© 2007 McGraw-Hill Higher Education. All rights reserved. Hip, Groin, and Pelvis PE 236 Juan Cuevas, ATC © 2007 McGraw-Hill Higher Education. All rights reserved.

Recognition and Management of Specific Hip, Groin, and Pelvic Injuries Groin Strain –Cause of Injury One of the more difficult problems to diagnose Often seen in early part of season due to poor strength and flexibility Occurs from running, jumping, twisting w/ hip external rotation or severe stretch –Signs of Injury Sudden twinge or tearing during active movement Produce pain, weakness, and internal hemorrhaging

© 2007 McGraw-Hill Higher Education. All rights reserved. Groin Strain (continued) –Care RICE, NSAID’s and analgesics for hours Rest is critical Restore normal ROM and strength -- provide support w/ wrap Refer to physician if severe groin pain is experienced

© 2007 McGraw-Hill Higher Education. All rights reserved. Sprains of the Hip Joint –Cause of Injury Result of violent twist due to forceful contact Force from opponent/object –Signs of Injury Signs of acute injury and inability to circumduct hip Pain in hip region, w/ hip rotation increasing pain –Care X-rays or MRI should be performed to rule out fx RICE, NSAID’s and analgesics Depending on severity, crutches may be required ROM and PRE are delayed until hip is pain free

© 2007 McGraw-Hill Higher Education. All rights reserved. Piriformis Syndrome –Cause of Condition Compression of sciatic nerve; irritation due to tightness or spasm of muscle May mimic sciatica –Signs of Injury Pain, numbness and tingling in butt – may extend below knee and into foot –Care Stretching and massage NSAID’s may be prescribed Cessation of aggravating activities will be prescribed Corticosteroid injection may also be suggested

© 2007 McGraw-Hill Higher Education. All rights reserved. Dislocated Hip –Cause of Injury Rarely occurs in sport Result of traumatic force directed along the long axis of the femur –Signs of Injury Flexed, adducted and internally rotated hip Displaced femoral head, posteriorly! Serious problem –Soft tissue, neurological damage and possible fx –Care Immediate medical care (blood and nerve supply may be compromised) Contractures may further complicate reduction 2 weeks immobilization and crutch use for at least one month

© 2007 McGraw-Hill Higher Education. All rights reserved. Iliac Crest Contusion (hip pointer) –Cause of Injury Contusion of iliac crest or abdominal musculature Direct blow –Signs of Injury Pain, spasm, and transitory paralysis of soft structures Decreased rotation of trunk or thigh/hip flexion due to pain –Care RICE for at least 48 hours, NSAID’s, Bed rest 1-2 days in severe cases Referral must be made, X-ray Padding should be used upon return to minimize chance of added injury

© 2007 McGraw-Hill Higher Education. All rights reserved.

Avulsion Fractures –Cause of Injury Avulsions seen in sports w/ sudden accelerations and decelerations Pulling of tendon away and off of bony insertion Common sites include ASIS (sartorius), AIIS (rectus femoris attachment), ischial tuberosity (hamstring –Signs of Injury Sudden localized pain w/ limited movement Pain, swelling, point tenderness –Care Rest, limited activity and graduated exercise

© 2007 McGraw-Hill Higher Education. All rights reserved.