1	THE HIP Presented By: Lindsey Mae Deamel Tammy Leigh Denis Chantel Kia Lewis CoraLee Taylor-Wolk
2	Overview of the topic Anatomy (bony structures and muscles) Kinesiology (ligature and motion) Integrity tests Abduction restrictions Adduction restrictions Hip replacement Capsular impingement
3	Anatomy Bony landmarks of the femur Bony landmarks of the innominate Muscles of the hip
4	Bony Landmarks of the Femur Anterior View
5	Bony Landmarks of the Femur Posterior View
6	Bony Landmarks of the Innominate Lateral View
7	Bony Landmarks of the Innominate Medial View
8	Musculature Quadriceps Hamstrings Adductors TFL and Glutes Obturators Hip Flexors
9	Rectus Femoris Quadriceps Origin: AIIS Insertion: tibial tuberosity by way of the patellar tendon Action: hip flexion, knee extension Nerve innervation: femoral
10	Vastus Lateralis Quadriceps Origin: greater trochanter and lateral lip of linea aspera Insertion: tibial tuberosity by way of the patellar tendon Action: knee extension and lateral patellar tracking Nerve innervation: femoral
11	Vastus Intermedius Quadriceps Origin: anterior lateral aspect of the shaft of the femur Insertion: tibial tuberosity by way of the patellar tendon Action: knee extension, straight patellar tracking Nerve innervation: femoral
12	Vastus Medialis Quadriceps Origin: medial lip of linea aspera and inter-trochanteric line Insertion: tibial tuberosity by way of the patellar tendon Action: knee extension and medial patellar tracking Nerve innervation: femoral
13	Sartorius (the tailor’s muscle) Quadriceps Origin: ASIS Insertion: medial aspect of tibia below the tibial tuberosity (pes anserinous) Action: hip flexion, abduction, lateral rotation of the femur Nerve innervation: femoral
14	Biceps Femoris Hamstrings Origin: long head - ischial tuberosity; short head - lateral supracondylar ridge Insertion: head of fibula Action: hip extension, knee flexion, lateral rotation of tibia Nerve innervation: sciatic
15	Semimembranosus Hamstrings Origin: ischial tuberosity Insertion: posterior medial condyle of tibia Action: hip extension, knee flexion, medial rotation of the tibia Nerve innervation: sciatic
16	Semitendonosus Hamstrings Origin: ischial tuberosity Insertion: superior medial surface of tibia (pes anserinous) Action: hip extension, knee flexion, medial rotation of the tibia Nerve innervation: sciatic
17	Pectineus Adductors Origin: superior ramus of pubis Insertion: pectineal line of femur Action: adduction and flexion of femur Nerve innervation: obturator
18	Adductor Brevis Adductors Origin: body and inferior ramus of pubis Insertion: lower pectineal line and proximal linea aspera of femur Action: adduction and minor flexion of femur Nerve innervation: obturator
19	Adductor Longus Adductors Origin: body of pubis, inferior to pubic crest Insertion: medial 1/3 of linea aspera of femur Action: adduction and medial rotation of femur Nerve innervation: obturator
20	Adductor Magnus Adductors Origin: inferior ramus of pubis Insertion: posterior linea aspera and adductor tubercle of femur Action: adducts and medial rotation of femur Nerve innervation: obturator and sciatic
21	Gracillis Adductors Origin: body and inferior ramus of pubis Insertion: superior portion of medial tibia (pes anserinous) Action: adduction and flexion of femur, medial rotation of the tibia Nerve innervation: obturator
22	Tensor Fascia Latae TFL and Glutes Origin: ASIS Insertion: lateral condyle of tibia by way of the iliotibial band Action: abduction, flexion and medial rotation of the femur Nerve innervation: superior gluteal
23	Gluteus Minimus TFL and Glutes Origin: anterior gluteal line Insertion: anterior aspect of the greater trochanter of the femur Action: abduction and medial rotation of the hip Nerve innervation: superior gluteal
24	Gluteus Medius TFL and Glutes Origin: external aspect of iliac fossa Insertion: lateral aspect of greater trochanter of the femur Action: abduction and rotation of the hip Nerve innervation: superior gluteal
25	Gluteus Maximus TFL and Glutes Origin: posterior sacrum and ilium Insertion: posterior femur distal to greater trochanter and IT band Action: extension and lateral rotation of femur Nerve innervation: inferior gluteal
