The Hip and Pelvis

1. The Hip and Pelvis

2. 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 ischialtuberosities 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

3. 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

4. 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

6. Sacroiliac Joint • Sacrum • Composed of 5 fused vertebrae and connects directly to the iliumposteriorly • 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

7. Hip and Pelvis Musculature • Primary Muscles of the Hip and Pelvis • Gluteals • Hip Flexors • Hip Adductors • Quadriceps • Hamstrings

8. Gluteal Muscles • Gluteal muscles are the largest group • Gluteus Maximus • Performs hip extension • Gluteus Minimus and medius • Perform internal and external rotation and abduction

9. 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 • AdductorLongus • Adductor Brevis • Adductor Magnus

10. Quadriceps and Hamstrings • Quadriceps • Perform hip flexion • VastusMedialis • VastusLateralis • VastusIntermedius • Rectus Femoris • Hamstings • Perform hip extension • Biceps Femoris • Semitendinonsus • Semimembranosus

11. 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 • Myositisossificans • Iliac Crest contusions • Stress fractures

12. Bursitis • Bursitis is most commonly located over the outside of the hip at the trochantericbursa • 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. MyositisOssificans • 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

21. 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

22. 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

23. 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 wateror swimming