The Hip: Bones through Muscles. Bones of the Hip 1.The ____, a.k.a. the Innominate Bone Made up of 3 bones: the _, the _, and the _____ bone

The HipThe Hip:: Bones through MusclesBones through Muscles

Bones of the Hip1. The ______, a.k.a. the Innominate

Bone

• Made up of 3 bones: the _____, the _____, and the _______ bone.

• ___________: formed by the articulation of the three pelvic bones.

• It is the cup-shaped structure into which the femur fits (the “socket” of the ball-and-socket joint).

AcetabulumAcetabulum

iliumiliumischiumischiumpubicpubic

PelvisPelvis

Bones of the Hip: Hip Joint• Why is the hip joint much more

stable than the shoulder joint?

The acetabulum is much deeper than the very shallow glenoid fossa of the scapula.

• What transfers the weight of the trunk & arms to the lower extremities?

The hip joint

Bones of the Hip: The Ilium• __________________

_____ (ASIS): large “bump” on the front side of the pelvis that can be palpated on the outside of the body.

• _________________ _____ (AIIS): smaller bump just below the ASIS.

Anterior Superior Iliac Anterior Superior Iliac SpineSpine

Anterior Inferior Iliac Anterior Inferior Iliac SpineSpine

Bones of the Hip: The Ilium• _____________________

_____ (PSIS): large “bump” on the backside of the pelvis.• Can be palpated on the

outside of the body.• Helps to create the “dimple

s” visible on the lower back.

• ____________________ ______ (PIIS): smaller bump just below the PSIS.

Posterior Superior Iliac Spine

Posterior Inferior Iliac Posterior Inferior Iliac SpineSpine

Bones of the Hip: The Ischium • _____________:

projection of bone that is found on the medial part of the pelvis within the pelvic ring.

• __________________: large, often rough, surface found at the most inferior portion of the pelvis.

(It’s what you sit on!)

Ischial SpineIschial Spine

Ischial TuberosityIschial Tuberosity

Bones of the Hip: The Pubic Bone

• ________________: the articulation between the two pubic bones.

• __________________: large hole located in both pubic bones of the hip.

Pubic SymphysisPubic Symphysis

Obturator ForamenObturator Foramen

• The _______: the longest and largest bone in the body

• The ball, or head, of the femur articulates with the acetabulum.

• The head is separated from the shaft by the neck.

• _________________________: two large projections of bone just distal to the neck that serve as insertion points for the major muscles that perform hip actions.

FemurFemur

Greater & Lesser TrochantersGreater & Lesser Trochanters

Bones of the Hip: The Femur

• The greater trochanter can be palpated when performing internal and external rotation of the hip.

• ____________________: the ridge of bone running between the lesser and greater trochanters.

• ____________: A large ridge or crest of bone running down the posterior aspect of the shaft of the femur. It is Latin for “rough line.”

• It serves as a source of muscular attachment for numerous muscles of both the hip and the knee joint.

Intertrochanteric LineIntertrochanteric Line

Linea AsperaLinea Aspera

Bones of the Hip: The Femur

Joints of the Hip1. The Hip Joint = The articulation

between the femur and the pelvis.

• It is a tri-axial, ball-and-socket joint.

• Where does the hip joint derive most of its stability from?

The articulation between the head of the femur and the acetabulum of the pelvis.

2. The pubic symphysis is a synarthrodial joint (no joint cavity, very little movement).

Joints of the Hip

Ligaments of the Hip1. ________ Ligament:

runs from the edge of the acetabulum of the pelvis to the neck of the femur.

2. __________ (a.k.a. Acetabular Labrum): a fibrocartilaginous rim on the outer edge of the acetabulum that helps to deepen the hip socket.

Capsular Capsular

Glenoid lipGlenoid lip

3. __________ Ligament: connects the ilium to the femur

• Looks like a “Y” and is sometimes called the Y ligament.

• Crosses the _______ aspect of the hip and attaches to the neck of the femur.

