The document provides information on the anatomy and function of the pelvis, hip, knee, ankle, and foot. It describes the bones, joints, ligaments, and muscles of the pelvic girdle and lower extremities. Key points covered include the bones and joints of the pelvis, hip muscles and their actions, knee ligaments and movements, ankle and foot arches, and common injuries or conditions that affect the lower extremities.

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. Lumbosacral Joint
• https://www.youtube.com/watch?v=7aH8c2kToQo

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

19. Sacrococcygeal Joint
• Cartilaginous

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

23. Gluteus Muscles

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

27. Hip rotators

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

32. Piriformis muscle

34. G. Medius, dual function

35. 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

37. 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

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

41. Gluteus Maximus & Medius
• Extention

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

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

46. Sciatic Nerve, Innervation
• L4-S3
• Lateral rotator group (except piriformis and
quadratus femoris) and the posterior
compartment of thigh

47. Sciatic Nerve & Piriformis Variations

50. Hip flexor, Psoas muscle
• Strongest hip flexor

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

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

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

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

60. Hip ligaments, anterior

61. Hip ligaments, posterior

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

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

67. Adductors
oLongus
oMagnus
oBrevis
o Minimus

68. Adductor Brevis & Longus
• ORIGIN:
Superior ramus. Adductor
magnus also takes origin
from ischial tuberosity.
• INSERTION:
Linea Aspera
• ACTION:
Adduct and laterally rotate
hip joint
Adductors longus/brevis
also flex extended femur
and extend flexed femur

69. 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

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

75. Sartorius Muscle
• Longest muscle
– ~50cm
• 2 joint muscle

76. Sartorius Muscle

78. e

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

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

83. Rectus femoris

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

91. Hip & knee

97. Hamsterings
• All dual joint
muscles

104. Quadriceps Tendon, Patellar Ligament

106. Popliteus muscle
• Starts flexion

107. “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.

108. Screw-home
mechanism

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

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

113. Anterior view

114. Ligaments & menisci

115. Tibia, Superior View

116. Ligaments & menisci

118. Q angle

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

123. Gastrocnemius muscle
• Two joint muscle
• Knee flexion
• Plantar flexion

127. , Two Joint Muscle

128. Plantaris Muscle
• Has longest thin
tendon in human body
(30-45cm)
• Absent in 8-12% of
population

129. Plantaris Muscle

136. Tarsal Bones
• Calcaneus
• Talus
• Navicular
• Medial cuneiform
• Intermediate cuneiform
• Lateral cuneiform
• Cuboid
• Foot contains:
• 26 bones
• 33 joints
• 100 tendons, muscles & ligaments

137. Foot bones
• Forefoot
• Midfoot
• Hindfoot

138. Ankle bones
• Lateral view

139. Ankle bones & ligaments
• Medial view

140. Lateral ligaments

141. Foot ligaments, medial view

143. • Longus
• Brevis
• Tertius
Fibularis Muscles
(Peroneus)

144. & Plantar flexion

146. Peroneus Longus & Brevis

153. Deep Plantar-flexors

156. Leg Muscles

157. Muscles of the Leg
12 muscles cross the ankle. Four groups of 3 muscles. Two of the groups
contribute to the power movement: plantar-flexion. One muscle group
contributes to dorsi-flexion. The final group of three are evertors; these are
the peroneal muscles. Two of them, the peroneus longus and peroneus
brevis also contribute to plantar-flexion, while the smallest, the peroneus
tertius, assists dorsi-flexion. (It makes sense that two of the three would
assist the power movement of the ankle).
All the muscles, except the gastrocnemius and soleus (part of the superficial
plantar flexor group) go to the three distinct parts of the foot: the
metatarsals, the digits (toes), or the great toe (hallucis).
Anterior
Plantar-flexors: Deep
Tibialis Posterior
Flexor Digitorum Longus
Flexor Hallucis Longus
Plantar-flexors: Superficial
Soleus
Plantaris
Gastrocnemius
Evertors:
Peroneus Tertius
Peroneus Brevis
Peroneus Longus
Fibula
Tibia
Dorsi-flexors
Tibialis Anterior
Extensor Digitorum Longus
Extensor Hallucis Longus
Posterior
Leg Muscles