26	Piriformis Obturators Origin: anterior aspect of sacrum Insertion: top of greater trochanter Action: lateral rotation and abduction (when hip flexed to 90) of femur Nerve innervation: nerve to piriformis
27	Gemellus Superior Obturators Origin: ischial spine Insertion: trochanteric fossa of femur Action: lateral rotation and abduction of femur Nerve innervation: nerve to obturator internus
28	Obturator Internus Obturators Origin: internal surface of obturator foramen Insertion: trochanteric fossa Action: lateral rotation and abduction of femur Nerve innervation: nerve to obturator internus
29	Gemellus Inferior Obturators Origin: between ischial spine and ischial tuberosity Insertion: trochanteric fossa Action: lateral rotation and abduction of femur Nerve innervation: nerve to quadratus femoris
30	Obturator Externus Obturators Origin: outer surface of obturator foramen Insertion: trochanteric fossa Action: lateral rotation and abduction of femur Nerve innervation: obturator
31	Quadratus Femoris Obturators Origin: ischial tuberosity Insertion: quadrate tubercle Action: lateral rotation and adduction of femur Nerve innervation: nerve to quadratus femoris
32	Iliacus Hip Flexors Origin: iliac crest, iliac fossa and anterior sacroiliac ligament Insertion: lesser trochanter of femur by way of common tendon of psoas Action: flexion and lateral rotation of femur Nerve innervation: femoral
33	Psoas Major Hip Flexors Origin - body and discs of T12-L5, transverse processes of L1-L5 Insertion - lesser trochanter Action - flexion and lateral rotation of femur, flexion and rotation to the opposite side of the trunk Nerve innervation - lumbar nerves L2-L3
34	Kinesiology Ligature Motions
35	Transverse Acetabular Ligament Location: inferior medial aspect of the acetabulum and joining the two ends of the labrum Function: deepens the acetabulum inferiorly and creates the acetabular notch to complete the socket for the head of the femur
36	Ligamentum Teres Location: just above the transverse acetabular ligament to the fovea of the head of the femur Function: acts as a conduit for blood vessels and nerves to the head of the femur
37	Iliofemoral Ligament Location: ilium anterior and superior to the acetabulum and splitting to insert in two places along the intertrochanteric line of the femur Function: provides anterior support, resists extension of the femur Note: this is the strongest ligament of the hip
38	Ischiofemoral Location: runs from the ischium and spirals to the inner surface of the greater trochanter of the femur Function: restricts extension and internal rotation of the femur Note: this is the weakest ligament of the hip
39	Pubofemoral Ligament Location: runs anteriorly from the superior pubic ramus to the intertrochanteric line of the femur, blends with the iliofemoral ligament Function: provides anterior support, resists extension and abduction of the femur
40	Motions of the Hip Flexion Extension Abduction Adduction Internal Rotation External Rotation
41	Flexion Axis – X Plane – sagittal ROM – 90 degrees with the knee extended 120 degrees with the knee flexed Femoral Head – moves posteriorly Distal femur – moves anteriorly
42	Extension Axis – X Plane – sagittal ROM – 30 degrees Femoral Head – moves anteriorly Distal femur – moves posteriorly
43	Abduction Axis – Z Plane – frontal/coronal ROM – 45 degrees Femoral Head – inferior and medial Distal femur - moves laterally
44	Adduction Axis – Z Plane – sagittal ROM – 30 degrees Femoral Head – moves superior and lateral Distal femur – moves medially
45	Internal Rotation Axis – Y Plane – transverse ROM – 35 degrees Femoral Head – moves posteriorly Distal femur – moves posterior and medial
46	External Rotation Axis – Y Plane – transverse ROM – 45 degrees Femoral Head – moves anteriorly Distal femur – moves anterior and lateral
47	Integrity Tests for the Hip Well Leg Straight Leg Squat test Valsalva Slump test Nobel’s or crepitus Figure 4 or Patrick’s or Faber Ober’s test Trendelenburg test
48	Well Leg Test tests for herniated disc patient lying supine with the therapist standing on the side opposite of the complaint elevate the leg to the point where the patient complains of pain being felt if the pain is radiates down the opposite leg, the test is positive for a herniated disc
