Edited by Doctor Luca Franzon
The hip is the proximal joint of the lower limb. Located at the level of the pelvis, it connects the head of the femur with the acetabular cavity.
The hip belongs to the enarthrosis family, it is in fact a type of joint that has two articular surfaces, one concave and one convex, held in contact by a fibrous capsule reinforced by ligaments. Enarthrosis are the most mobile joints in the human body: they allow flexion-extension, adduction-abduction, internal-external rotation and circumduction movements.
The great possibility of movement that characterizes the hip derives from the fact that this joint is crossed by three axes, on which the various movements are carried out. These axes are:
- Vertical axis: on which extra-internal rotation is carried out
- Transverse axis: on which flexion-extension is performed
- Sagittal axis: on which abduction-adduction is performed
MOVEMENTS OF THE HIP
active flexion with knee extended 90 °
active flexion with knee flexed> 120 °
passive flexion with knee extended always exceeds 120 °
passive flexion with knee flexed exceeds 140 °
passive extension 20 °
active extension 20 ° with knee extended
active extension 10 ° with knee flexed
passive extension 20 ° with knee extended
30 ° passive extension with flexed knee pulled back.
active abduction 45 °
passive abduction 180 °
adduction is possible only if accompanied by a slight flexion or extension of the hip. Since the adduction movement depends on the degree of flexion or extension of the hip, we do not speak of a typical angular excursion.
90 ° external rotation with bent knee
internal rotation varies from 30 ° to 40 °
The spherical femoral head has a diameter of 40-50 mm, and is attached to the shaft via the neck. The acetabular cavity has the shape of a hemisphere and is surrounded by the cotyloid edge which serves to increase its capacity. The whole is stabilized and covered by the joint capsule.
The joint capsule appears as a cylindrical sleeve stretched between the ilium and the upper extremity of the femur. The extremity has the shape of a sleeve that from the cotyloid edge, goes to insert itself on the anterior intertrochanteric line and on the posterior intertrochanteric line. The joint capsule is reinforced both anteriorly and posteriorly by powerful ligaments:
anteriorly by the ilio-femoral ligament (Bertin) and the pubo-femoral ligament; posteriorly from the ischio-femoral ligament
Precisely because of its great mobility and since it is a "joint that bears considerable loads (being located in a strategic point of our body that receives influences both from below and from" above), the "hip is a" joint that is often subject to degenerative pathology.
Hip arthrosis is a disease that occurs mainly in the population over 50, however it is not uncommon to find the same problem in much younger subjects. The pathology is given by the premature wear of the joint heads. It usually manifests as pain in the affected joint or nearby muscles. The pain is greatest in the morning, subsides with movement, can be awakened after exertion and generally relieves at night.
Subsequently, the joint function becomes limited, first by pain, then by mechanical obstacles, which can prevent the carrying out of normal activities or make even the usual functions of social life difficult.
The decrease in the joint line is the first sign of cartilage damage and may allow the diagnosis of initial osteoarthritis to be made. Subsequently, the other radiological symptoms are observed, which are not always evident. The presence of osteophytes and joint deformities are a sign of long standing arthrosis, which ends with radiologically detectable ankylosis of the joint.
The evolution of the pathology often leads to having to undergo surgery which must be followed by an adequate recovery phase in order to return to a condition as similar as possible to the physical condition prior to the operation and the beginning of the pathology.
Of fundamental importance, before starting a rehabilitation program, is the consultation with the surgeon who performed the operation, to obtain permission to start this phase and the instructions to follow during the recovery period. it is equally essential to carry out physiotherapy therapies and rehabilitation to reacquire the greatest possible joint function. Subsequently, always subject to medical authorization, a phase of muscle recovery, joint mobility and all conditional and coordinative skills must begin, in a way to be able to resume daily activities without particular problems or limitations.
The first exercises that can be performed are the following:
TO THE GROUND
- Flexed foot extensions
- Foot circles clockwise and counterclockwise
- From extended leg, flex the knee and hip without lifting the heel off the ground (good to do it with socks on a smooth surface)
- Femoral quadriceps isometric contractions. Maintain the contraction for 6 -10 "" with a 4-5 "" rest between repetitions.
- Contract the quadriceps muscle and keeping it contracted, lift the lower limb about 20 cm. Stay in that position for 8-10 "".
- Contract the quadriceps muscle and keeping it contracted, raise the lower limb by about 20 cm by drawing numbers, letters or geometric figures in the air
- Abductions sliding on a smooth surface without detaching the lower limb from the ground leaning on a chair, armchair or bar on the wall.
Perform 15 repetitions per exercise, starting with 1/2 series to get to 4 series over time. When you get to the 4 series add the following exercises:
- Hip flexions less than 90 °, maintaining the position for a few seconds.
- Hip extensions without arching the back. Maintaining the position for a few seconds.
- Hip abductions keeping the knee and foot straight.
Always perform 15 repetitions starting with 2 sets to get to 4. To subsequently insert the following exercises:
Hip extensions with elastic
Hip abductions with elastic
Elastic hip push-ups
At a later time, replace the rubber bands with sand-filled anklets. Always start with 2 sets of 15 to get to 4 sets. In this period it will be good to perform 10 minutes of biking at the beginning and end of training, keeping the saddle very high or starting with the pedaling backwards. Water gymnastics are also welcome.
At this point, you should be able to practice everyday activities without major problems, regaining your freedom and independence. If the controls are successful, the boost can be increased.