IliofemoralIliofemoral

anterioranterior

Ligaments of the Hip

4. ____________ Ligament: connects the ischium to the femur

• Crosses the ________ aspect of the hip and attaches to the neck of the femur.

Ligaments of the HipIschiofemoralIschiofemoral

posteriorposterior

5. ____________Ligament: connects the pubic bone to the femur

• Crosses the ________ aspect of the hip and attaches to the neck of the femur.

Ligaments of the HipPubofemoralPubofemoral

anterior

6. ____________________ Ligament: spans a small notch in the lower portion of the glenoid lip and creates a foramen that blood vessels pass through to and from the hip joint.

Ligaments of the HipTransverse AcetabularTransverse Acetabular

7. ___________________________: runs between the Transverse Acetabular Ligament and a hole in the superior edge of the femoral head called the femoral fovea.

Ligaments of the HipLigamentum Capitis FemorisLigamentum Capitis Femoris

The Hip: Fundamental Movements• How many planes and axes does the hip

joint move in?

It moves in all three planes, about all three axes.

• What are the 6 movements of the hip joint?• Flexion and extension in the sagittal plane

about a frontal horizontal axis• Abduction and adduction in the frontal plane

about a sagittal-horizontal axis• Internal and external rotation in the horizontal

plane about a vertical axis

The Hip: Muscles - Anterior Hip Muscles

Muscle Origin Insertion Action

(Iliopsoas)

Transverse processes of all 5 lumbar vertebrae, and the bodies and IVDs of T12-L5

Lesser trochanter of the femur

Flexion of the hip; assists with adduction and external rotation of the hip joint; assists with flexion and rotation of the lumbar spine

(Iliopsoas)

Iliac fossa of the pelvis to the tendon of psoas major

Just distal to the lesser trochanter of the femur

Flexion of the hip; assists with adduction and external rotation of the hip joint; (when the femur is stabilized) assists with flexion of the lumbar spine

T12 and L1 vertebrae and the IVD between them

Pubic bone Assists the psoas major with flexion of the lumbar spine

Psoas Psoas MajorMajor

IliacusIliacus

Psoas Psoas MinorMinor



Anterior superior iliac spine (ASIS)

Medial aspect of the proximal end of the tibia, just inferior to the medial condyle.

Hip flexion, abduction, and external rotation.

Anterior inferior iliac spine (AIIS)

Tibial tuberosity Flexion of the hip joint; a weak hip adductor.

(TFL) External rim of the crest of the ilium

Combines with the gluteus maximus to form the Iliotibial band, which inserts onto Gerdy's tubercle.

Flexion and abduction of the hip.

Between the anterior superior aspect of the pubic bones

Just distal to the lesser trochanter of the femur.

Hip flexion, and strong adduction and external rotation.

SartorisSartoris

Rectus Rectus FemorisFemoris

Tensor Tensor Fascia Fascia LataLata

PectineusPectineus





• The iliopsoas muscle is a combination of the ______ and ______ muscles.

• What are the iliacus, psoas major, & psoas minor are commonly referred to as?

The TRUE groin muscles

• What aspect of the hip does the term “groin” actually refer to?

The Anterior aspect


iliacusiliacuspsoaspsoas

• The psoas minor is not present on one or both sides in more than ___% of people.

• Why is the psoas minor not considered to be a muscle of the hip joint?

It does not cross the hip joint.• Which two anterior hip muscles cross both

the hip and knee joint?

