Gluteus Mechanics (Full Version)

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MaverickNH -> Gluteus Mechanics (May 12, 2008 4:11:56 PM)

A question on gluteus mechanics:

1. In a "normal" individual, how does internal/external rotation of the hips effect the contraction of the gluteus maximus? That is, does the magnitude of contraction increase/decrease with internal/external rotation?

2. In an individual with a large natural "turnout", attributed to more laterally "fish-eyed" acetabula on X-Ray, how is the normal contraction altered? More increased/decreased magnitude of contraction with internal/external rotation?

Questions relevant to hip replacement design.

Thanks!




MuscleMatrix -> RE: Gluteus Mechanics (May 17, 2008 5:02:31 PM)

Gluteus maximus is a fan shaped muscle, therefore it can function in several roles around multiple axes depending on hip joint position. The direction and point of application of the specific external force that is creating a torque challenge for the musculature is key to determining need for an opposing internal torque created by gluteus maximus as well. In other words, we can't begin to discuss the contractile capabilities of a muscle unless we are referring to a specific joint position AND a specific external torque challenge around a specific axis.

One can be actively moving into hip extension with virtually no need for contraction of the gluteus maximus. Example - eccentric portion of supine straight leg raise. Around the longitudinal axis of the femur, one can move into external rotation without active contraction of the gluteus maximus as well. Example - prone knee bent 90 degrees, TB pulling tibia into external rotation against my active eccentric contraction of my hip internal rotators.

The point is that we need to abandon the idea of associating a motion with a muscle like we get from our kinesiology and biomechanics textbooks. The textbooks' list of motions associated with a muscle are usually biased toward concentric actions and from a starting point of anatomical position. The key is the direction of the resistance (external torque challenge around an axis of a joint) which creates the need for a select group of muscle tissue that is strategically positioned on the other side of the axis with a line of force from the fibers that can directly oppose the externally imposed resistance. Forget about the motion...it is the resistance created around a joint axis that's the key. In addition, consider an isometric where there is no motion.

Now, let me get back to your first question. Let's say you are positioned prone with your knee bent 90 degrees. If you extend your hip against gravity, any muscle tissue that falls on the posterior side of the med-lat axis of the hip joint can be involved in hip extension. However, gluteus maximus as a whole has the largest mechanical advantage due to moment arm length. With the hip in neutral around the longitudinal axis the sacral fibers actually have the largest moment arm for hip extension around the med-lat axis. With the hip in external rotation the moment arm size for hip extension begins to shift toward the iliac fibers. With the hip in internal rotation the moment arm size for hip extension begins to shift toward the coccygeal fibers. The largest hip extension mechanical advantage for gluteus maximus as a whole though is when the hip is in neutral around the longitudinal axis.

The magnitude of contraction will primarily be dependent on the external torque created by the resistance (whatever that happens to be: gravity, TB, manual, etc) and the ability of gluteus maximus to contract and resist that external torque. IF g max is inhibited, there are plenty of other hip extensors that can compensate/substitute and try to "pick up the slack". Hamstrings are usually one of the faithful volunteers. However, they will never be as effective as the gluteus maximus properly innervated. Well actually ... in a position of 90+ degrees of hip flexion, hamstrings actually have a bigger moment arm for hip extension than most of the g max though. Here's an example of where another muscle may gain mech advantage for hip extension over g max dependent on hip joint position.

Iliac g max can even act as a hip internal rotator (concentric, isometric) when the hip is in 90 + degrees of hip flexion. Coccygeal g max can adduct (concentric, isometric) and other parts can abduct depending on hip joint position and resistance encountered.

So your question doesn't turn out to be that simple after all.




TexasOrtho -> RE: Gluteus Mechanics (May 17, 2008 5:23:44 PM)

Wait...what?




MuscleMatrix -> RE: Gluteus Mechanics (May 17, 2008 7:17:50 PM)

Do you have a specific question TexasOrtho?




TexasOrtho -> RE: Gluteus Mechanics (May 17, 2008 8:05:25 PM)

Nah mate.  Just impressed with the unexpectedly comprehensive reply. It's the most I've ever read about the butt. [;)]




SJBird55 -> RE: Gluteus Mechanics (May 17, 2008 11:31:34 PM)

The comprehensive reply didn't answer Maverick's question though.  I believe Maverick is looking at the biomechanics of the hip from a closed chain perspective.  MM, I think I somewhat disagree with your proposal of direction of resistance and instead think of gravity and the effect gravity is having on the joint center of rotation and joint position during functional activities.




MuscleMatrix -> RE: Gluteus Mechanics (May 18, 2008 1:50:06 AM)

The purpose of my original response was to demonstrate that the question must be much more specific in order for it to be answered with any degree of clarity and applicability. A broad question engenders a broad response. I think the original post brings up a lot of good questions that need to be addressed in order for us to obtain a fuller picture of hip joint mechanics.

