Anterior superior iliac spine (ASIS)
Position of patient
Palpation notes
Standing or supine
- Bony bump at the front of the hip
Posterior superior iliac spine (PSIS)
Position of patient
Palpation notes
Standing or supine
- Start @ ASIS (bony bump at the front of the hip)
- Palpate superiorly & posteriorly, keeping in contact with iliac crest
- PSIS is the first bony/round bump posteriorly
*in males, might sit more superiorly than females
Iliac crest
Position of patient
Palpation notes
Standing or supine
- Start @ ASIS (bony bump at the front of the hip)
- Palpate superiorly & posteriorly, keeping fingers in contact with the bone
- First hard lumps you feel on each side are the iliac crests
Iliac tubercle
Position of patient
Palpation notes
Standing or supine
- Start @ ASIS (bony bump at the front of the hip)
- Palpate 5cm posterior to ASIS
*muscle over the top so often is hard to find
Sacrum
Position of patient
Palpation notes
Standing or prone
- Start @ ASIS (bony bump at the front of the hip)
- Palpate superiorly & posteriorly, keeping in contact with iliac crest
- PSIS is the first bony/round bump posteriorly
- Sacrum will be in between L & R PSIS
Pubic tubercle & symphysis
Position of patient
Palpation notes
Supine
Pubic symphysis
1. Start at inferior abdominal and gradually palpate from superior to inferior
2. Palpate until centre bone is felt in pubic region
Ischial tuberosity
Position of patient
Palpation notes
Prone
- Start by placing pressure inferior to the glute on the posterior thigh
- Continue until just superior of the gluteal fold, rounded bony feel
Greater trochanter
Position of patient
Palpation notes
Side-lying (test side on top)
- Largest bony bump superficial on the lateral hip
Tensor fascia latae (TFL)
Position of patient
Muscle performed to recruit muscle
Instructions given to person
Palpation notes
Side-lying (test side on top)
Hip in slight flexion & internally rotated (to bias TFL)
Hip abduction
- Slightly flex hip
- Knee & ankle internally rotated (turn towards plinth)
- Lift leg up to the ceiling
- Like where your hands sit in your pocket
Gluteus medius
Position of patient
Muscle performed to recruit muscle
Instructions given to person
Palpation notes
Side-lying (test side on top)
Hip in slight extension (to bias glut med.)
Hip abduction
- Slightly extend hip
- Lift leg up towards the ceiling
- Lateral hip - find top of iliac crest & greater trochanter
- Place hands in triangle shape before completing action
Gluteus maximus
Position of patient
Muscle performed to recruit muscle
Instructions given to person
Palpation notes
Prone
Knee flexed 90° (to bias glut max.)
Hip extension
- Take hamstring off tension, lift knee & bend to 90°
- Lift knee up to ceiling
- It is the most superficial glute muscle
Iliopsoas
Position of patient
Muscle performed to recruit muscle
Instructions given to person
Palpation notes
Supine
Hip flexion
- Lift leg up to ceiling
Iliac - difficult to palpate alone
Psoas - lower lumbar region
1. Find ASIS 2. Few fingers up & medial 3. Want to be quite close to the VC, apply pressure
Squat - down phase
Movement occurred at the hip joint
Agonist
Antagonist
Was the agonist producing the movement during this activity?
Yes - type of contraction?
No - what was the prime mover?
Was the antagonist active during this activity?
Yes - type of contraction & why?
Movement occurred at the hip joint
Hip flexion
Agonist
Iliopsoas
Antagonist
Gluteus maximus
Was the agonist producing the movement during this activity?
No - gravity was prime mover
Was the antagonist active during this activity?
Yes - eccentric contraction to control the movement
**antagonist is only active when controlling movement with gravity as the prime mover
Squat - up phase
Movement occurred at the hip joint
Agonist
Antagonist
Was the agonist producing the movement during this activity?
Yes - type of contraction?
No - what was the prime mover?
Was the antagonist active during this activity?
Yes - type of contraction & why?
Movement occurred at the hip joint
Hip extension
Agonist
Gluteus maximus
Antagonist
Iliopsoas
Was the agonist producing the movement during this activity?
Yes - concentric contraction to oppose gravity
Was the antagonist active during this activity?
No
**antagonist is only active when controlling movement with gravity as the prime mover (e.g. squat: down phase)
Trendelenburg test
To conduct
Standing on one limb (hip joint), pelvis should remain relatively stable
Trendelenburg test
Active muscles
Gluteus medius
Trendelenburg test
Type of contraction
Isometric (muscle does not change length)
Positive Trendelenburg Test
Positive Trendelenburg sign - pelvis drops on the side of the unsupported limb
* Possible reason for this is damage to the superior gluteal nerve
* This is because the superior gluteal nerve innervates the gluteus medius
How to tell if the pelvis is approximately in a neutral position
- By palpation of the ASIS & PSIS in the anatomical position, they should be level
Anterior pelvic tilt
Definition
Movement at hip joint
Movement at lumbar spine
Which muscles are recruited to adopt this position?
Anterior pelvic tilt - if the ASIS is lower than the PSIS
Movement at hip joint
Extension
Movement at lumbar spine
Flexion
Which muscles are recruited to adopt this position?
Above pelvis - rectus abdominis (flexion)
Below pelvis - gluteus maximus (extension)
Posterior pelvic tilt
Definition
Movement at hip joint
Movement at lumbar spine
Which muscles are recruited to adopt this position?
Posterior pelvic tilt - if the ASIS is higher than the PSIS
Movement at hip joint
Flexion
Movement at lumbar spine
Extension
Which muscles are recruited to adopt this position?
Above pelvis - erector spinae (extension)
Below pelvis - rectus femoris (flexion) OR iliopsoas
Moving from sit to stand
Change in orientation of the pelvis
Change in curvature of the lumbar VC
Change in orientation of the pelvis
Anterior tilt, then once standing goes back into posterior tilt
Change in curvature of the lumbar VC
Flexion then extension once standing
Moving from stand to sit
Change in orientation of the pelvis
Change in curvature of the lumbar VC
Change in orientation of the pelvis
Posterior tilt, then once sitting goes back into anterior tilt
Change in curvature of the lumbar VC
Extension then flexion once seated
knee jerk reflex
Position of person
How to conduct test
Movement that occurs & muscle(s) responsible
Spinal levels being tested
Sitting
*vital that patient is as relaxed as possible
1. Patient relaxes leg
2. Brief tap to “squishy part” between patella & shin bone
Knee extension
L3/4
