep-max snatch would be if acetabulum. During weight-bearing activities, however, the femur remains in a relatively fixed position and it is the you were in constant fear pelvis that moves on the head of the femur. For purposes that you might of this discussion, the moving segment will be the femur, dislocate your hip? unless otherwise stated. 4 of 8 Copyright © 2010 CrossFit, Inc. All Rights Reserved. Subscription info at http://journal.crossfit.com CrossFit is a registered trademark ® of CrossFit, Inc. Feedback to [email protected] Visit CrossFit.com Athletic Hip ... (continued) The coxofemoral joint is an incredibly stable joint when spine). Posterior tilt produces extension of the hip and can compared to other ball-and-socket joints, such as the be visualized as flattening of the normal lumbar lordosis. shoulder. This stability comes at the cost of mobility, Quite often, new athletes will need to be taught anterior however. The hip joint enjoys significantly less freedom of and posterior pelvic tilt before they are able to understand motion than the shoulder does. While this may seem like a cues regarding maintaining a “neutral” spine position during limitation of the joint, it is in actuality what allows the joint complex movements such as the squat or deadlift. Lateral to be as strong and powerful as it is. Can you imagine how pelvic tilt occurs when one hip joint acts as a pivot point challenging landing a 1-rep-max snatch would be if you while the opposite
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