In response to your point about gravity, I have several thoughts. Gravity is an acceleration that pulls downward on a mass and if that direction of pull occurs around one side of an axis of the hip joint, it will create an external resistance that must be opposed by internal "resistance fighters" (aka - muscles). If the resistance imposed by gravity acting on the superincumbent mass to the hip joint is anterior to the med-lat hip joint axis, then the gluteus maximus will be one of those resistance fighters. In addition, the GRF may also be directed in front of the med-lat hip joint axis (ex - gait) and this would cause gluteus maximus activation. So, hip joint position relative to these force-imposed torques determines recruitment/activation of gluteus maximus and any other relevant muscle for that matter. SJ, gravity is not affecting hip joint position as much as a specific hip joint position determines the challenge the effect of gravity will have on the hip musculature.

Thanks for your comments SJ.

Maverick, can you be more specific with your question so we can have a better starting point to answer?




Sebastian Asselbergs -> RE: Gluteus Mechanics (May 18, 2008 6:37:53 AM)

MM, very nice reviews.
But I have one small addition: although your point is well-taken about the effect of hip position on the muscular response to gravity, we can not forget the effect gravity has on the single hip when one considers the post-ant. axis of rotation of the hip. In other words, the effect on the abductors and lateral stabilisers. Furthermore, the position of the trunk and pelvis above the hip, also influences hip muscle action in relation to gravity.

This all illustrates that you are very right: the question has to be REALLY specific to generate a specific answer [;)]




SJBird55 -> RE: Gluteus Mechanics (May 18, 2008 7:15:42 AM)

MM... I believe that is what I was saying, you just said it better.  A

And, no.. internal muscles do not necessarily need to oppose the forces of gravity.  People can do all sorts of goofy things with their own center of mass which can be the variable that responds to the effect of gravity.  The main example I can think of right now for the hip would be Trendelenburg gait OR think of someone with cerebral palsy and their gait abnormalities.  Poor motor recruitment  or lack of an ability to use a muscle group can lead to compensatory mechanisms that don't necessarily require the musculature around the hip to function normally.  I'm not sure if that makes sense.




TexasOrtho -> RE: Gluteus Mechanics (May 18, 2008 7:40:30 AM)

All good things to think about, and MM I think you did answer it well.  I think the question was fairly specific and seems to have been answered by MM's post.  However, as we sometimes base our notions of these issues on theoretical biomechanics such as length-tension, force-velocity, lever systems, etc..I might recommend an Ovid search of the topics for a more precise answer.  I might suggest the journal of Arthroplasty or the various Bone and Joint Surgery (American or British) to extract some peer-reviewed info on the matter.

This might allow you to reconcile the theoretical with the applied research that I'm sure has been done on the topic.  In my experience of reviewing some of hard data on biomechanics, we realize that many of the theoretical notions we have are fully inline with both kinetic and kinematic research.  However, there are times when they are poorly generalizable to a specific question

I've access to Ovid if I can help you with the answer.  Just let me know.




MaverickNH -> RE: Gluteus Mechanics (May 22, 2008 3:54:49 PM)

Time, then, for me to get more specific:

Consider two cases:

1. A "rehab" exercise case lying supine on the back with legs extended. A typical exercise is to contract the glutes with legs together, but one can look at legs in varying degrees of abduction and external rotation. Trying it myself, I seem to generate progressively less contraction as I abduct to hip width and 150% hipwidth, with moderate external rotation. As external rotation is reduced, and feet become parallel, glute contraction diminishes sharply. Reduction in perceived contraction is additive with abduction and internal rotation.

2. A typical squat, with feet slightly rotated (10-11 & 1-2 o'clock), with feet at hip width and 150% of hip-width. I haven't tried that myself.

I don't have an artificial hip, but am designing. As I have signaificant natural turn-out, I may not be a good example to build from, but I'm all I've got :)




SJBird55 -> RE: Gluteus Mechanics (May 22, 2008 7:31:55 PM)

What is 150% hip width?

I need a video.  LOL  I'm lost. 

In #1, frankly I really wouldn't care.  That type of exercise definitely isn't functional and I don't have patients doing that sort of movement pattern.  How are you measuring the forces generated?  How do you know that what you are describing isn't normal? 

With #2... ummm, I have no idea what exactly you want to know.  There have been some EMG studies and the gluteus medius does contract during the performance of a static single leg wall squat. 

In my opinion, from a functional perspective, the gluteus medius is very relevant for normal qualities of gait.  I'm sure the gluteus maximus has a large role (no pun intended), but from a physical therapy perspective and focusing on normalizing function, I know I spend quite a bit of time assisting people to recruit their gluteus medius muscle.

I'm not a surgeon, but I would assume that surgeons don't change the location or angles of the replaced acetabulum.  I'd be curious if the acetabulum was altered in location, what would happen to the joint capsule and the ligaments stabilizing the joint?




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