• The sartorius and rectus femoris


5050

The Hip: Muscles - Posterior Hip Muscles


Long Head: Ischial Tuberosity Short Head: Lateral aspect of the linea aspera

Head of the fibula and lateral condyle of the tibia

Extension of the hip; assists in adduction and external rotation

Ischial tuberosity Medial aspect of the tibia, just below the medial condyle

Extension of the hip; assists in internal rotation and adduction

Ischial tuberosity Medial condyle of the tibia Extension of the hip; assists in internal rotation and adduction

Posterior aspects of the ilium, sacrum, and coccyx

Blends with the tensor fascia lata to form the Iliotibial Band (which inserts on Gerdy's tubercle)

Extension and external rotation of the hip

Biceps Biceps FemorisFemoris

Semi-Semi-tendinosustendinosus

Semi-Semi-membran- membran- osusosus

Gluteus Gluteus MaximusMaximus



Upper portion of the sacrum

Upper surface of the greater trochanter

External rotation of the hip

Spine of the ischium

Greater trochanter External rotation of the hip

Inner surface of the obturator foramen

Medial aspect of the greater trochanter


Ischial tuberosity Medial aspect of the greater trochanter


Outer surface of the pubic bone and ischium around the obturator foramen

Pelvis to the trochanteric fossa of the femur


Ischial tuberosity Intertrochanteric ridge of the femur


PiriformisPiriformis

Superior Superior GemellusGemellus

Internal Internal OrbturatorOrbturator

Inferior Inferior GemellusGemellus

External External OrbturatorOrbturator

Quadratus Quadratus FemorisFemoris

The Hip: Muscles – Posterior Hip Muscles




• Which hamstring muscle can you palpate on the lateral posterior knee?• The Biceps Femoris

• On the medial posterior knee?• The Semimembranosus and

Semitendinosus

• Which muscle, if in spasm, may be responsible for impingement of the sciatic nerve?• The piriformis


The Hip: Muscles – Medial Hip Muscles


Body of the pubic bone

Middle 1/3 of the linea aspera of the femur

Adduction of the hip; assists in flexion and external rotation.

Body and inferior surface of the pubic bone

Proximal 1/3 of the linea aspera of the femur

Adduction of the hip; assists in flexion and external rotation.

Inferior surface of the pubic bone, the ischium, and the ischial tuberosity.

The entire length of the linea aspera and the adductor tubercle of the femur.

Anterior portion: adduction, flexion, and external rotation of the hip; Posterior portion: adduction, extension, and internal rotation of the hip.

Lower portions of the anterior aspect of the pubic symphysis and the pubic bone.

Just distal to the medial condyle of the tibia.

Adduction and flexion of the hip.

Adductor Adductor LongusLongus

Adductor Adductor BrevisBrevis

Adductor Adductor MagnusMagnus

GracilisGracilis

The Hip: Muscles - Medial Muscles

• What are the medial muscles of the hip joint often referred to as?

The COMMON groin muscles• What common athletic injury will affect the medial

muscles?

A groin strain• Which medial hip muscle is the only adductor that

crosses the knee joint?

The gracilis• Which adductor muscle can perform flexion and

extension, and internal and external rotation of the hip?

The adductor magnus

The Hip: Muscles – Medial Muscles

The Hip: Muscles – Lateral Hip Muscles


Middle of the external aspect of the ilium to the iliac crest.

Posterior lateral aspect of the greater trochanter

Abduction of the hip; Anterior portion assists with flexion and internal rotation; Posterior portion assists with extension and external rotation.

Middle of the external aspect of the ilium to the iliac crest.

Anterior surface of the greater trochanter

Abduction and internal rotation of the hip.

Gluteus Gluteus MediusMedius

Gluteus Gluteus MinimusMinimus

• Formed by 2 muscles that cross the hip: 1. The tensor fascia lata2. The gluteus maximus

• The ITB passes back and forth across the ________________ of the femur as the hip joint flexes and extends.

• What is located between the ITB and the greater trochanter to facilitate this movement? A large trochanteric bursa

• Excessive flexion and extension or direct trauma can cause ____________ of the bursa.

The Hip: Muscles – Iliotibial Band

greater trochantergreater trochanter

inflammationinflammation

The HipThe Hip:: EvaluationEvaluation

Hip Evaluation: Inspection• From the front, do the hips look even? • Can the athlete stand on one leg without

pain?• Can the athlete sit and walk normally

without pain?• Is there a lateral tilt of the pelvis?

