The Hip!

     No, not the Tragically Hip... which would possibly make for a more interesting article, who doesn’t love Gord Downie and the boys? Instead today we’re going to have an overview of the hip and some aspects of it that are important for everyone to understand. 

Great hip flexion Mr. Downie! But not the point of this post. Source: www.windsorstar.com

     Depending on who you ask, the hip can mean different things. It’s a large area and it is vital to differentiate between the hip joint, the hip bone, the sacroiliac joint or soft tissue surrounding the area. Often, patients will present with pain saying that their hip hurts and be pointing vaguely to somewhere near the iliac crest or perhaps their anterior superior iliac spine. While these are part of the hip bone, also known as your pelvic or coxal bone, it’s important to have a good understanding of the hip to help you discern exactly which structure the patient is talking about. 

Source: Gray's Anatomy

    The left hip bone with a good view of the acetabulum
where the femoral head sits. Source: Gray's Anatomy

     The hip bone is actually made up of three bones- the ilium, ischium and pubis, which do not finish fusing together until approximately age 25. The hip bones come together anteriorly at the pubic symphysis and posteriorly at the two sacroiliac joints. An important thing to remember is that three of the SI joint ligaments (sacrotuberous ligament, sacrospinus ligament and sacroiliac ligament) are three of the strongest you will find in the human body. The hip bone has a myriad of important muscular attachments, some of these include the quadratus lumborum, iliacus, gluteus max, med and min. Pictures help for a better understanding of all the bone structure and muscle attachments in this area and The Pro Health Muscle Manual is a great tool to help you learn. On the lateral side of the hip bone is where you will find your hip joint, also known as the acetabulofemoral joint (because of the hip structure acetabulum creating a ball and socket joint with the head of the femur). This is the area replaced when you hear about somebody getting a hip replacement (not for the squeamish). For more information on both the anatomy of this area and testing it, check out the Physical Assessment Manual.                                          

     Another area of the hip bone worth mentioning is the ischial tuberosity. I don’t know how many of you practice yoga, but if you have ever heard a teacher tell you to “root down into your sit bones” and not know what the heck they were talking about, this is it. Your ischial tuberosity is the bony segment you can feel if you pull a cheek away while sitting on your bottom, and it really helps you find stability on the floor for seated postures. It’s an important anatomical location in yoga (check out this article for a better understanding) and also in everyday anatomy. The ischial tuberosity wraps around towards the pubis bone, creating a space known as our obturator foramen which allows the passage of blood vessels and nerves. 

An excellent picture from Gray's showing all three bones of the hip bone and 

the Ischial Tuberosity (Tuberosity of Ischium). Source: Gray's Anatomy

     Hip injuries are a common issue today. Maybe it’s an athlete with a hip flexor problem, the development of osteoarthritis in the hip joint, or the unfortunate case of an elderly person falling and breaking their hip. All of these problems will require a thorough understanding of the hip’s anatomy and if you want solid resources to learn from or supplement your practice with, take a look at Pro Health’s full line of products.