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The hip joint is a ball-and-socket joint that acts as a central pivot point for the body, allowing a wide range of movements. Twenty-one muscles cross the hip joint, working with the hip tendons and ligaments to enable these movements. The hip muscles can be divided into two main categories: the muscles of the hip joint and the muscles of the hip girdle. The muscles of the hip joint facilitate the movement of the hip joint, while the muscles of the hip girdle offer stability and support. The hip flexor muscles, situated at the front of the hip, are responsible for hip flexion, i.e., moving the leg forward or bringing the thigh towards the chest. The hip extensors, located at the back of the hip, are responsible for hip extension, i.e., moving the leg backward.
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Iliacus and Psoas major
The iliopsoas muscle is a large compound muscle of the inner hip, composed of the iliacus and psoas major muscles. The iliopsoas is the body's most important hip flexor. It is responsible for flexing the hip, which involves bringing the thigh towards the chest.
The iliacus is a triangular-shaped muscle that occupies the internal iliac fossa. It originates on the upper two-thirds of the iliac fossa, on the medial edge of the iliac crest, and on the ilium-lumbar ligament. The iliacus muscle blends with the bundles of the quadratus lumborum muscle and the anterior capsule of the hip joint. The iliacus is innervated by branches of the femoral nerve (L2, L3) and receives its blood supply from the iliolumbar, lumbar, obturator, external iliac, and femoral arteries.
The psoas major muscle is a long fusiform muscle on either side of the vertebral column and the brim of the lesser pelvis. It has traditionally been described as having deep and superficial segments. The deeper segment of the muscle originates from the first four lumbar vertebrae, while the superficial segment originates along the lateral surface of the distal thoracic vertebrae and adjacent intervertebral discs. The psoas major is innervated by the anterior rami of the lumbar spinal nerves, mainly L1 and L2, with some contributions from L3 and L4. Its blood supply is derived mainly from the iliolumbar branch of the internal iliac artery, with contributions from other arteries such as the obturator and femoral arteries.
The fibres of the iliacus and psoas major muscles merge into a single muscle belly around the pelvic brim, forming the iliopsoas muscle. The iliopsoas ends in a tendon that inserts into the lesser trochanter of the femur. The simultaneous contraction of these two muscles produces a powerful flexion of the thigh at the hip joint. This action is crucial for various lower body movements such as walking and running.
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Hip flexor muscles
The hip flexor muscles are situated at the front of the hip and are responsible for hip flexion, which is the action of moving the leg forward or bringing the thigh toward the chest. The hip flexors are used while walking, running, cycling, and climbing stairs. Every time you take a step, you are using your hip flexor muscles.
The hip flexor muscles include the iliopsoas group of muscles, which is made up of the iliacus, psoas major, and psoas minor. The iliopsoas is the body's most important hip flexor. The iliacus and psoas muscles are often grouped together as the iliopsoas musculotendinous unit due to their overlapping function and anatomic proximity. The psoas muscle contracts when the hip is flexed. The iliopsoas has an associated bursa, which is the largest bursa in the body and lies between the iliopsoas and the hip capsule/pubis.
Other hip flexor muscles include the rectus femoris, which is one of the quadriceps, and the sartorius, which is the longest muscle in the body. The pectineus also acts as a hip flexor and secondary adductor.
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Hip extensors
The hip extensors are a group of muscles that include the gluteus maximus, hamstrings, and adductor magnus. The gluteus maximus is the most powerful muscle in this group, contributing more than 75% of the total power output. The hamstrings include the long head of the biceps femoris, the semitendinosus, and the semimembranosus. The extensor head of the adductor magnus is also considered a primary hip extensor.
Hip extension occurs when the hip joint is extended or "opened", increasing the angle between the pelvis and thigh. This movement is involved in many daily activities such as walking, standing up from a chair, and climbing stairs. It is also crucial in various sports like running, jumping, kicking, ice skating, sprint racing, cycling, and swimming.