49	Straight Leg Test test for sciatic problems patient lying supine with the therapist standing on the side of complaint elevate the leg to the point where the patient complains of pain being felt ease off of the elevation and dorsiflex the foot if the pain returns, the test is positive for sciatic problems if the pain is not recreated upon dorsiflexion, the hamstrings may be tight causing the initial pain
50	Squat Test general test for the lower extremity patient standing with therapist watching ask patient to perform a squat if they have difficulty performing the squat, you need to look at the lower extremity
51	Valsalva tests for herniated disc ask the patient if they have the pain that they are complaining of when bearing down for a bowel movement if they answer yes, the test is positive
52	Slump Test tests for herniated disc patient sits at the edge of the table have them slouch forward and extend legs out in front of them if the pain returns, the test is positive
53	Nobel’s or Crepitus tests for crepitus patient lying supine with the therapist standing on one side flex the hip and knee fully, apply a downward pressure into the joint aligning your pressure with the direction of the femur keeping the pressure on, use the lower leg to control the motion, and take the limb through flexion, abduction, extension and adduction repeat on the opposite leg (this should be performed on the unaffected leg first) if a grinding or crackling sensation is felt from the coxa, the test is positive
54	Figure 4/Patrick’s/Faber Test tests for pelvic or SI joint dysfunction or could lead you to look at a possible capsular impingement patient lying supine with the therapist standing on one side flex, abduct and externally rotate the femur into a figure 4 position place one hand on the patient’s bent knee and the other on the opposite ASIS apply a downward pressure if the pain returns, the test is positive
55	Ober’s Test tests for IT band adherence and TFL tightness patient lying lateral recumbent with the therapist standing behind stabilize the superior pelvis and extend the femur until the IT band is over the greater trochanter, abduct the femur no more than 45 slow let the leg fall if the leg stays up on its own, the test is positive
56	Trendelenburg Test tests for gluteus medius weakness patient standing with the therapist standing behind watching have the patient stand on one leg for approximately 30 seconds if the unsupported side drops, the test is positive for the leg that they are standing on
57	Restrictions What would make you look at these motions? Abduction restriction due to hypertonicity Abduction restriction due to hypotonicity Adduction restriction due to hypertonicity Adduction restriction due to hypotonicity
58	What would make you look at these motions? one leg further from mid-line in standing assessment more weight on one leg patient complains of pain when doing one of these motions occupation – E.g. Someone who sits with their leg crossed one over the other all day
59	Abduction Restriction due to Hypertonicity Active test Passive Test Resisted Test Extrinsic Treatment including Hydrotherapy Intrinsic Treatment Exercise Rehabilitation
60	Abduction Active Test patient is standing facing the therapist have them bring their leg into abduction in the frontal plane as far as comfortably possible compare bilaterally being sure to look for body compensation and pain asymmetry found
61	Abduction Passive Test patient lying supine on the table with the therapist standing on the unaffected side place one hand on the opposite ASIS and grasp the ankle with the other hand abduct the leg until resistance is felt or ASIS moves off of the table (no more than 45) repeat on the affected leg compare bilaterally asymmetry found
62	Abduction Resisted Test patient lying supine on the table with the therapist standing at the feet place hands on the outside of the lower legs, legs should be shoulder width apart have the patient push into your hands moderately to maximally for no more than 6 seconds compare bilaterally symmetry found
63	Abduction Restriction due to Hypertonicity Conclusion Active Test - unequal Passive Test - unequal Resisted Test - equal We have found that the adductor muscles and the gracillis are tight which is restricting the motion of abduction
64	Extrinsic Treatment Abduction Restriction due to Hypertonicity This treatment is best done with the patient lying supine.
