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Hip Joint
Part (5)
Hip External &
Internal Rotation
Hip External
Rotation
Goniometry
 Range of motion 
0 to 45
Testing position 
Sitting on a supporting surface with knees flexed 90
degrees and the hip in 90 degrees of flexion
Stabilization 
Stabilize the distal end of femur to prevent
abduction or further flexion of the hip. Avoid
rotation and lateral tilting of the pelvis.
 Goniometer Alignment
Fulcrum
Anterior aspect of the patella
Proximal Arm
Align it perpendicular to the floor
Distal Arm
Alight it with the anterior midline of the lower leg,
using the crest of the tibia and a point midway
between the two malleoli for reference
 Patient Instruction 
Ask the patient to move their leg in toward the
opposite leg.
 Normal End Feel 
Firm, because of tension in:
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Anterior joint capsule
Iliofemoral ligament
Pubofemoral ligament
Anterior portion of gluteus medius
Gluteus minimus
Adductor magnus
Adductor longus
Pectineus
Piriformis
Hip External
Rotation
Muscle
Testing
 Hip External Rotation Muscles 
• Obturator externus
• Obturator internus
• Quadratus femoris (may be
absent)
• Piriformis
• Gemellus superior
• Gemellus inferior
• Gluteus maximus (posterior)
Obturator Externus
Origin:
Obturator membrane + ramus of ischium + inferior ramus of pubis +
pelvis
Insertion:
Trochanteric fossa of femur
Innervation:
Obturator Nerve (L3-L4)
Obturator Internus
Origin:
Inferior ramus of pubis + ramus of ischium + obturator fascia + obturator
foramen + obturator membrane + upper brim of greater sciatic
foramen
Insertion:
Greater trochanter of femur
Innervation:
Nerve to obturator internus (L5-S1)
Quadratus femoris
Origin:
Ischial tuberosity
Insertion:
Quadrate tubercle on the trochantric crest of femur
Innervation:
Nerve to quadratus femoris (L5-S1)
Piriformis
Origin:
Sacrum + ilium + sacrotuberous ligament + capsule of sacroiliac joint
Insertion:
Greater trochanter of the femur
Innervation:
Nerve to piriformis (S1-S2)
Gemellus Superior
Origin:
Ischium
Insertion:
Greater trochanter of the femur
Innervation:
Nerve to obturator internus (L5-S1)
Gemellus Inferior
Origin:
Ischial tuberosity
Insertion:
Greater trochanter of the femur
Innervation:
Nerve to quadratus femoris (L5-S1)
Gluteus Maximus
Origin:
Posterior gluteal line of the ilium + Iliac crest + Sacrum coccyx +
Aponeurosis over gluteus medius
Insertion:
Femur (gluteal tuberosity) + Iliotibial tract of fasia lata
Innervation:
Inferior Gluteal Nerve (L5-S2)
 Test For Grades 5, 4 and 3 of 
 Patient Position 
Short sitting, trunk may be supported by
placing hands flat at sides.
 Therapist and Patient Instructions 
The therapist sitting or kneeling in front of the patient, placing one hand
on the lateral aspect of the knee and the other hand just above the
medial malleolus. The resistance will be inward at the knee and
outward at the ankle to create a sort of rotary resistance. The
patient should be in the end position for testing. End Positioning
means that the patient is trying to hold the movement at the end of
the ROM. Ask the patient to, “bring your leg inward toward your
other leg, don’t let me turn your leg out.”
 Test For Grade 2 
 Patient Position 
Supine. The test limb is in internal
rotation.
 Therapist and Patient Instructions 
The therapist should be standing at side of limb to be tested.
Patient externally rotates hip in available range of motion.
One hand may be used to maintain pelvic alignment at
lateral hip. Tell the patient “Roll your leg out”
 Test For Grades 1 and 0 
 Patient Position 
Supine. The test limb is in internal rotation.
 Therapist Position 
Standing at side of limb to be tested.
 Patient Instructions: 
patient attempts to externally rotate the hip. Ask the
patient to, “Try to bring your leg out.”
Hip Internal
Rotation
Goniometry
 Range of motion 
0 to 45
Testing position 
Sitting on a supporting surface with knees flexed 90
degrees and the hip in 90 degrees of flexion
Stabilization 
Stabilize the distal end of femur to prevent
abduction, adduction, or further flexion of the
hip. Avoid rotation and lateral tilting of the pelvis.
 Goniometer Alignment
Fulcrum
Anterior aspect of the patella
Proximal Arm
Align it perpendicular to the floor
Distal Arm
Alight it with the anterior midline of the lower leg,
using the crest of the tibia and a point midway
between the two malleoli for reference
 Patient Instruction 
Ask the patient to bring their leg out to the side.
 Normal End Feel 
Firm, because of tension in:










Posterior joint capsule
Ischiofemoral ligament
Piriformis
Obturator internus
Obturator externus
Gemellus superior
Gemellus inferior
Quadratus femoris
Posterior fibers of gluteus medius
Gluteus maximus
Hip Internal
Rotation
Muscle
Testing
 Hip Internal Rotation Muscles 
• Gluteus minimus
• Gluteus medius
• Tensor fasciae latae
Gluteus Minimus
Origin:
Ilium + Greater sciatic notch
Insertion:
Greater trochanter of the femur + Fibrous capsule of hip joint
Innervation:
Superior Gluteal Nerve (L4-S1)
Gluteus Medius
Origin:
Ilium + Fascia over the upper part
Insertion:
Greater trochanter of the femur
Innervation:
Superior Gluteal Nerve (L4-S1)
Tensor Fasciae Lata
Origin:
Iliac crest + Anterior superior iliac spine
Insertion:
Iliotibial tract
Innervation:
Superior Gluteal Nerve (L4-S1)
 Test For Grades 5, 4 and 3 of 
 Patient Position 
Short sitting, arms may be used for trunk
support or may be crossed over chest.
 Therapist and Patient Instructions 
The therapist sitting or kneeling in front of the patient, placing one
hand on the medial aspect of the knee and the other hand just
above the lateral malleolus. Resistance will be in an outward
direction at the knee and in an inward direction at the ankle to
create a rotary resistance. The patient should be in the end
position for testing. Ask the patient to, “move your leg outward,
don’t let me pull it back in.”
 Test For Grade 2 
 Patient Position 
Supine. The test limb is in external
rotation.
 Therapist and Patient Instructions 
The therapist should be standing at side of limb to be tested.
Palpate the internal rotators and ask the patient to try and
roll their leg in toward their other leg.
 Test For Grades 1 and 0 
 Patient Position 
Supine. The test limb is in external rotation.
 Therapist Position 
Standing at side of limb to be tested.
 Patient Instructions: 
Patient attempts to internally rotate the hip. One hand is used to
palpate gluteus medius over the posterolateral surface of the hip
above the greater trochanter. The other hand palpates tensor
fasciae latae on the anterolateral surface of the hip below the
ASIS. Ask the patient to, “Try to bring your leg in.”
 Good Luck To You All 