• A lateral tilt could indicate a leg-length discrepancy or abnormal muscle contraction on one side of the hip or low back.

• In people who are not physically active, leg-length discrepancies of more than 1 inch may produce symptoms. However, shortening of as little as 3 mm (1/8 inch) may cause symptoms in highly active athletes.

• 2 Types of Leg Length Discrepancy: • True (anatomical)

• Functional (shortening)

• What is the most valid means of measurement?

• X-ray examination

• Anatomical Discrepancy: Shortening may be equal throughout the limb or localized within one bone (femur or tibia).

Hip Evaluation: Inspection

• With the athlete lying supine and fully extended on a table, measurement is taken between the medial malleoli and the anterior superior iliac spine of each leg.

Hip Evaluation: Anatomical Discrepancy

• Can occur as a result of lateral pelvic tilt (obliquely) or from a flexion or adduction deformity.

• Measurement is taken from the umbilicus to the medial malleolus of each ankle.

Hip Evaluation: Functional Discrepancy

• Bony Palpation: Iliac crest, ASIS, AIIS, Greater/lesser trochanter, Pubic symphysis, Ischial tuberosity, PSIS, PIIS

• Soft Tissue Palpation: Rectus Femoris/Quad. muscles, Adductor muscles, Hamstrings, Piriformis, Gluteal muscles, Iliotibial band

Hip Evaluation: Palpation

• Flexion = ____ degreesFlexion = ____ degrees

• Extension = ___ degreesExtension = ___ degrees

• Abduction = ___ degreesAbduction = ___ degrees

• Adduction = ___ degreesAdduction = ___ degrees

• Internal Rotation = ___ degreesInternal Rotation = ___ degrees

• External Rotation = ___ degreesExternal Rotation = ___ degrees

Hip Evaluation: Range of Motion

125125101045454040

45454545

Orthopedic Tests: Hip Flexor Tightness

• 1. ________ Test• Technique: The athlete lies supine on a

table with one knee flexed towards his chest, and the back completely flat. The other knee is flexed/hanging off the end of the table.

• Result: Normal extensibility of the hip flexors allows the thigh to touch the table with the knee flexed to approximately 70 degrees. Tight hip flexors are suspected if the athlete cannot keep their thigh flat on the table. If only the rectus femoris is tight, the thigh will lie flat, but the knee will extend more than 70 degrees.

Kendall Kendall

Kendall Test for hip flexor tightness

• 2. _________ Test• Technique: The athlete lies supine on a table,

arms across the chest, legs together and fully extended. The trainer places one hand under the athlete’s lumbar curve (low back). One thigh is brought towards the chest, flattening the spine. The extended thigh should remain flat on the table, and the curve in the low back should return once the leg is fully extended again.

• Result: If the thigh does not remain flat on the table, there is a hip flexion contracture (a tightness of the hip joint).

Orthopedic Tests: Hip Flexor Tightness

Thomas Thomas

Thomas Test for Hip Contracture

Orthopedic Tests: Hip and Sacroiliac Joint

1. _______ (FABER) Test:• FABER = Flexion, ABduction, External

Rotation of the hip

• Technique: With the athlete supine on the table, the foot of the side that is painful is placed on the opposite extended knee. A downward pressure is applied on the bent knee.

• Result: Pain in the hip or sacroiliac region indicates a pathological condition (this is a non-specific test, it just localizes the area of pain).

PatrickPatrick

Patrick test for a pathological condition of the hip and sacroiliac joint

2. ____________ Test• Technique: With the athlete supine on the

table, position him so that the affected side is on the edge of the table, and the affected leg is hanging off the side. The unaffected thigh is flexed towards the abdomen, and a downward pressure is applied to the thigh on the affected thigh, moving the hip and sacroiliac joint into extension.

• Result: The test is positive for hip or sacroiliac joint involvement if hyperextension on the affected side causes increased pain.