65	Extrinsic Treatment Abduction Restriction due to Hypertonicity Flex the hip and knee Palpate the muscles closer to the pubis apply a passive stretch on the tissue by abducting the leg
66	Extrinsic Treatment Abduction Restriction due to Hypertonicity Treat towards the hip Be sure to get right to the origin on the pubis Be attentive to pressure as this is a very tender area to have treated Be sure to increase the stretch as the tissue allows
67	Intrinsic Treatment Abduction Restriction due to Hypertonicity patient lying supine with the therapist standing on the affected side grasp leg as for the passive test abduct the leg to the first barrier have them adduct into your non-yielding resistance mildly to moderately abduct to the next barrier repeat 3-5x; 7-10 seconds each RETEST passively
68	Exercise Rehabilitation Abduction Restriction due to Hypertonicity Standing with the affected foot on a stool, keep the elevated foot facing forward. Bend the leg that you are standing on keeping a neutral spine until you feel a gentle pull on the inner thigh.
69	Exercise Rehabilitation Abduction Restriction due to Hypertonicity Sit on the edge of a stool with the affected leg straight out to the side keeping the foot facing forward. Lean forward while maintaining a neutral spine, until you feel a gentle pull on the inner thigh. To increase the stretch, place a riser under the affected foot.
70	Exercise Rehabilitation Abduction Restriction due to Hypertonicity Seated on a massage table or the bed, place the affected leg on the table straight out to the side with the foot facing forward. Bend the opposite until you feel a gentle pull on the inner thigh. Keep a neutral spine throughout. Note: this is an advanced stretch
71	Exercise Rehabilitation Abduction Restriction due to Hypertonicity Lay on your back with your buttocks against the wall, try to keep a neutral spine. Splay your legs out against the wall until you feel a gentle pull on the inner thigh. Note: this is an advanced stretch
72	Abduction Restriction due to Hypotonicity Active test Passive Test Resisted Test Extrinsic Treatment including Hydrotherapy Intrinsic Treatment Exercise Rehabilitation
73	Abduction Active Test patient is standing facing the therapist have them bring their leg into abduction in the frontal plane as far as comfortably possible compare bilaterally being sure to look for body compensation and pain asymmetry found
74	Abduction Passive Test patient lying supine on the table with the therapist standing on the unaffected side place one hand on the opposite ASIS and grasp the ankle with the other hand abduct the leg until resistance is felt or ASIS moves off of the table (no more than 45) repeat on the affected leg compare bilaterally symmetry found
75	Abduction Resisted Test patient lying supine on the table with the therapist standing at the feet place hands on the outside of the lower legs, legs should be shoulder width apart have the patient push into your hands moderately to maximally for no more than 6 seconds compare bilaterally asymmetry found
76	Abduction Restriction due to Hypotonicity Conclusion Active Test - unequal Passive Test - equal Resisted Test - unequal We have found that TFL and glute med.. and min. are weak which is restricting the motion of abduction
77	Extrinsic Treatment Abduction Restriction due to Hypotonicity This treatment is best done with the patient in the lateral recumbent position
78	Extrinsic Treatment Abduction Restriction due to Hypotonicity To place a passive stretch on the TFL, we place the superior leg behind Treat by stimulating the muscle
79	Extrinsic Treatment Abduction Restriction due to Hypotonicity To place a passive stretch on the glute med. and min, we place the leg in front Treat by stimulating the muscle
