Transcript Athletic Therapy

Lecture # 12
Thigh , Hip and
Pelvis
Thigh , Hip and Pelvis
since the hip and pelvis have a sturdy
anatomical composition, they are seldom
injured in sports participation , however
the soft tissue of the thigh may be
frequently injured
 compressive forces may lead to
contusions , which should not be serious
unless they are mismanaged
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many injuries are the result of inflexibility
and muscle imbalances of the quads and
hamstrings
 Hip injuries commonly involve collision
sports or forceful movements
 Hip and pelvic injuries more common in
older active people
 Approx 1% of general active population ,
5-9 % of high school , however 15 % of
runners ( stress fractures to femoral neck )
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Structure of the Hip
the femur of the thigh is a major weight
bearing bone – it is the longest, largest
and strongest bone in the body
 its weakest component is the femoral neck
 the hip joint is the articulation between the
concave acetabulum of the pelvis and the
head of the femur
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it is a ball and socket joint , which provides
considerable stability
 ligamentus teres, blood supply to the head
and acetabulum
 strong ligamentus support from the
iliofemoral, pubofemoral and ishiofemoral
 plus a number of strong muscles cross the
hip, enhancing its stability( RF, IP,ADD’s)
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Structure of the Pelvis
the pelvis of pelvic girdle consists of a
protective bony ring formed by 4 fused
bones
 the pelvis protects the enclosed inner
organs , transmits loads between the trunk
and lower extremity and provides a site for
a number of major muscle attachments
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21-10
Muscular support of the Hip
and Pelvis
Flexion - iliopsoas, rectus femoris and
sartorius
 Extension
- glut max, hamstring,
Abduction - glut med & min
 Adduction
- pectinus, adductor brevis,
longus, magnus and gracilis
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lnt Rot - glut min, TFL
 Ext Rot - piriformis, glut max
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Muscles of the Thigh
 - all muscle of the above, plus the Quads RF, VI, VM , VL
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Common Injuries of the
Thigh, Hip and Pelvis
Quad Contusions
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AKA Charlie horse
most common site for
contusion is the antero-lateral
thigh, which almost always
damages muscle tissue
severity of injury is almost
always underestimated and
under treated
l st, 2nd & 3 rd degree depends on severity of S&S
s/s - immediately after impact pain and
swelling may be extensive, ROM will be
limited due to severity
 if severe the individual may not be able
to bear weight and not able to fully flex
the knee
 there may be a palpable firm hematoma
with in 24 hours – resulting in the
inability to contact the quads
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First Aid Care
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Immediately apply ice,
compression and elevate
Can apply a pad, keep it in
place with a elastic wrap.
Have athlete rest , use crutches
Athlete must get plenty of rest
and time to permit healing .
should be iced in a flexed
position
DO NOT HEAT
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Myositis ossificans is an
abnormal ossification involving
bone deposits within muscle
tissue
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may result from a single traumatic
blow or several repeated blows to
the area
examination reveals a warm, firm
, swollen thigh nearly 2 to 4 cm
larger than unaffected leg
a palpable mass may limit flexion
this individual must see a
physician and if mass does not
reabsorb with 6 to 12 months,
surgery may be necessary
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Risk Factors
 Continuing to play after injury
 Early massage or hydrotherapy
 Passive stretching
 Too rapid of progression of therapy
 Premature return to play
 Reinjury of same area
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Strains
muscular strains to the thigh and hip are
frequent in sports, Rectus Femoris,
Adductors and hamstrings
 hamstrings are the most commonly
strained muscle in the body
 individual may report a snapping or
tearing during an explosive action ,
followed by immediate pain and loss of
function , with local tenderness and
possibly a palpable defect
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Hamstring Strain
usually caused by
rapid contraction or a
violent stretch
 hamstring strain has
the reputation of
being a chronic and
reoccurring problem
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Risk factors
 Poor flexibility
 Poor posture
 Muscle imbalance
 Improper warm up
 Muscle fatigue
 Previous injury
 Overuse
 Improper technique
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First Aid Care
Immediately apply ice, compression and
elevate
 Can apply a pad, keep it in place with a
elastic wrap.
 Have athlete rest , use crutches
 Have athlete evaluated by medical
personnel
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Dislocated Hip Joint
rare b/c of support and a
wide range of motion
available at the hip
 injury usually occurs with
violent twisting or
catastrophic trauma when
knee is driven into a
stationary object, ie the
dashboard of a car
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severe sprains or dislocations result in
immediate intense pain and an inability to
walk or even move the hip
a dislocated hip is an emergency situation –
call an ambulance and stabilize
Major complication is the damage to the
femoral head and loss of blood supply
causing avascular necrosis of the femoral
head, this may lead to chronic pain ,
instability and eventually a total hip
replacement
21-33
First Aid Care
Treat for shock
 Immobilize the athlete and transport to
nearest medical centre, where it will be
reduced
 Can apply a pad, keep it in place with a
elastic wrap.
 Care should be given to monitor blood flow
to rest of leg at all times .
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Hip Pointer
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are contusions to
the unprotected iliac
crest and the
muscles that insert
there, generally a
fall or contact with
objects or
equipment
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any movement of the trunk will be painful ,
including coughing , laughing and breathing
Localized pain at iliac crest
immediate pain ands spasm will prevent the
individual from rotating the trunk or laterally
flexing
protect from re-injury with a doughnut pad,
when they return to play
First Aid Care
Immediately apply ice to injured area
 Have athlete rest , possibly use crutches
 Avoid activity that involves bending
stretching etc.
 Can try icing in a stretched position
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Bursitis
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an inflammation of the bursa
found most often in the trochanteric bursa
occurs with running ( friction between
trochanter and ITB) or as a result of a
contusion
usually presented as a deep burning , or
aching feeling
Rx – PIER , NSAIDS, stretching to relieve
pressure
Piriformis Syndrome
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Compression or irritation
of the sciatic nerve
Found in runners and
women especially if tight
hip flexors and weak
gluteals,
Tight piriformis
Sciatic nerve
s/s
 tight piriformis -pain in butt or down
posterior leg
 Numbness or burning in butt or down
posterior leg pain with internal rotation
 General loss of strength of hip
 General treatment , lots of rest , stretching
and strengthening
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First Aid Care
Can try icing
 Stretch of glutes
 Refer to therapist for attention
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