GaenslenGaenslen’’ss


Gaenslen’s Test

3. _________ Test• Technique: The athlete is lying prone

(on his stomach). The trainer places his hand under one knee, while the other hand stabilizes the low back. He then passively extends the hip and applies a downward pressure on the sacroiliac joint.

• Result: Pain in the SI joint region indicates inflammation, infection, or a sprain.


YeomanYeoman’’s s

Orthopedic Tests: TFL and Iliotibial Band

1. ________ Test• Technique: The athlete

stands and supports full weight on the affected leg with the knee bent at 30-40 degrees.

• Result: A positive test occurs when pain is felt at the lateral femoral condyle, indicating TFL tightness.

RenneRenne’’ss

2. ________ Compression Test• Technique: With the athlete lying or sitting,

flex the knee being tested to 90 degrees. Use your thumb to apply pressure over Gerdy’s tubercle (on the lateral condyle of the tibia), and then passively extend the knee.

• Result: Severe pain over the lateral condyle at about 30 degrees of flexion indicates Iliotibial Band Friction Syndrome (ITBFS) or “Runner’s Knee.”


Noble’sNoble’s

3. ______ Test• Technique: The athlete is lying on the

unaffected side. Stabilize the pelvis with one hand while slightly extending and abducting the affected hip. With the knee flexed to 90 degrees, allow the hip to drop into adduction.

• Result: A tight or contracted TFL or ITB will keep the thigh in an abducted position, not allowing it to fall into adduction.


OberOber’’ss

Ober’s Test for Iliotibial Band tightness

Orthopedic Tests: Other Hip Tests1. _______________ Test• Technique: Have the athlete

stand on one foot (on the affected side), and slightly flex the non-weight bearing hip.

• Result: Normally, in this position, the iliac crest (upper hip region) of the non-weight bearing (unaffected side) would be slightly higher than the weight bearing side. The test is positive if the iliac crest is higher on the affected side than the unaffected side. This indicates weakness of the hip abductors, especially the gluteus medius.

TrendelenburgTrendelenburg’’ss

normal positive

• __________ Test• Technique: The athlete lies prone (face-down)

on the table. With one hand, the trainer flexes the knee of the affected side to 60 degrees, while stabilizing the pelvis with the other hand. The leg that is flexed is then internally rotated.

• Result: Tightness or pain indicates piriformis tightness.

PiriformisPiriformis

Orthopedic Tests: Other Hip Tests

• _____ Test• Technique: The athlete lies prone (face-down)

on the table. While stabilizing the pelvis, the knee of the affected side is flexed.

• Result: If the hip on that side goes into flexion as the knee is flexed, there is tightness of the rectus femoris, or possibly a hip flexion contracture.

Orthopedic Tests: Other Hip TestsElyEly’’s s

The HipThe Hip:: Common Sports InjuriesCommon Sports Injuries

Common Injuries of the Hip and Thigh

1. ___________ Contusion• Cause: Exposure to traumatic blunt

blows in a variety of sports activities. Contusions usually develop as a result of a severe impact to the relaxed thigh that compresses the muscle against the hard surface of the femur. The extent of force and the degree of thigh relaxation determine the depth of injury and the amount of damage.

QuadricepsQuadriceps

• Signs/Sx: Pain, a temporary loss of function, and immediate capillary effusion usually occur at the instant of trauma.

• The athlete will describe being hit sharply in the thigh, and feeling immediate pain and weakness.

Common Injuries: Quadriceps Contusion

• Grade 1 = superficial intramuscular bruise with mild hemorrhage, little pain, no swelling, and mild point tenderness at the trauma site.

• Grade 2 = deeper than Grade 1; produces mild pain, swelling, and point tenderness, with the athlete able to flex the knee no more than ___ degrees.


9090

• Grade 3 = moderate injury; causes pain, swelling, and a range of knee flexion that is 45 to 90 degrees with an obvious limp present.