80	Intrinsic Treatment Abduction Restriction due to Hypotonicity patient lying supine with the therapist standing on the affected side at the corner of the plinth (at feet) grasp leg as for the passive test adduct the leg to just past midline have them abduct into your yielding resistance maximally as you control the motion repeat 3-5x or as needed through full range of motion (this should take about 7-10 seconds) RETEST resisted
81	Exercise Rehabilitation Abduction Restriction due to Hypotonicity Place an elastic around the affected leg just above the ankle Have patient fully adduct the leg and move through abduction using the elastic as resistance Make sure that they go through the full range of motion
82	Exercise Rehabilitation Abduction Restriction due to Hypotonicity Tie an elastic around both legs just above the knees Abduct both legs at the same time Make sure that they go through the full range of motion
83	Exercise Rehabilitation Abduction Restriction due to Hypotonicity Patient lying lateral recumbent affected leg up Lift affected leg through full range of motion
84	Adduction Restriction due to Hypertonicity Active test Passive Test Resisted Test Extrinsic Treatment including Hydrotherapy Intrinsic Treatment Exercise Rehabilitation
85	Adduction Active Test patient is standing facing the therapist have them bring their leg into adduction in the frontal plane as far as comfortably possible both in front of and behind the other leg keeping the toe to the ground compare bilaterally being sure to look for body compensation and pain asymmetry found
86	Adduction Passive Test patient lying supine on the table with the therapist standing at the feet grasp the unaffected leg just above the ankle bring over the top of the affected leg until resistance is felt repeat moving the leg behind repeat on the affected leg compare bilaterally
87	Adduction Resisted Test patient lying supine on the table with the therapist standing at the feet place hands on the inside of the lower legs, legs should be shoulder width apart have the patient push into your hands moderately to maximally for no more than 6 seconds compare bilaterally symmetry found
88	Adduction Restriction due to Hypertonicity Conclusion Active Test - unequal Passive Test - unequal Resisted Test - equal We have found that the TFL and glute med.. and min. are tight which is restricting the motion of abduction
89	Extrinsic Treatment Adduction Restriction due to Hypertonicity Treatment is best done with the patient in a lateral recumbent position with the restricted side up
90	Extrinsic Treatment Adduction Restriction due to Hypertonicity To place a passive stretch on the TFL, we place the superior leg behind Treat towards the hip
91	Extrinsic Treatment Adduction Restriction due to Hypertonicity To treat the glute med. and min, we place the superior leg in front Treat towards the hip Be sure to increase the stretch as the tissue allows
92	Intrinsic Treatment Adduction Restriction due to Hypertonicity patient lying supine with the therapist standing on the affected side -grasp leg as for the passive test adduct the leg to the first barrier have them abduct into your non-yielding resistance mildly to moderately adduct to the next barrier repeat 3-5x; 7-10 seconds RETEST passively
93	Exercise Rehabilitation Adduction Restriction due to Hypertonicity Unaffected leg crossed in front, weight on the unaffected leg. Push the affected hip out and away from the wall. Bend the knee on the unaffected leg. In this picture the left leg is the one being stretched.
94	Exercise Rehabilitation Adduction Restriction due to Hypertonicity Sitting sideways on the edge of a chair, draw the affected leg beneath the chair.
95	Exercise Rehabilitation Adduction Restriction due to Hypertonicity Lying on a table with the affected side up, lift the affected leg slightly and rotate it so that the toe is pointing towards the ceiling. Let the leg drop behind the opposite one.
