The Hip

1. The Hip http://www.youtube.com/watch?v=wdxIz3iqxaQ

2. Bo Jackson Injury • Dislocated hip in game • Alleged that he popped hip back in place. Raiders trainer – “…that’s impossible, no one’s that strong.” • Surgery and Rehab • Found to have avacular necrosis which led to femoral head deteriorating • Hip replacement • Returned to play baseball with the White Sox and hit home run in 1st at bat against the Yankees • Finished season with 16 HR’s and 45 RBI’s • Retired in 1994

3. Bones of the Hip • Coxal Bone – hip bone composed of 3 fused bones: 1. Ilium iliac crest – serves as attachment point for abdominal muscles 2. Ischium ischial tuberosity – hamstring attachment 3. Pubis pubic symphysis The 3 bones fuse at the acetabulum – receives the head of the femur

4. Coxal Bones – hip bones consists of 3 fused bones - ilium - ischium - pubis • Pelvis – 2 hip bones and the sacrum • Pelvic girdle – the paired coxal bones

6. The Femur Greater Trochanter and Lesser Trochanter are sites for muscle attachments • The hip joint is a ball and socket joint that is designed for STABILITY and not for MOBILITY

7. Motions of the Hip Joint Hip Flexion Hip Extension Hip Abduction Hip Adduction Rotation

8. Exercises that work the Hip Flexors include: Exercises that work the Hip Flexors include: Sit-ups Sit-ups Hanging leg raises Hanging leg raises Leg raises Leg raises Resisted hip flexion Resisted hip flexion Muscles of the Hip Joint • Hip Flexors: 1. Iliopsoas - Iliacus - Psoas Major 2. Rectus Femoris(one of the Quad m.) a hip flexor as well as a knee extensor

9. Exercises that work the hip flexors: - situps - leg raises - hanging leg raises

10. Hip Extensor Muscles • Gluteus Maximus – main hip extensor • Hamstring muscles – can not flex the knee and extend the hip fully at the same time

12. 6 Deep Outward Rotators – externally rotate leg • Piriformis – sciatic nerve runs directly under and can get irritated: Piriformis Syndrome • Gemellus Superior • ObturatorInternus • Gemellus Inferior • ObturatorExternus • QuadratusFemoris

14. NY Times • Jerome Bettis said today that he was certain he would return from a seven-week layoff to play in the American Football Conference championship game. He was also sure about something else: no more needles. Bettis, the Pittsburgh Steelers' Pro Bowl running back, said he realized it was a mistake to get a painkilling shot just before Sunday's A.F.C. playoff game against Baltimore. The injection apparently struck a nerve and caused one of Bettis's legs to go numb, preventing him from playing. • January 22, 2002

15. Hip Adductors • Adductor Longus • Adductor Brevis • Adductor Magnus • Gracilis • Pectineus

16. Hip Abductors • Gluteus Medius • Gluteus Minimus 2 parts of the same muscle

17. Tensor Fascia Lata Muscle – inserts into the Iliotibial Band. Helps to stabilize the hip joint

18. Borders: Inguinal Lig Sartorius Adductor longus Contents: Femoral Vein Femoral Artery Femoral Nerve The Femoral Triangle

21. Injuries to the Hip

22. Sacral Fractures - MOI: fall in a sitting position or direct contact • Displacement can injure nerves and the urinary bladder • Bed rest, only surgery for severe displacement

23. Coccyx Fractures • MOI – fall in a sitting position • Sitting is almost impossible • Treatment aimed at pain relief, sitting “forward” on the ischialtuberosities • Return to athletics as soon as comfortable

24. Acetabular Fractures • Rare, results from severe trauma • MOI – direct, violent force that passes through femoral neck into the acetabulum • Immediate pain, inability to walk on leg • Shortening of extremity • Bed rest, possible surgery, followed by ROM exercises • Best treatment may still result in osteoarthritis of the hip

25. Acetabular Fractures

26. Dislocations of the Hip • Posterior dislocations most common - 95% of all hip dislocations - Why? Anterior hip capsule is strong, and MOI occurs more commonly in athletics - MOI: hip and knee flexed at 900 , force exerted through shaft of femur, driving it posteriorly “dashboard injury” - S & S: severe pain, inability to move, hip flexed and internally rotated, shortened extremity - Complications: fractures, sciatic nerve problems, avascular necrosis, arthritis

28. Dislocations of the Hip • Anterior Hip Dislocation - less than 5% of hip dislocations - MOI: forceful ABDuction and external roation - S & S: immediate pain, limb is ABDucted and externally rotated, palpable mass in groin - Complications: avascular necrosis, compression of femoral vein which can lead to a thrombus

30. Fractures of the Femur • Strength of femur is very good in young athletes • Severe trauma causes the injury

31. Femoral Fractures

32. Femoral Neck Fractures

33. Slipped Capital Femoral Epiphysis • Occurs in growing athlete • More common in boys, usually between ages of 11 – 15, short, heavy boys more common • MOI: not always identifiable • S & S: pain, may be referred to knee, common to have coach “run it out” Common to see glutuesmedius limp Treament depends on degree of slippage

35. Hip Pointer

36. Avulsion of Lesser Trochanter of Femur • Forceful Strain of Ilioposas muscle

37. Avulsion of Ischial Tuberosity • Forceful stretch of Hamstring muscles

38. Avulsion of Anterior Superior Iliac Spine (ASIS) • Origin of the Sartorius muscle

40. Avulsion of Crest of Ilium • Forceful contraction of the abdominal muscle

41. Osteitis Pubis

42. Snapping Hip Syndrome

43. Legg-Calve-Perthes Disease

44. Slipped Capital Femoral Epiphysis

45. Quadriceps Contusion

46. Myositis Ossificans

47. Iliotibial Band Syndrome

48. Piriformis Syndrome

49. The Abdominal Muscles • Rectus Abdominus trunk flexion • Internal Oblique rotates trunk to same side • External oblique rotates trunk to opposite side