The hip extensors are responsible for upward and forward propulsion of the body. With the femur stabilized, they can also tilt the pelvis. Their strength is essential for maintaining pelvic and spinal stability and reducing strain on the back. Weak hip extensors can lead to an anterior pelvic tilt, causing excess pressure on the lower back and increased hamstring strain.
To maintain strong hip extensors, it is important to incorporate hip extension exercises into your workout routine. Warm-up with light cardio and dynamic stretching, and focus on good form during strength training. Contracting the glute muscles during exercises can help ensure they are engaged along with the hamstrings. Maintaining a neutral spine and pelvis during exercises can help target the hip extensors effectively.
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Hip adductors
There are five primary hip adductor muscles:
- Adductor longus: This is a triangular muscle and the most anteriorly placed muscle of the adductor group. It originates from the anterior surface of the body of the pubis and inserts onto the middle third of the linea aspera. The adductor longus is the most frequently injured muscle in athletes, with strains being a common cause of groin pain.
- Adductor brevis: This is a triangular muscle and the shortest of the adductors. It lies underneath the adductor longus. The adductor brevis also has a role in the flexion of the hip, and some studies suggest it may be involved in the external rotation of the thigh.
- Adductor magnus: This is a massive fan-shaped sheet of muscle and the largest of the hip adductors. It consists of two parts: the adductor part, which contributes to the flexion of the thigh, and the hamstring part, which contributes to the extension of the thigh.
- Gracilis: This is the most medial and most superficial muscle of the hip adductors. It is the only muscle in the group that crosses both the hip and knee joints. It adducts the thigh at the hip and flexes the leg at the knee.
- Pectineus: This muscle is not considered a primary hip adductor but assists in the movement of bringing the thigh closer to the body's central axis. It also plays a role in hip flexion.
In addition to their role in hip flexion, the hip adductors help stabilize the pelvis and lower extremity during walking, contributing to postural control. They receive their nerve supply from the obturator nerve and their blood supply primarily from the femoral and obturator arteries.
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Hip abductors
The hip abductors are a group of muscles located on the lateral thigh. They include the gluteus medius, gluteus minimus, and tensor fasciae latae. The secondary hip abductors include the piriformis, sartorius, and superior fibres of the gluteus maximus.
The hip abductors are responsible for moving the leg away from the body and rotating the leg at the hip joint. They are necessary for stability when walking or standing on one leg. Weakness in these muscles can cause pain and interfere with proper movement. For example, weakness in the hip abductors can cause the knees to cave inward, resulting in a "knock-kneed" appearance.
Hip abduction exercises can help prevent and treat pain in the hips and knees. Some examples of these exercises include lying side leg lifts, clamshells, and banded side steps or squats.
Weak hip abductors can also cause issues with pelvic stability during locomotion, resulting in problems such as increased medial femoral rotation and valgus knee moments, which can lead to pain and injury.
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Frequently asked questions
The hip flexor muscles are situated at the front of the hip and are responsible for hip flexion, which involves moving the leg forward or bringing the thigh toward the chest. The hip flexors include the iliopsoas (iliacus and psoas major), rectus femoris, pectineus, sartorius, and psoas minor (present in about 40%-60% of people).
The hip flexors play a crucial role in lower body movements such as walking, running, climbing stairs, and cycling. They also contribute to pelvic stability and alignment.
Sitting for extended periods can shorten and tighten the hip flexor muscles, leading to functional problems. This condition is common among individuals who sit for long hours, such as desk workers or bus drivers. Shortened hip flexors can cause anterior pelvic tilt and lumbar hyperlordosis.
You can perform various exercises to stretch and strengthen your hip flexors, such as hip flexion lying supine, rhythmic leg oscillations, and hip circumduction. These exercises can improve hip mobility, flexibility, and stability.
In addition to the hip flexors, there are several other muscle groups that contribute to hip movement and stability. These include the hip extensors (gluteus maximus), abductors, adductors (adductor muscles on the inner thigh), and internal and external rotators.
