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Hip and Pelvis

Hip and Pelvis. Chapter 19. Hip & Pelvis. Strongest articulation in body Most stable articulation Well protected & surrounded by muscle on all sides Muscles of back, abdomen, hamstrings, quadriceps, abductors, adductors, and gluteals attach Freely moveable, ball-and-socket.

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Hip and Pelvis

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  1. Hip and Pelvis Chapter 19

  2. Hip & Pelvis • Strongest articulation in body • Most stable articulation • Well protected & surrounded by muscle on all sides • Muscles of back, abdomen, hamstrings, quadriceps, abductors, adductors, and gluteals attach • Freely moveable, ball-and-socket

  3. Function of Pelvis • Transmit weight from axial skeleton to LE when standing or to ischial tuberosities when sitting • Provides attachments for various muscles that insert onto and control LE • House parts of digestive and urinary tract • Houses reproductive systems

  4. Pelvis—Skeletal Structure • Ilium • Iliac crest • Greater sciatic notch • Iliac fossa • Sacrum • Ischium • Obturator foramen • Pubis • Pubic Symphsis • Coccyx

  5. Pelvis—Skeletal Structure • Anterior Superior Iliac Spine (ASIS) • Anterior Inferior Iliac Spine (AIIS) • Posterior Superior Iliac Spine (PSIS) • Ischial Tuberosity • Greater Sciatic Notch • Obturator Foramen

  6. Pelvis—Skeletal Structure

  7. Pelvis—Skeletal Structure

  8. Pelvis—Skeletal Structure Ischial Tuberosity

  9. Ischial Tuberosity

  10. Comparison of Male & Female Pelvis • Male • More dense • Muscle attachments more sharply defined • Female • Smaller • Shorter • Wider

  11. Male versus Female Male Female

  12. Hip—Skeletal Structure

  13. Hip—Skeletal Structure

  14. Hip—Ligaments • Iliofemoral • Pubofemoral • Ischiofemoral

  15. Primary Muscles of the Pelvis, Hip & Thigh • Gluteal muscles • Gluteus medius • Gluteus minimus • Gluteus maximus • Hip flexors • Iliopsoas • Psoas Major/Minor • Sartorius • Pectineus • Rectus femoris • Adductors • Adductor longus • Adductor brevis • Adductor magnus • Hamstrings • Biceps femoris • Semimembranosus • semitendinosus

  16. Primary Muscles of the Pelvis, Hip & Thigh

  17. Gluteal Muscles • Hip extension • Internal rotation • External rotation • Abduction

  18. Hip Flexor Muscles

  19. Hip Flexor Muscles

  20. Adductor Muscles

  21. Iliotibial Band • Thickening of the fascia • Runs up outside of thigh • 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)

  22. Common Injuries and ConditionsOf The Hip and Thigh

  23. Bursitis • Most frequent location is over lateral hip • Greater trochanteric bursitis • Tenderness lateral hip • Made worse by walking, running, or twisting hip • Insufficient stretching or warm-up • Treatment: • Limit activity • Stretching exercises • Ice & ice massage • NSAIDs

  24. Fracture • 3 classifications: • Femoral neck • Intertrochanteric • Subtrochanteric • Causes: • Falling (elderly) • Extreme trauma (car accidents) • Impact injury (athletics) • Signs & Symptoms • Leg may appear abnormally rotated • Cannot move hip without pain • X-ray to confirm • Treatment • Depends on fracture type and medical condition

  25. Fracture

  26. Quad & Hip Flexor Strain • Common in those sports that require jumping, kicking, or repetitive sprinting • Quad: rectus femoris • Hip Flexor: rectus femoris and/or iliopsoas • Treatment • Ice • Compression • NSAIDs • Rehab • Progressive • Sport specific

  27. Hamstring Strain • Causes • 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 • Signs & Symptoms • Sharp pain (most common in belly of muscle) • Bruising • Swelling • Loss of strength • Feel or hear “pop”

  28. Hamstring Strain • Treatment • RICE • Medication • Physical therapy/rehab • Crutches • Massage • Rehabilitation • Progressive • Weight-training • Preventative • Proper stretching • Recovery Time • Mild: 2-10 days • Moderate: 10 days-6 weeks • Severe: 6-10 weeks

  29. Adductor Strain • MOI: sudden sideways change in direction • Skating • Soccer • Track & field • Tennis • Adductor longus • Treatment: • Difficult to treat • Risk of re-injury is high • Rest, ice, anti-inflammatory meds • Stretching & strengthening exercises

  30. Iliotibial Band Syndrome Treatment • Lateral knee pain • Pain worse after running • Especially after climbing hills/stairs • Often not present until mid-way through run • Associated with “snapping hip” • Attributed to: • Over-training • Doubling mileage • Increase in hill repeats • Running on uneven roads • Tight indoor tracks • Poor running shoes • Address faulty pelvic mechanics • Reduce or stop running • 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

  31. Quadriceps Contusion • Direct blow to thigh from helmet or knee • Football, rugby, soccer, basketball • Limit motion • Affect gait • Severity graded by ROM at time of injury • Treatment • Immediate compression, ice, NWB • Massage contraindicated • Recovery Time: 2 days to 6 months • Complication: Myositis Ossificans

  32. Myositis Ossificans Signs & Symptoms Treatment • Ossifying mass (calcium deposit) forms within the muscle • Result of recurrent trauma to quad muscle that was not properly protected after mild injury • Hard, painful mass in soft tissue • Progressive loss of knee flexion • X-ray at four weeks • Heat • Limit joint motion • Rehab exs limit pain • Discouraged 6months: • Passive stretching • Vigorous exercise • Calcium reabsorbtion may take 3-6 months

  33. Myositis Ossificans

  34. Iliac Crest Contusion • “hip pointer” • Caused by direct blow to hip • Common in football due to improperly fitted hip pads • Signs & Symptoms: • Extreme tenderness • Swelling • Ecchymosis • Treatment • Ice, compression • Pad injured area • RTP: dictated by athlete’s pain level

  35. Iliac Crest Contusion

  36. Overuse Injuries • MOI: cumulative effects of very low levels of stress • Repetitive action of running • Chronic muscle strains • Stress fractures • Tendonitis • Overuse/overload fatigue within the tendon • Snapping hip • Iliopsoas tendon snapping over the head of the femur • Bursitis • CROSS-TRAINING

  37. Stress Fractures • Pelvis: occur most often in runners & dancers • Femur: occur usually in runners • Signs/Symptoms: • Chronic, ill-defined pain over groin and thigh • Initially diagnosed with muscle strain • Symptoms do not resolve with rest & rehab • Treatment: • Rest • Non-weight-bearing endurance exercises

  38. Stress Fractures

  39. Stress Fractures

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