The Hip and Pelvis
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Transcript The Hip and Pelvis
The Hip and Pelvis
The Hip and Pelvis
The hip, one of the most stable joints in the body, is a
freely movable, ball-and-socket joint
Most hip injuries result from smaller muscles being overused or
pushed too hard
The pelvis transmits weight from the axial skeleton to the
lower limb when standing or to the ischial tuberosities
when sitting
Pelvis provides attachments for various muscles
Houses parts of the digestive, urinary, and reproductive systems
Female bone structure
Slightly less dense than the male’s and is smaller, shorter and wider
Bone protrusions for muscle attachments are not sharply defined
Bones of the Hip and Pelvis Joints
Hip Joint
Where the spherical head of
the femur fits into the
acetabulum of the pelvis
Pelvis
The bones of the pelvis are
the ilium, ischium and
pubis
Connects with the sacrum
and coccyx of the vertebral
column posteriorly
Sacroiliac (SI) joint
Pelvis ~ Skeletal Structure
Ilium
Broad, flared portion that constitutes the upper and lateral sections
of the pelvis
Iliac crest is the upper ridge
Greater sciatic notch allows the sciatic nerve to pass through the leg
below
Ischium
Bears weight when sitting and is attached to the pubis anteriorly, the
ilium laterally and to the back
Large opening in the ischium is the obturator foramina, where blood
vessels and nerves pass into the legs.
Pubis
Makes up the front of the pelvis bones and located in the front and
below the bladder
The pubis symphysis, located in the center of the pubis, is where the
two sides fuse
Sacroiliac Joint
Sacrum
Composed of 5 fused
vertebrae and connects
directly to the ilium
posteriorly
Coccyx
Composed of 3-5 vertebrae
and is connected to the
lower portion of the
sacrum
Susceptible to shock
fracture, as might be
induced from a fall
Hip and Pelvis Musculature
Primary Muscles of the Hip and Pelvis
Gluteals
Hip Flexors
Hip Adductors
Quadriceps
Hamstrings
Gluteal Muscles
Gluteal muscles are the largest group
Gluteus Maximus
Performs hip extension
Gluteus Minimus and medius
Perform internal and external rotation and abduction
Hip Flexors and Adductors
Hip Flexors
Muscles that assist in hip
flexion
Iliopsoas
Sartorius
Pectineus
Rectus Femoris
Hip Adductors
Muscles that assist in hip
adduction
Adductor Longus
Adductor Brevis
Adductor Magnus
Quadriceps and Hamstrings
Quadriceps
Perform hip flexion
Vastus Medialis
Vastus Lateralis
Vastus Intermedius
Rectus Femoris
Hamstings
Perform hip extension
Biceps Femoris
Semitendinonsus
Semimembranosus
Common Injuries of the Hip and Thigh
Injuries to the hip and thigh are very common in
athletics
Major injuries and conditions are
Bursitis
Hip fracture
Strains
IT Band syndrome
Quadriceps contusions
Myositis ossificans
Iliac Crest contusions
Stress fractures
Bursitis
Bursitis is most commonly located over the outside of the
hip at the trochanteric bursa
Most common among athletes who do not sufficiently stretch and
warm up in this area
Symptoms
Tenderness over outer portion of hip
Worsens by walking, running,
or twisting the hip
Treatment
Initially treated with heat
Followed by stretching exercises
Ice massage
NSAIDS are also helpful
Hip Fracture
Refers to a break in the proximal portion of the femur,
most common types
In young patients, extreme trauma, is usually necessary for a hip
fracture
Femoral neck fractures
Intertrochanteric fractures
Subtrochanteric fractures
Symptoms
Severe hip pain
Abnormally rotated leg
Increase pain with movement
Treatments
May vary and must be
discussed with surgeon
Quadriceps and Hip Flexor Strain
Common in sports that require jumping, kicking and
repetitive sprinting
Common muscles involved are the rectus femoris and/or
iliopsoas muscles.
Treatment
Icing
Compression wrap
Anti-inflammatory medications
Rehab
Should be progressive
and sport-specific
Hamstrings Strain
Most frequently affect the long head of the biceps femoris
Can range from microtears in a small area to a complete tear in the
muscle or its tendons (usually called a hamstring tear)
Causes
Insufficiently warming up
Developing quads more than hamstrings
Inflexibility
Direct blow to back of leg
Symptoms
Sharp pain in back of thigh
Bruising
Swelling
Loss of strength in upper leg
Hamstrings Strains ~ Treatment and Rehab
Treatment
RICE
Medication (asprin/ibuprofen)
Physical Therapy
Crutches and massage can be recommended
Rehab
Should begin soon after the injury occurs
Progress into weight-training program to focus on balancing
strength between the quads and hamstrings
Adductor (Groin) Strains
Common in sports that require sideways changes in
direction
Most involved muscles in the adductor longus
Symptoms
Most strains are Grade I or II
Characterized by groin pain when running or kicking
Treatment
Can be difficult and risk of
re-injury is high
Rest
Ice
Anti-inflammatory meds
Adductor stretching and
strengthening is common
Iliotibial Band Syndrome
Involves inflammation of the IT Band
Thick band of fibrous tissue that runs down the outside of the leg,
beginning at the hip an extending to the outer side of the tibia just
below the knee
Symptoms
Irritation and pain when knee is moved
Increasing pain with movement
Treatment
Analysis of the athlete’s gait and
training program to rule out mechanical
problem or training errors
Using proper footwear
Icing
Stretching
Reduce activity until symptoms subside
Quadriceps Contusions
Usually caused by a direct blow to the thigh from a
helmet or knee
Common in football, rugby, soccer and basketball
The injury can limit motion and affect gait
Severity of the contusion is determined by the range of motion in the
hip when evaluated
Treatment
Immediate compression
Ice
Use of crutches
Massage is contraindicated
May cause more damage
Myositis Ossificans
A very painful condition in which an ossifying mass may form
within the muscle
Usually the result of recurrent trauma to a quadriceps muscles that was not
properly protected after the initial injury
Symptoms
Hard, painful mass is the soft tissue of thigh
Loss of ROM
Ultimately diagnosed with x-ray
About 4 weeks after injury
Treatment
acute, with heat
Limit ROM
Rehab
Passive stretching and vigorous exercise discouraged for first 6
months
Surgical excision may be necessary if pain and limited motion
persist beyond year
Iliac Crest Contusion
Also called a hip pointer
Very painful injury caused by a direct blow to the hip
Symptoms (all over iliac crest)
Extreme tenderness
Swelling
Eccymosis
Treatment
Application of ice
compression
protection
Overuse Injuries
Common among one-sport athletes
Caused by cumulative effects of very low levels of stress
Examples:
Chronic muscles strains
Stress fractures
Tendonitis
Snapping hip
Bursitis
Athletes with these problems should rest from the
sport and use cross-training techniques
Stress Fractures
Occur most often in runners and dancers
Femur stress fractures are common in runners
Symptoms
Chronic, ill-defined pain over groin and thigh
If symptoms do not resolve with rest and rehab, athlete should be
exaimined by specialist using x-rays and bone scans
Treatment
Rest
Non-weight bearing endurance exercises
Running in water or swimming