• Grade 4 = severe injury causing major disability; the blow may be so hard as to split the fascia, allowing for a muscle herniation; a characteristic deep intramuscular hematoma with an intermuscular spread is present; knee movement is severely restricted to ___ degrees or less, and the athlete shows a decided limp.


4545

Tx:• Early detection and avoidance of profuse internal

hemorrhage are vital, both for a speedy recovery and for preventing widespread scarring.

• The leg should be immediately placed in flexion with an ice pack to avoid muscle shortening.

• RICE, NSAIDs, and pain-relievers are given as needed.

• Crutches may be needed for greater than Grade 2 contusions.

• Any developing hematoma may need to be aspirated, and any herniated muscle tissue must be surgically repaired.



Tx (continued):• Cold packs combined with gentle

stretching are the preferred treatment. • An elastic bandage should be worn to

provide constant pressure and mild support in the quadriceps area.

• Follow-up care includes ROM exercises.

• *Heat, massage, and ultrasound should be avoided to prevent the possibility of myositis ossificans.


2. ________________ Traumatica• Cause: A severe blow or repeated blows to the

thigh, usually the quadriceps muscle, can lead to ectopic (meaning abnormal) bone production.

• Myositis Ossificans often follows bleeding into the quadriceps muscle and a hematoma. After the inflammation has been resolved, the irritated tissue may produce calcified formations that resemble cartilage or bone.

• Particles of bone may be seen during X-ray examination 2-6 weeks after the injury.

• If the injury is in the muscle belly, the formation may be re-absorbed or decrease in size.

• However, if the injury is at the muscle origin or insertion, a decrease in size is much less likely.

Myositis Ossificans

Common Injuries: Myositis Ossificans

• Improper care of a thigh contusion can also lead to myositis ossificans. The following can initially cause the condition, or, once present, can aggravate it:

• Attempting to “run off” a quadriceps contusion

• Treatment that is too vigorous for a contusion (e.g. massage directly over the contusion, ultrasound, or superficial heat)

Myositis Ossificans

• Signs/Sx: The athlete will complain of pain, muscle weakness, soreness, swelling, and decreased muscle function. Upon examination, there is tissue tension and point tenderness along with decreased ROM.

• Tx: Once myositis ossificans is apparent, treatment should be extremely conservative. If the condition is painful and restricts motion, the formation may be surgically removed after ______ with much less likelihood of return. Removing the formation too early may cause it to return.

1 year1 year

Common Injuries: Myositis Ossificans

Common Injuries: Quadriceps Strain

• ___________ Strain• Cause: The _____________ can be

occasionally strained by a sudden stretch, such as a fall on a bent knee, or a sudden contraction, such as when the athlete jumps in volleyball or kicks in soccer. The strain is usually associated with a weakened or overly constricted muscle.

QuadricepsQuadricepsrectus femorisrectus femoris

• Signs/Sx: A peripheral tear causes fewer symptoms than a deeper tear. In general, there is less point tenderness and a smaller hematoma.

• More centrally located partial tears cause the athlete more pain and discomfort than a peripheral tear.

• Deep tears cause a great deal of pain, point tenderness spasm, and loss of function, but little discoloration from internal bleeding.

• A complete muscle tear may leave the athlete with little disability and discomfort, but with some deformity of the anterior thigh.


• Tx: Initially, RICE, NSAIDs, and pain-relievers are given as needed. The extent of the tear should be determined quickly before the swelling appears. Crutches may be used for the first few days. After the inflammatory phase, isometric exercises in a pain-free range can be initiated along with cryotherapy. Cold whirlpool and ultrasound treatment may also be used. An elastic sleeve may be worn for support.


• ____________ Strains:

*Hamstring strains are the most common thigh injuries.

Athletes suffer more strains to the hamstrings than any other thigh muscle.


