3-D Hips with a focus on the capsular ligaments

(Technical level: Intermediate-Advanced)

In case you haven't noticed, I'm a HIP guy. Not the "cool" hip though. However, I am trying.

As we make our way through the body, I thought the first station we should stop at is the Hip and my last two posts have been about the joint itself and then I started digging into the muscles with the iliopsoas. This post, I am going to dig a little bit deeper with the anatomy of the  ligaments of the hip and their 3-D functional function.

When we loook at the hip, we see a bunch of muscles that are very important to its function. We even take a good look at the hip joint itself and the arthrokinematics or joint motion as it relates to function.  I unfortunately came to an understanding of the LIGAMENTS of the hip capsule very late in my career. Of course, throughout my education, I understood the "ligaments connect bone to bone" phrase,and I left it at that. Well, that was a huge mistake for me because ligaments do so much more than just that.

Ligament Functional Anatomy: Skeletal ligaments are defined as collageneous bands of tissue that span a joint and are anchored to the bone at either end. They vary in size, width and depth as well as positions on the bone. What is interesting is that they are organized in a very special way that contributes to the stability and mobility of the joint. Because of their orientation on the bone as fibrous bands, a ligament can be both loosening and tighetening at the same time depending on the relative motion of the joint. The outer layer of the ligament is called the 'epiligament' and it is here where the ligament is the most vascular (blood flow nourished) as well as where many of the proprioceptive nerves lie.  At a microscopic level, we know that the ligament is made up of cells called fibroblasts. Recent research has pointed out thtese cells actually communicate via ctyoplasmic extensions between adjoining cells giving the impression of a very 3-D architectureand communication system within the tissue. Biochemically, ligaments are 2/3 water and 1/3 solid. Out of the 1/3, it is made up with 75% collagen and the rest being proteglycan, elastin and glycoproteins. Because the ligaments are made up of these solids and water, it gives us an interesting nutritional strategy to promote healing.

Hip Capsular Ligament Functional Patterns: The hip has 3 ligaments that blend into the hip capsule. They are:

• 
  
  Ischiofemoral Ligament
  
  
  
• 
  
  Pubofemoral Ligament
  
  
  
• 
  
  Iliofemoral Ligament
  
  
  

Functionally, these ligaments create stability for the joint as well as maintains balance of the joint motion. However, it should be noted that these ligaments, like muscle, can become hyperstable (tight) or hypermobile (loose). In dealing with 3-D functional soft tissue movement therapy, a balance must be observed so as to not favor either extreme of the spectrum to a ligament.

Functional Hip Capsule Function:

Ischiofemoral: is attached at the ischium at a point behind and below the acetabulum, blends with the fibers of the hip capsule and insert into the intertrochanteric line of the femur. However, if you take a look at the picture, you can see how the fibers have a very bottom to top and medial to lateral orientation. If we put our 3-D glasses on, we see that the ligament:

• 
  
  Restricts FLEXION via inferior aspect
  
  
  
• 
  
  Restricts ADDUCTION  via superior aspect
  
  
  
• 
  
  Restricts INTERNAL ROTATION via superior aspect
  
  
  

Pubofemoral: is attached at the obturator crest and superior pubic ramus and blends into the capsule as well as lateral arm of the iliorfemoral ligament. Functionally, it:

• 
  
  Restricts EXTENSION
  
  
  
• 
  
  Restricts ADDUCTION
  
  
  
• 
  
  Restricts EXTERNAL ROTATION
  
  
  

Iliofemoral: THE BIG GUY...I wanted to save the best for last because this ligament is not only the strongest of the three capsular ligaments, it is the strongest of the WHOLE HUMAN BODY! That is pretty intense especially given its functions:

• Restricts EXTENSION via medial arm
• Restricts ABUDCTION
• Restricts EXTERNAL ROTATION via lateral arm

Now, why all the info on the ligaments??? Well, my rationale is that when I work with clients and athletes on their muscles and joint motion, I get results but sometimes those results are not quite as profound as I would like them to be or don't "stick". IF this happens, I may go to do the other soft tissue like fascial work or ligament work. Both hold the same principles but the strategies and the corresponding technique shfit.

PRACTICAL APPLICATION: The question becomes with all of this info, how does one apply  it so that it start working for me? Well, in yoga, there is a pose/asana called "Triangle" or Trikonasana. What I see a lot, is that people don't know that this rather intense neuromuscular stretch can also be great 3-D Hip Capsular Ligament Therapy. I typically like to take this pose to the wall so that the body will sense the added stabilty of the wall behind you so that your body will be more inclined to get into the deeper stretch. Here goes:

1. Stand with your back to the wall about 6-8" away.
2. Open the legs to about 2-3' part so you're in a wide stance.
3. With your legs facing in a netural or 12 o'clock direction, just start to shift your hips to the right and left so that you are "cleaning the wall with your backside." You should feel a deep stretch in the inner part of the groin.
4. Make sure as you do that you do not rotate your backside away from the mirror. It's important to keep the pelvis as neutral as possible. Also, make sure that you are not overarching your lower back.
5. Now focusing on the right leg, turn your foot out so that it is externally rotated or facing a 3 o'clock position.
6. Like you did when you were cleaning the wall" with your butt, do the same thing again, only know just shift your left hip to the left. You should get that same deep inner groin stretch that you got before.
7. Gently put your right hand on your thighbone for support.
8. Left arm floats up toward the ceiling.
9. Make sure that your back is against the wall as well as both 'butts".
10. Stay there for at least 30 seconds.

This should start to get into the deeper soft tissue. Go slowly. There is no need race through it.

This movement pattern may be very diffferent from what some yogis do in their class. One is not better than the other, just different. Try it out.

Again, still working to get things on video. Will post as soon as I can. I'm headed out to watch my boys play their second junior varisty football game.

Happy Saturday!

Will

I hope this post wasnt too long. I promise the next few will be shorter and sweeter.