This presentation is about hip, knee and ankle joints and muscles

1. By
Hossein Khorrami, Ph.D. DOMP
Pelvic-Hip-Knee Joints & Rehab
khorrami4@yahoo.com
http://www.scribd.com/khorrami4

2. Pelvic bone, lateral view

3. Anterior View

4. Pelvic bone, medial view

5. Lat. View

7. Male vs. Female Pelvic

13. • https://www.youtube.com/watch?v=7aH8c2k
ToQo

14. Sacrum Flexion vs Extension
• Lumbar extension (backward bending) results in
sacral flexion (nutation), while lumbar flexion
(foreward bending) results in sacral extension
(counternutation)
• Anterior nutation (sacral flexion) is a nodding
movement of the sacrum between the
innominates, with the sacral base moving
anteriorly and inferiorly and the sacral apex
moving posteriorly and superiorly
• Posterior nutation (sacral extension) occurs when
the sacral base moves posteriorly and superiorly
and the sacral apex moves anteriorly and inferiorly

15. Sacro-iliac(SI) joint
• Synovial, anterior
• Syndesmosis(fibrous), posterior

17. Sacrococcygeal Joint
• Cartilaginous

18. Pelvic muscles
• Gluteus maximus: extensor
• Gluteus medius & minimus: abductors &
rotator
• Obturator internus & Quadratus femoris:
rotator

21. Gluteus Muscles

23. Gluteus Muscles
• Gluteus maximus: L4-S2
• Gluteus medius: L4-S1
• Gluteus minimus: L4-S1

25. Hip rotators

26. Piriformis muscle
• External rotation in extension
• Abduction in hip flexion

27. Piriformis muscle

29. G. Medius, dual function

30. Gluteus medius & minnimus
• Abduction in neutral
• Hold level of pelvic in gaiting with assist of
tensor fascia latae
• To prevent pelvic from dropping to the
opposite side

32. External Rotators of Hip
• Gemellus superior
• Gemellus inferior
• Piriformis, S1-S2(L5)
• Quadratus femoris
• Obturator internus
• Obturator externus
https://www.healthline.com/human-body-maps/gemellus-superior#1

35. Gluteus Maximus & Medius
• Rotation
• G.Max: external rotation
• G.Med: external and
internal rotation

36. Gluteus Maximus & Medius
• Extention

37. Gluteus Maximus & Medius
• Adduction/Abduction
• G.max: minimal abduction

38. • Contralateral hip/pelvic fall: varus deformity
• Ipsilateral hip/pelvic drop: valgus deformity

41. Sciatic Nerve, Innervation
• Lateral rotator group (except piriformis and
quadratus femoris) and the posterior
compartment of thigh

42. Sciatic Nerve & Piriformis Variations

45. Hip flexor, Psoas muscle
• Strongest hip flexor

46. Hip flexor, Psoas muscle
• Origin: T12-L4/L5
• Insertion: lesser trochanter of femur
• Innervation: L1-L3

47. Iliacus muscle
• Origin: iliac fossa
• Insertion: base of lesser trochanter
• Innervation: femoral nerve

49. https://www.youtube.com/watch?v=7BbxUIhYxzA

50. Pelvic Muscles, Functions
• Ext. Rot
• Int. Rot
• Stabilizer
• Abductor
• Adductor
• Extensor
• Flexor
• Vascular pump
• SI joint mobility

52. Hip ligaments, anterior

53. Hip ligaments, posterior

55. Hip movements
• Flexion
• Extension
• Adduction
• Abduction
• Internal rotation
• External rotation

58. Adductors
• NERVE
Magnus: posterior division of obturator nerve L2, 3,
4. Tibial portion of sciatic nerve, L4, 5, S1. Brevis:
anterior division of obturator nerve, (L2–L4), and
sometimes the posterior division
Longus: anterior division of obturator nerve, L2, 3, 4
• BASIC FUNCTIONAL MOVEMENT
bringing second leg in or out of a car

59. Adductors

60. Pectineus Muscle
• Or: pectineal line of pubic bone
• Ins: pectineal line of femur
• Function:
– Hip flex
– Hip adduction
– Med rotation

61. Adductor muscle

63. Adductor Brevis & Longus
• ORIGIN:
Anterior part of pubic bone
(ramus). Adductor magnus
also takes origin from ischial
tuberosity.
• INSERTION:
Whole length of medial side of
femur, from hip to knee.
• ACTION:
Adduct and laterally rotate hip
joint. Adductors longus/brevis
also flex extended femur and
extend flexed femur

64. Gracillis
• Or:Ischiopubic ramus
• Ins: med tibia
• Two joint adductor
• Most superficial
on med
• Hip adduction
• Knee flexion assist

66. Hip-Knee muscles
• Hamstering
– Biceps femoris(2joint)
– Semitendinosus
– Semimembranosus
• Quadriceps
– Rectus femoris
– Vastus medialis
– Vastus lateralis
– Vastus intermedialis
• Sartorius
• Popliteus muscle
• IT band

67. Quadriceps
• Knee extensors
– Rectus femoris(dual joint)
– Vastus medialis
– Vastus lateralis
– Vastus intermedius

69. Rectus femoris

71. Vastus Medialis
• Or: medial lip of linea aspera
• Ins: tibial tuberosity

76. Sartorius
• Longest muscle

77. Sartorius Muscle

79. e

81. Hip & knee

89. Hamsterings
• All dual joint
muscles

97. Popliteus muscle
• Starts flexion

98. “Screw-home Mechanism”
• Medial rotation of the femur on the tibia at end of
knee extension. This action nestles the condyles of
the femur onto the shallow platform of the tibia so
that the knee is “locked”. The posterior cruciate
ligament becomes taut and little muscle activity is
necessary to stand for extended periods of time.
• There is a special muscle, the popliteus, located in the
back of the knee, which initiates knee flexion by
laterally rotating the femur on the tibia. This aligns
the condyles of the femur so that flexion can proceed.

99. Screw-home
mechanism

101. Plantaris Muscle

102. , Two Joint Muscle

104. Knee bones
• Femur
• Tibia
• Fibula
• Patella

105. • Medial meniscus
• Lateral meniscus
• Anterior Cruciate
Ligament(ACL)
• Posterior Cruciate
Ligament(PCL)

106. Ligaments & menisci

110. Ligaments & menisci

111. Anterior view

113. Knee tendons & ligaments

114. Q angle

117. Leg Muscles
• Gastrocnemius(Medial & Lateral)
• Soleus
• Fibularis(Peroneus) longus, brevis & tertius
• Plantaris
• Tibialis posterior & anterior
• Extensor digitorum longus

118. Gastrocnemius muscle
• Knee flexion
• Plantar flexion

121. Soleus Muscle

127. Ankle bones
• Lateral view

131. Popliteal Fossa

132. Sciatic & Sural Nerve

133. Fibularis Muscles

134. & Plantar flexion

136. Peroneus Longus & Brevis

145. Knee problems
• Romatoid Arthritis (RA)
• Osteoarthritis (OA)
• Patellofemoral pain syndrome
– Weakness of vastus medialis
• Ligaments & Meniscus injuries