HamstringHamstring


Cause: The exact cause is __________. One theory is that the short head of the biceps femoris muscle is subject to the highest incidence of hamstring strain because it contracts at the same time as the quadriceps (due to an unusual neurological pathway). Another theory cites the quick change of the hamstring muscle from the role of knee staibilization to that of hip extension when running could be a cause for the strain. Possible other reasons include: muscle fatigue, faulty posture, leg-length discrepancy, tight hamstrings, improper form, or adverse neural tension.

unknownunknown

*The hamstring muscle group should have a strength of 60-70 percent of that of the quadriceps group.

• Signs/Sx: A hamstring strain can involve the ____________ or bony attachment. The extent of the injury can vary from pulling apart of a few muscle fibers to complete rupture or an avulsion fracture. Hemorrhage, pain, and immediate loss of function vary according to the degree of trauma.

Common Injuries: Hamstring Strain

muscle bellymuscle belly

• Grade 1 strain = muscle soreness during movement accompanied by point tenderness. These strains are often difficult to detect when they first occur. The athlete usually will not feel the irritation and stiffness until they have cooled down after activity. Fewer than ___% of fibers are torn in this grade.


2020

• Grade 2 strain = Partial tearing of muscle fibers, identified by a sudden snap or tear of the muscle, accompanied by severe pain and loss of function during knee flexion. Fewer than ___% of fibers are torn in this grade.


7070

• Grade 3 strain = Rupture of tendinous or muscular tissue, involving major hemorrhage and disability. With more than ___% of fibers torn, there is severe edema, tenderness, loss of function, ecchymosis, and a palpable gap in the muscle.


7070


• Tx: Initially, RICE, NSAIDs, and pain-relievers are given as needed. Activity should be reduced until soreness is gone.

• An athlete should not be allowed to return to competition until complete function of the muscle is restored.

• In Grade 2 or 3 strains, extreme caution should be taken in treatment. RICE should be used for 24-48 hours for Grade 2, and for 48-72 hours for Grade 3.

• After the inflammatory phase has ended, isometric exercise, cryotherapy, and ultrasound may be beneficial.

• Later on, gentle stretching, jogging, stationary cycling, or isokinetic exercises may be used.



• _____ Strain:• The groin muscles include the iliopsoas,

rectus femoris, and the adductor group.• Groin pain is one of the more difficult

problems to diagnose, especially if chronic.• What is the most commonly strained

groin muscle?

Adductor longus• Cause: Running, jumping, or twisting with

external rotation can cause a groin pull.

GroinGroin

• Signs/Sx: The strain can be felt as a sudden twinge or feeling of tearing during an active movement, or the athlete may not notice it until after they have stopped their activity. Like other tears, it causes pain, weakness, and internal hemorrhage.

Common Injuries: Groin Strain

• Tx: If detected immediately, RICE, NSAIDs and pain-relievers can be used for 48-72 hours.

• Passive, active, and resisted muscle testing should be done to determine the exact muscle(s) involved.

• This injury is difficult to care for, and rest seems to be the most effective treatment.

• Whirlpool, cryotherapy, or ultrasound therapy may be used, but exercise should be delayed until the groin is __________.

• Rehabilitation should focus on gradual stretching and restoration of the normal range of motion.


pain-freepain-free

**Strains are always a problem for athletes because they tend to recur as a result of the inelastic, fibrous scar tissue that sometimes forms during the healing process. The higher the incidence of strain at a certain muscle site, the greater the amount of scar tissue and the greater the likelihood of further injury.



• ____________ Bursitis:• Cause: This is a relatively common

condition of the greater trochanter of the femur. Although commonly called bursitis, the condition could also be an inflammation at the site where the gluteus medius muscle inserts or the iliotibial band passes over the trochanter.

TrochantericTrochanteric

Common Injuries: Trochanteric Bursitis

• Signs/Sx: The athlete complains of pain in the lateral hip, which may radiate down to the knee, causing a limp. There is palpable tenderness over the lateral aspect of the greater trochanter.