158. Superficial Plantar-flexors
Soleus

159. Superficial Plantar-flexors

160. Superficial Plantar-flexors

161. Deep
Plantar-flexors

162. Deep Plantar-flexors

163. Dorsi-flexors

164. Dorsi-flexors

165. Dorsi-flexors

166. Foot Evertors: Peroneals

167. Peroneals

168. Fibularis

169. Dorsi-flexors &
Invertors

170. Intrinsic Muscles:
Foot

171. Intrinsic Muscles of the Foot

172. Intrinsic
Muscles
of the
Foot

173. Intrinsic Muscles of the Foot

174. hip
knee
Q H
hip
knee
Q H
hip
knee
Q
H
ankle
hip
knee
Q
H
ankle
ankle ankle
Q H
Q
H Q H Q
Biarticular Muscle Action

175. Biarticular Muscle Action: Power

176. Biarticular Muscle Action:
Endurance

177. Arches of the Foot

178. Arches of the Foot

179. Arches of the Foot

180. Arches of the Foot

181. Arches of the Foot

182. Effect of heel size changes on lower back posture
hip
knee
H Q
G
hip
knee
H Q
G
hip
knee
H Q
G

186. Popliteal Fossa

187. Sciatic & Sural Nerve

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

189. Osteoarthritis
• Decrease articular space
• Osteophytes
• Bone & cartilage fragment
• Cartilage breaking down

191. • Sacroiliitis is the inflammation of one or both of your
sacroiliac joints.
• Sacroiliitis is a common source of lower back pain or
pain in the buttocks or thighs. It is often difficult to
diagnose since many other conditions cause pain in
the same locations
• What causes sacroiliitis?
• Inflammation of the sacroiliac joint causes most of the
symptoms of sacroiliitis
• Many medical conditions cause inflammation in the
sacroiliac joint, including:
• Osteoarthritis -This type of wear-and-tear arthritis can
occur in the sacroiliac joints and results from the
breakdown of ligaments

192. Ankylosing spondylitis - This is a type of inflammatory arthritis of
the joints of the spine. Sacroiliitis is often an early symptom of
ankylosing spondylitis.
Psoriatic arthritis - This inflammatory condition causes joint pain
and swelling as well as psoriasis
Psoriatic arthritis can cause inflammation of the spinal joints, including
the sacroiliac joints.
Other causes of sacroiliitis include:
Trauma - A fall, motor vehicle accident, or other injury to the
sacroiliac joints or the ligaments supporting or surrounding the
sacroiliac joint can cause symptoms.
Pregnancy - Hormones generated during pregnancy can relax the
muscles and ligaments of the pelvis, causing the sacroiliac joint to
rotate. The weight of pregnancy can also stress the sacroiliac joint and
lead to wearing of the joint.
Pyogenic sacroiliitis - This is a rare infection of the sacroiliac joint
caused by the bacteria Staphylococcus aureus

193. What are the symptoms of sacroiliitis?
Common symptoms of sacroiliitis include pain that:
Occurs in the lower back, buttock, hip, or thigh
Gets worse after long periods of sitting or standing, or
getting out of a chair
Worsens after rotating your hips
Feels sharp or stabbing, or dull and achy
How is sacroiliitis treated?
Most people with sacroiliitis benefit from physical therapy. This
treatment helps strengthen and stabilise the muscles
surrounding your sacroiliac joints. Physical therapy also makes it
easier for you to move your sacroiliac joints through full range of
motion.

194. Patellofemoral pain syndrome
• Mostly happens in young females & athletes
• Pain in sitting, jumping & using stairs
• Because of weakness in vastus medialis
• Shortening of vastus lateralis
• Patella shifts to the lateral side
• Wearing down the cartilage under patella

195. Ligaments & meniscus injuries
• Ice pack
• Pulse US
• IFC
• Strengthening ex
• CPM
• Heel slide
• SLR

196. Total Hip Replacement(THR)
• Prevent leg adduction
• Avoid hip flexion over 90o
• Avoid hip extension over 0o
• Avoid hip internal rotation in involved side

197. THR, exercises
• Ankle pumping
• Heel strike
• Heel sliding
• Squeeze gluteus m.
• Squeeze knee extension