96	Adduction Restriction due to Hypotonicity Active test Passive Test Resisted Test Extrinsic Treatment including Hydrotherapy Intrinsic Treatment Exercise Rehabilitation
97	Adduction Active Test patient is standing facing the therapist have them bring their leg into adduction in the frontal plane as far as comfortably possible both in front of and behind the other leg keeping the toe to the ground compare bilaterally being sure to look for body compensation and pain symmetry found
98	Adduction Passive Test patient lying supine on the table with the therapist standing at the feet grasp the unaffected leg just above the ankle bring over the top of the affected leg until resistance is felt repeat moving the leg behind repeat on the affected leg compare bilaterally symmetry found
99	Adduction Resisted Test patient lying supine on the table with the therapist standing at the feet place hands on the inside of the lower legs, legs should be shoulder width apart have the patient push into your hands moderately to maximally for no more than 6 seconds compare bilaterally asymmetry found
100	Adduction Restriction due to Hypotonicity Conclusion Active Test - unequal Passive Test - equal Resisted Test - unequal We have found that the adductors and gracilis are weak which is restricting the motion of abduction
101	Extrinsic Treatment Adduction Restriction due to Hypotonicity This treatment is best done with the patient lying in the supine position
102	Extrinsic Treatment Adduction Restriction due to Hypotonicity Flex the hip and knee To place a passive stretch on the tissue, abduct the leg
103	Extrinsic Treatment Adduction Restriction due to Hypotonicity Treat by stimulating the muscle
104	Intrinsic Treatment Adduction Restriction due to Hypotonicity patient lying supine with the therapist standing on the affected side at the corner of the plinth (at the feet) grasp leg as for the passive test abduct the leg fully have them adduct into your yielding resistance maximally through the full range of motion (this should last about 7-10 seconds) repeat 3-5x or as necessary RETEST resisted
105	Exercise Rehabilitation Adduction Restriction due to Hypotonicity Tie an elastic around the affected leg just above the ankle Have the patient abduct to the end range and move through adduction Make sure that they are going through the full range of motion
106	Exercise Rehabilitation Adduction Restriction due to Hypotonicity Seated on the front edge of a chair place a ball between the legs Squeeze the ball, using it for resistance
107	Exercise Rehabilitation Adduction Restriction due to Hypotonicity Patient lying lateral recumbent with the unaffected leg up Bend the unaffected leg into a figure 4 position Lift the affected leg through the full range of motion
108	Hip Replacement processes and types of hip replacements contraindications to massage treatment exercise rehabilitation
109	A Hip That Needs Replacing
110	A Radiograph of a Hip With Osteoarthritis (replacement candidate)
111	Removing the Femoral Head The steps involved in replacing the hip begin with making an incision on the side of the thigh to allow access to the hip joint. There are several different approaches used to make the incision, usually based on the surgeon’s training and preferences. Once the joint is entered, the femoral head is actually dislocated from the acetabulum and the femoral head is removed by cutting through the femoral neck with a power saw.
112	Reaming the Acetabulum Attention is then turned towards the socket, where using a power drill and a special reamer, the cartilage is removed from the acetabulum and the bone is formed in a hemispherical shape to exactly fit the metal shell of the acetabular component.
113	Inserting the Acetabular Component Once the right size and shape is determined for the acetabulum, the acetabular component is inserted into place. In the uncemented variety of artificial hip replacement, the metal shell is simply held in place by the tightness of the fit or by using screws to hold the metal shell in place. In the cemented variety, a special epoxy type cement is used to anchor the acetabular component to the bone.
114	Preparing the Femoral Canal To begin replacing the femoral head, special rasps are used to shape the hollow femur to the exact shape of the metal stem of the femoral component.
115	Inserting the Femoral Stem Once the size and shape are satisfactory, the stem is inserted into the femoral canal. Again, the uncemented variety of femoral component is held in place by the tightness of the fit into the bone (similar to the friction that holds a nail driven into a hole drilled into a wooden board - with a slightly smaller diameter than the nail). In the cemented variety, the femoral canal is rasped to a size slightly larger than the femoral stem, and the epoxy type cement is used to bond the metal stem to the bone.
116	Attaching the Femoral Head The metal ball that makes up the femoral head is attached
117	The Completed Hip Replacement
118	The Completed Hip Replacement Radiograph A radiograph showing an artificial hip in place.
119	Contraindications to Massage Recent replacements No intrinsics No extreme heat or cold Be aware that there is usually an associated bone condition with a hip replacement e.g. osteoporosis, osteoarthritis and you need to treat accordingly
120	Massage Treatment In the early stages, lots of effleurage and petrissage to help reduce the pain and inflammation. In the later stages of healing, lots of work to the musculature around the replacement to allow for a return of range of motion. Lots of friction to help strengthen the ligaments and tendons and to help realign the scar tissue. Lots of work to the adductors.