• Tx: RICE, NSAIDs, and pain-relievers can be used as needed. Phonophoresis may be helpful. The athlete should return to running cautiously, and should avoid running on _______ surfaces.inclinedinclined


• _________ Sprain:• Cause: The hip joint, the strongest and

best-protected joint in the body, is rarely injured in sports. However, any unusual movement that exceeds the normal range of motion may result in tearing of tissue. An injury may occur from a violent twist, either from an impact force from another player, forceful contact with an object, or when the foot is planted and the trunk is forced in an opposing direction.

Hip JointHip Joint


• Signs/Sx: Hip sprains display all the normal signs of an acute injury, but are best revealed through the athlete’s inability to perform _____________ of the thigh. There is significant pain in the hip region, which increases with hip rotation.

• Tx: X-rays or MRIs should be done to rule out a fracture. Use RICE, NSAIDs, and pain-relievers as needed. Weight bearing may be restricted depending on the severity of injury (crutches should be used for a Grade 2 or 3 sprain). ROM exercises should not be done until the hip is pain-free.

Common Injuries: Hip Joint Sprain

circumductioncircumduction

• __________ Hip Joint:• Cause: This is a rare injury in sports. It

usually only results from a traumatic force directed along the long axis of the femur, especially when the knee is bent. The most common displacement is _________ to the acetabulum, with the femoral shaft adducted and flexed.

DislocatedDislocated


posteriorposterior

• Signs/Sx: The thigh is usually flexed, adducted, and internally rotated. Palpation of the femoral head will reveal posterior positioning. Often, the capsular ligament and other ligaments will be torn. An associated fracture may be present, along with possible damage to the ______ nerve.

Common Injuries: Dislocated Hip Joint

sciaticsciatic

• Tx: Immediate medical attention is required so that the joint can be reduced before muscle contractures occur. Treatment involves immobilization and 2 weeks of bed rest, followed by the use of crutches for one month or longer.

• Complications: Likely complications include palsy of the sciatic nerve, and later the development of osteoarthritis. Hip dislocation may also lead to disruption of the blood supply to the femoral head, which eventually causes a degenerative condition called avascular necrosis (death and collapse of the femoral head).

Common Injuries: Dislocated Hip Joint

• Hip ______ (Contusion): • Cause: Iliac crest and abdominal

musculature contusions, commonly called “hip pointers,” occur most often in contact sports. They result from a blow to an inadequately protected iliac crest. The hip pointer is considered to be one of the most handicapping injuries in sports, and one that is difficult to manage. A direct force to the unprotected iliac crest causes severe pinching of the local soft tissue.


PointerPointer

• Signs/Sx: Immediate pain, spasms, and temporary paralysis of the soft tissue may occur. The athlete is then unable to rotate the trunk or flex the thigh without pain.

• Tx: RICE should be applied immediately after the injury, and for at least 48 hours. In severe cases, bed rest may be recommended for 1-2 days to speed the recovery. Referral to a physician is required. Ice massage and ultrasound have been found to be beneficial treatments. A steroid injection may be required initially. Recovery time ranges from 1-3 weeks.

Common Injuries: Hip Pointer

• _____________:• Cause: Osteitis Pubis is associated with

soccer, football, and wrestling. It results from repetitive stress on the ________________ and the adjacent bony structures by the pull of muscles in the area, creating a chronic inflammatory condition.

• Signs/Sx: The athlete has pain in the groin region and in the area of the pubic symphysis. There is point tenderness on the pubic tubercle, and the athlete has pain with running, doing sit-ups, and doing squats.

• Tx: Rest, oral anti-inflammatories, and gradual return to play are recommended.

Osteitis PubisOsteitis Pubis

pubic symphysispubic symphysis


Common Injuries: Osteitis Pubis

Documents

The Hip: Bones through Muscles. Bones of the Hip 1.The ______, a.k.a. the Innominate Bone Made up of 3 bones: the _____, the _____, and the _______ bone

The Hip: Bones through Muscles. Bones of the Hip 1.The ____, a.k.a. the Innominate Bone Made up of 3 bones: the _, the _, and the _____ bone