The Anatomy of the Hip

In this piece I will be boring you with the anatomical facts of the hip...  However, I intend to explain the functions of the hip developing the understanding and importance of the hip joint.  If you are a coach, personal trainer, P.E. teacher, sports performer, etc... or an individual who cares about their health then this piece and last weeks entry on the spine should be of great importance to you.

The hip joint (commonly referred to as the pelvis) is another very complicated joint due to the various bony prominences.  Therefore it makes it hard to distinguish how many bones make up the hip joint.  Fortunately we understand that the pelvis is made up of three bones; the pubis, ischium and illium.  As you can see in the diagram (left) the two round flat surfaces of the hip are called the illium and

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are the largest bones of the pelvis.  Then there is the pubis located on the anterior surface of the hip and the ischium situated at the bottom of the hip.  Now that wasn't too hard was it?  Well now it gets a little bit more complicated.

The hip consists of numerous bony prominences. What's a bony prominence you may ask yourself?  Well if I haven't explained before, a bony prominence is a protruding bony process that can be palpated on the body.  These bony prominences collectively make up a vast majority of the pelvis thus confusing us with lots of medical scientific names.  If I was to begin boring you with the various names of all the bony prominences we could well be here until Christmas, so I won't.  However what I would invite you to do is imagine the hip as a mechanical device such as a lorry.  A lorry carries a mixture of loads to destinations and is made up of lots of specific mechanical parts that all have specific jobs to aid the function of the lorry.  Well essentially the hip joint is the same, it is made up of numerous bony prominences and has the greatest amount of muscle attachments in the body.  These all have specific jobs and aid the support and protection of the pelvis.  Most of all the hip joint provides support to our anatomy.  Through our evolution our anatomy needed the means of support to provide movement.  Therefore as we evolved and adapted to meet the needs of our environment so did our anatomy.  The means of our environment and evolution meant isotonic movements such as bending to pick things from the floor were vital.  Therefore our hip evolved in such a way that allowed us to do this.

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The evolution of the human hip joint and spine has allowed us to stand up right as shown in the (left) diagram.  It's a joint that adapts to meet the means of its environment.  For example Rugby players tend to have large hips because over the course of time it has adapted to meet the means of the environment.  To be specific the hip joint is the articulation between the femoral head and the acetabulum which is a deep socket of the pelvis.  The hip joint has sacrificed mobility for increased stability in our evolution.  This in addition aids us when we load weight on to our hip, thus holding the hip in place so it doesn't fall out of joint.  The acetabulum is surrounded with a layer of labrum.  Labrum is a type of fibrocartilage which wraps around the socket of the hip joint to increase depth of the socket.  During the evolution of the hip joint and the structure of the hip we are able to perform a variety of movements such as; flexion, extension, abduction, adduction, and medial and lateral rotation.

However with these movements can come some issues, for example piriformis syndrome.  Piriformis is a little muscle on the posterior inferior surface of our torso region that originates on our sacrum and attaches onto our femur.  This can also be referred to as lower cross syndrome of the hip which in this case would be when an individual has very tight hip flexors (which most of us do) causing their gluteus maximus muscle to turn off which means our main mobilisers of the hip have turned off.  Therefore the deeper stabilisers of the joint have had to take on the role of mobilisers also.  This in turn makes our piriformis muscle hypertonic, meaning the muscle is over active and essentially goes straight through our sciatic nerve giving us symptoms down the posterior surface of our leg.  This is called piriformis syndrome.  This happens as result to muscle imbalances but in particularly decreased mobiliser activity and increased stabiliser activity.

Athletes tend to develop muscular injuries associated to the hip.  Injuries such as 'groin pain'.  This is a vague diagnosis of an injury that doesn't really tell us much.  The 'groin' is a rough anatomical area, and the pain can occur in any one of four muscle groups.  The only way to define which muscle group is by performing resisted tests and looking at the results.  Theoretically 'groin pain' can occur in our hip flexors, deep rotators, hip abductors, or hamstrings.  This process again occurs due to long weak hypotonic muscles and short over active hypertonic muscles (lower cross syndrome).  Another potential injury that can occur upon our anatomy is hernia.  This is the protrusion of an organ or part of an organ through the fascia that usually contain it.  This again can develop through lower cross syndrome in your abdominal muscles which are hypotonic and then you attempt to load an extensive amount of weight that isn't sufficient for your abdominal muscles to withhold the stomach content, thus causing the muscles to tear.  Squeamish people do not read this!  If your abdomen tears/splits then a bit of your intestines pops out.  Gross right!  This then leaves a lumpy surface that can be palpated on the body and some excruciating pain for your stupidity.  The final issue I come onto related to the hip is iliotibial band syndrome.  This muscle originates on the anterior inferior third of our illium and runs down the lateral surface of our femur and inserts infra to our patella.  Our iliotibial band (ITB) is a thick fascia that tends to get adhesion's if it's having to work too hard, which is the downfall to hypotonic glutes causing medial rotation of our legs due to the lack of stability around the pelvis.  This is a common injury in runners and what is reffered to as 'runners knee'.  This can be because of one of two reasons:

1)  Our ITB begins brushing over the greater trochanter
Or
2)  Our ITB begins brushing over our lateral condyles of the femur.

In conclusion the hip joint is a forever evolving joint that is essential to the support and movement of the anatomy.  It is the link between our upper anatomical muscles and lower anatomical muscles.  Its a surface that is flat yet rigid in structure and vital to our everyday movement, allowing us to walk, run and jump.  Its a fascinating joint that evolves/adapts based on the environment.  It is a joint that protects our fertility organs and arteries and is vital to the creation and evolution of humans.