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Pathomechanics-WPS Office
Renal Anatomy and physiology
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Pathomechanics in the Hip Region
Abnormal structure or impaired function of the hip - such as a leg - length discrepancy , decreased flexibility , or muscle imbalances can contribute to stress in the spine or other joints of the lower extremities
Decreased Flexibility
Decreased flexibility in the structures around the hip joint cause weight - bearing forces and movement to be transmit ted to the spine rather than absorbed in the pelvis. Tight hip extensors cause increased lumbar flexion when the thigh flexes. Tight hip flexors cause increased lumbar extension as the thigh extends Hip flexion contractures with incomplete hip extension during weight bearing also place added stresses on the knee because the knee cannot lock while the hip is in flexion unless the trunk is bent forward. During weight bearing tight adductors cause lateral pelvic tilt opposite the side of tightness and side bending of the trunk toward the side of tightness. The opposite occurs with tight abductors.
Asymmetrical Leg Length
Functional as well as structural asymmetries of the lower extremities affect the posture of the pelvis.
Unilateral short leg.
A unilateral short leg causes lateral pelvic tilting ( drop on the short side ) and side - bending of the trunk away from the short side ( convexity of lateral lumbar curve toward side of short leg ) This may lead to a functional or eventually a structural scoliosis. Causes of a short leg could be unilateral lower extremity asymmetries such as flat foot , genu valgum , coxa vara , tight hip muscles , anteriorly rotated innominate bone , poor stand ing posture , or asymmetry in bone growth.
Coxa valga and coxa vara.
A pathologically large angle of inclination between the femoral neck and shaft of the femur is called coxa valga , and a pathologically smaller angle is called coxa vara. Unilateral coxa valga results in a relatively longer leg on that side and associated genu varum. Unilateral coxa vara leads to a relatively shorter leg with associated genu valgum.
Anteversion and retroversion. An increase in the torsion of the femoral neck is called anteversion and causes the shaft of the femur to be rotated medially , a decrease in the torsion is called retroversion and causes the shaft of the femur to be rotated laterally. Anteversion often results in genu valgum and pes planus. Unilateral anteversion results in a relatively shorter leg on that side , retroversion causes the opposite effects
Hip Muscle Imbalances and Their Effects
Muscles function through habit Faulty mechanics from inadequate or excessive length and an imbalance strength cause hip , knee , or back pain 116 Overuse syndromes , soft tissue stress , and joint pain
develop in response continued abnormal stresses. Common muscle length strength imbalances include the following
Shortened iliotibial ( IT ) band with shortened tensor fasciae latae ( TFL ) or gluteus maximus Postural impairments often associated with a shortened TFL or gluteus maximus include an anterior pelvic tilt posture , slouched posture , or flat back posture
Dominance of the two - joint hip flexor muscles ( TFL rectus femoris sartorius ) over the iliopsoas. This imbalance may cause faulty hip mechanics or knee pain from over use of these muscles as they cross the knee
Hip Muscle Imbalances Related to Postural Impairments
Anterior Pelvic Tilt
Posture Short TFL and IT band General limitation of hip external rotation Weak , stretched posterior portion of the gluteus medius and piriformis Excessive medial rotation of the femur during the first half of stance phase gait with increased stresses on the medial structures of the knee Associated lower extremity compensations including medial rotation of the femur , genu valgum , lateral tibial torsion , pes planus , and hallux valgus
Slouched Posture
Shortened rectus femoris and hamstrings General limitation of hip rotators Weak , stretched iliopsoas Weak and shortened posterior portion of the gluteus medius Weak , poorly developed gluteus maximus Associated lower extremity compensations including hip extension , sometimes medial rotation of the femur , genu recurvatum , genu varum , and pes valgus
Fla t Back Posture
A shortened rectus femoris , IT band , and gluteus maximus Variations of the above two postures Dominance of the TFL over the gluteus medius. This imbalance leads to lateral knee pain from IT band ten sion or medial rotation of the femur with medial knee stresses from an increased bowstring effect. Dominance of hamstring muscles over the gluteus max imus. The gluteus maximus becomes short and the range of hip flexion decreases ; compensation occurs with excessive lumbar spine flexion whenever the thigh is flexed. Limited mobility in the gluteus maximus also causes increased tension on the IT band with associated trochanteric or lateral knee pain. Overuse of the ham string muscles causes decreased flexibility as well as muscle imbalances with the
Bony and joint deformities change alignment of the lower extremity and therefore the mechanics of gait. Painful conditions cause antalgic gait patterns , which are characterized by minimum stance on the painful side to avoid the stress weight bearing.
Pathomechanics-WPS Office
Course: Renal Anatomy and physiology
University: Rajiv Gandhi University of Health Sciences
