Transcript Hip and Pelvis

Hip and Pelvis
Chapter 19
Hip & Pelvis
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Strongest articulation in body
Most stable articulation
Well protected & surrounded by muscle on all sides
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Muscles of back, abdomen, hamstrings, quadriceps, abductors,
adductors, and gluteals attach
Freely moveable, ball-and-socket
Function of Pelvis
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Transmit weight from axial skeleton to LE when standing
or to ischial tuberosities when sitting
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Provides attachments for various muscles that insert onto and
control LE
House parts of digestive and urinary tract
Houses reproductive systems
Pelvis—Skeletal Structure
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Ilium
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Sacrum
Ischium
Obturator foramen
Pubis
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Iliac crest
Greater sciatic notch
Iliac fossa
Pubic Symphsis
Coccyx
Pelvis—Skeletal Structure
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Anterior Superior Iliac
Spine (ASIS)
Anterior Inferior Iliac
Spine (AIIS)
Posterior Superior Iliac
Spine (PSIS)
Ischial Tuberosity
Greater Sciatic Notch
Obturator Foramen
Pelvis—Skeletal Structure
Pelvis—Skeletal Structure
Pelvis—Skeletal Structure
Ischial Tuberosity
Ischial Tuberosity
Comparison of Male & Female Pelvis
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Male
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More dense
Muscle attachments more
sharply defined
Female
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Smaller
Shorter
Wider
Male versus Female
Male
Female
Hip—Skeletal Structure
Hip—Skeletal Structure
Hip—Ligaments
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Iliofemoral
Pubofemoral
Ischiofemoral
Primary Muscles of the Pelvis, Hip & Thigh
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Gluteal muscles
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Gluteus medius
Gluteus minimus
Gluteus maximus
Hip flexors
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Iliopsoas
Psoas Major/Minor
Sartorius
Pectineus
Rectus femoris
Adductors
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Adductor longus
Adductor brevis
Adductor magnus
Hamstrings
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Biceps femoris
Semimembranosus
semitendinosus
Primary Muscles of the Pelvis, Hip & Thigh
Gluteal Muscles
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Hip extension
Internal rotation
External rotation
Abduction
Hip Flexor Muscles
Hip Flexor Muscles
Adductor Muscles
Iliotibial Band
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Thickening of the fascia
Runs up outside of thigh
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Top of hip & crosses knee
Holds our leg straight
when we stand, giving the
larger thigh muscles a
chance to rest
Tensor Fasciae Latae (TFL)
Common Injuries and Conditions
Of The Hip and Thigh
Bursitis
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Most frequent location is
over lateral hip
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Greater trochanteric bursitis
Tenderness lateral hip
Made worse by walking,
running, or twisting hip
Insufficient stretching or
warm-up
Treatment:
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Limit activity
Stretching exercises
Ice & ice massage
NSAIDs
Fracture
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3 classifications:
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Femoral neck
Intertrochanteric
Subtrochanteric
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Causes:
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Falling (elderly)
Extreme trauma (car
accidents)
Impact injury (athletics)
Signs & Symptoms
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Leg may appear abnormally
rotated
Cannot move hip without
pain
X-ray to confirm
Treatment
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Depends on fracture type
and medical condition
Fracture
Quad & Hip Flexor Strain
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Common in those sports
that require jumping,
kicking, or repetitive
sprinting
Quad: rectus femoris
Hip Flexor: rectus femoris
and/or iliopsoas
Treatment
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Ice
Compression
NSAIDs
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Rehab
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Progressive
Sport specific
Hamstring Strain
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Causes
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Sudden, explosive starts and
stops
Chronic overuse
Making quick start or stop
when leg extended
Overtraining (fatigued
hamstring muscles)
Muscle imbalance (quad
muscles overdeveloped)
Inflexibility
Overstretched
Insufficient warm-up,
stretching, or conditioning
Direct blow while muscles
contracted
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Signs & Symptoms
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Sharp pain (most common in
belly of muscle)
Bruising
Swelling
Loss of strength
Feel or hear “pop”
Hamstring Strain
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Treatment
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RICE
Medication
Physical therapy/rehab
Crutches
Massage
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Rehabilitation
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Progressive
Weight-training
Preventative
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Proper stretching
Recovery Time
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Mild: 2-10 days
Moderate: 10 days-6 weeks
Severe: 6-10 weeks
Adductor Strain
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MOI: sudden sideways change in direction
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Skating
Soccer
Track & field
Tennis
Adductor longus
Treatment:
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Difficult to treat
Risk of re-injury is high
Rest, ice, anti-inflammatory meds
Stretching & strengthening exercises
Iliotibial Band Syndrome
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Lateral knee pain
Pain worse after running
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Especially after climbing
hills/stairs
Often not present until midway through run
Associated with “snapping
hip”
Attributed to:
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Over-training
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Doubling mileage
Increase in hill repeats
Running on uneven roads
Tight indoor tracks
Poor running shoes
Treatment
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Address faulty pelvic
mechanics
Reduce or stop running
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Cross-train
Ice
Stretch Gluteals and TFL
Self-massage outside thigh
and/or gluteals
Address faulty foot
mechanics, running shoes, or
orthotics
Return to running gradually
Quadriceps Contusion
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Direct blow to thigh from helmet or knee
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Limit motion
Affect gait
Severity graded by ROM at time of injury
Treatment
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Football, rugby, soccer, basketball
Immediate compression, ice, NWB
Massage contraindicated
Recovery Time: 2 days to 6 months
Complication: Myositis Ossificans
Myositis Ossificans
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Ossifying mass (calcium deposit) forms within the muscle
Result of recurrent trauma to quad muscle that was not
properly protected after mild injury
Signs & Symptoms
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Hard, painful mass in soft
tissue
Progressive loss of knee
flexion
X-ray at four weeks
Treatment
 Heat
 Limit joint motion
 Rehab exs limit pain
 Discouraged 6months:
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Passive stretching
Vigorous exercise
Calcium reabsorbtion may
take 3-6 months
Myositis Ossificans
Iliac Crest Contusion
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“hip pointer”
Caused by direct blow to hip
Common in football due to improperly fitted hip pads
Signs & Symptoms:
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Treatment
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Extreme tenderness
Swelling
Ecchymosis
Ice, compression
Pad injured area
RTP: dictated by athlete’s pain level
Iliac Crest Contusion
Overuse Injuries
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MOI: cumulative effects of very low levels of stress
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Chronic muscle strains
Stress fractures
Tendonitis
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Repetitive action of running
Overuse/overload fatigue within the tendon
Snapping hip
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Iliopsoas tendon snapping over the head of the femur
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Bursitis
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CROSS-TRAINING
Stress Fractures
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Pelvis: occur most often in runners & dancers
Femur: occur usually in runners
Signs/Symptoms:
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Chronic, ill-defined pain over groin and thigh
Initially diagnosed with muscle strain
Symptoms do not resolve with rest & rehab
Treatment:
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Rest
Non-weight-bearing endurance exercises
Stress Fractures
Stress Fractures