121	Home Care and Exercise Rehabilitation Start with aquatic therapy. This involves doing stretches and exercises in the water to prevent excessive weight bearing. As weight bearing can be increased, stretching and strengthening can start being done on land. Closed-chained exercises are good for recovery. Passive range of motion exercises can be done with the therapist’s or at home care person’s assistance through out. Because the patient has not been walking or walking properly for a great length of time, you will want to give them exercises to help retrain the joint movement and also help them to transfer their weight properly
122	Wall Walk Stability/Walking Exercise Stand next to a wall with one hand on it for balance, make sure that you have lots of room in front of you Slowly walk forward making sure that you are stepping starting with the heel to the lateral aspect of the foot, roll across the ball of the foot to the big toe Repeat with other foot Use the full length of the wall
123	Foot Rock Stability/Walking Exercise Standing next to a wall with one hand on it for balance Lift the unaffected leg Rock from a flat foot to the ball of the affected foot Rock back onto the heel of the same foot
124	Capsular Impingement possible causes tests treatment exercise rehabilitation
125	Possible Causes Capsular Impingement hip replacement surgery car accident - especially driving a standard vehicle and having the foot on the clutch when hit
126	Tests Capsular Impingement When you are getting no results with the treatment and assessment that you are doing, try treating for an impingement of the joint capsule. Ask lots of questions with the patient history and also if they have told you that they recently had an accident (oral patient history for return patients). Get as much information as possible. This could lead you in the right direction.
127	Sheet Technique Treatment for Capsular Impingement patient lying lateral recumbent affected side up, with the therapist standing facing the patient
128	Sheet Technique Treatment for Capsular Impingement tie a long sheet together to make a loop, wrap the loop around one shoulder and underneath the opposite arm place the loop around the affected leg and have the patient pull high up into the groin area
129	Sheet Technique Treatment for Capsular Impingement gently lift the leg, using your legs not your back, straight up to create a traction gently lower the leg back down reassess the hip, they may have a tightness or weakness that is caused by the impingement
130	Exercise Rehabilitation Capsular Impingement Give appropriate stretches and strength exercises depending on the associated restrictions. Be sure to fully assess the hip to determine these as an impingement may cause weakness or tightness or both. See previous exercises for some examples.
131	THE QUIZ
132	Question #1 If you had an abduction restriction due to hypertonicity what muscles would you treat?
133	Answer #1 You would treat the adductor group
134	Question #2 Which is the weakest ligament of the hip?
135	Answer #2 Ischiofemoral ligament
136	Question #3 List all of the integrity tests which test for a herniated disc.
137	Answer #3 Well Leg Valsalva Slump Test
138	Question #4 Patient supine Therapist abducts the leg to end range Patient adducts into yielding resistance through full range of motion This intrinsic treatment is for what?
139	Answer #4 Adduction restriction due to hypotonicity
140	Question #5 What muscles make up the quadriceps group?
141	Answer #5 Rectus femoris Vastus lateralis Vastus intermedius Vastus medialis Sartorius goes along with these but is not a true quadricep
142	Question #6 What plane and axis does internal rotation occur in and on?
143	Answer #6 Transverse plane Y axis
144	Question #7 What is the range of motion in flexion at the hip, with the knee flexed?
145	Answer #7 120 degrees
146	Question #8 What restriction(s) can occur at the hip if you have a hypertonic piriformis?
147	Answer #8 Internal rotation due to hypertonicity
148	Question #9 What does the Trendelenburg test test for?
149	Answer #9 Weak glute med. on the opposite side
150	Question #10 Given: adduction active test - unequal adduction passive test - equal adduction resisted test - unequal What restriction do you have and what is the cause?
151	Answer #10 Restriction - adduction due to hypotonicity Cause - weak adductor group
152	Credits Lindsey Deamel - drawings of all muscles Tammy Denis - drawings of bones Joanne Thompson and Kristin Penner - Hip Replacement information and pictures Janie Lysak and Joe Caldwell for their help with the capsular impingement assessment and treatment
153	Credits Kevin Wolk - for help figuring out all of the computer stuff Andrew Taylor - for helping with the pictures
154	LINDSEY MAE DEAMEL
155	TAMMY LEIGH DENIS
156	CHANTEL KIA LEWIS
157	CORALEE TAYLOR-WOLK