Unit III - Understanding Athletics - Related Injuries to the Lower Quarter Chapter 10 Hip, Pelvis & Thigh Injuries

Objectives Describe the basic anatomy of the hip Describe the basic anatomy of the hip Explain common hip, pelvis & thigh injuries that occur with athletic participation Explain common hip, pelvis & thigh injuries that occur with athletic participation Identify common signs & symptoms of hip, pelvis & thigh injuries Identify common signs & symptoms of hip, pelvis & thigh injuries Explain the treatments performed by an ATC for specific hip, pelvis & thigh injuries Explain the treatments performed by an ATC for specific hip, pelvis & thigh injuries

Hip Joint Facts Contains some of the strongest muscles in the body Contains some of the strongest muscles in the body Subject to tremendous demands Subject to tremendous demands Vulnerable to injuries that can sideline a player for long periods of time Vulnerable to injuries that can sideline a player for long periods of time Important to know how to prevent & treat injuries to these areas Important to know how to prevent & treat injuries to these areas

Anatomy Classified as a synovial ball-and-socket type of joint Classified as a synovial ball-and-socket type of joint Articulation Articulation –Between the femur & pelvis  Connected with thick strong ligaments –Femur  Longest bone in the body  Two muscle groups of the femur –quadriceps & hamstrings –Pelvis  Acetabulum-hip socket –Head of femur fits into “cup shaped” acetabulum –Very deep –Covered by thick ligamentous structure  provide stability

Anatomy-Hip Joint

Anatomy-Hip Muscles Include most powerful muscles in the body Include most powerful muscles in the body Hip flexion Hip flexion –Hip flexors Hip extension Hip extension –Hamstrings & gluteus maximus Abduction Abduction –Lateral muscles  gluteus medius, gluteus minimus & tensor fascia latae Adduction Adduction –Groin muscles  Run down the medial aspect of the femur

Anatomy-Hip Muscles/Anterior

Anatomy-Hip Muscles/Posterior

Anatomy-Hip Muscles/Lateral

Preventing Hip Injuries Hip is a very stable joint Hip is a very stable joint –Trainer sees few sprained ligaments or dislocations in this area –Trainer will see many muscular strain-related injuries Proper flexibility training & stretching prior to activity is warranted Proper flexibility training & stretching prior to activity is warranted Proper strength training to muscles around hip & lower torso Proper strength training to muscles around hip & lower torso –i.e. “core” region –Proper strength necessary for normal balance & stability Sports expose thigh to contact Sports expose thigh to contact –Athletes must wear proper equipment (pads) –Contact-type injuries can occur at the iliac crest (point of the hip)  This area has little natural protection –Football players required to wear a hip pad here

Treating Hip, Pelvis & Thigh Injuries & Conditions Most injuries to hip, pelvis & thigh are Most injuries to hip, pelvis & thigh are –Strains –Contusions Area is not exempt from other injuries Area is not exempt from other injuries –Fractures –Dislocations

Muscle & Tendon Injuries Thigh strains are common athletic injuries Thigh strains are common athletic injuries –Hip flexor –Hip extensor –Groin muscles Many muscles in the leg cross two joints Many muscles in the leg cross two joints –Some see this as the cause of strains in the region Strength imbalance occurs Strength imbalance occurs –Stronger muscle group puts excessive tension on the opposing muscle group  i.e. athlete has a great deal of strength in quads but hamstrings are weak making hams prone to strain

Muscle & Tendon Injuries Care PRICE PRICE Wrap with a supportive elastic bandage Wrap with a supportive elastic bandage Moderate & severe strains Moderate & severe strains –Need to be referred to a physician Rehabilitation Rehabilitation –Focus on regaining  Strength  ROM  Enhancing flexibility –Prior to returning to play

Assorted Hip Area Stretches

Bone Injuries Athletic-related fractures of the hip, pelvis & femur Athletic-related fractures of the hip, pelvis & femur –Often occur as a result of an avulsion  Tendon pulling away the bone –Disruption of the epiphysis  Damage to the growth plate –Stress –Trauma to the femur Pelvic fractures are not common Pelvic fractures are not common –Do occur –Excessive stress is placed on the bone tissue

Avulsions Avulsion fracture Avulsion fracture –Result of forceful muscle contractions –Literally pull the bone away at the site where tendon attaches –Example  Football player continues to run aggressively forward  While a defender is holding his leg  Hip flexor forcefully contracts  Causes a fracture

Growth Plate Fractures Epiphyseal fractures Epiphyseal fractures –Occur at the growth plates of bones –Especially at the capital femoral epiphysis  Where the neck & head of the femur join  Most common hip disorder in active children between the ages pf  Head of femur splits off the neck –Causes pain in groin, hip & knee  If trainer suspects this –Athlete referred to a physician –Treatment includes  Stopping the slippage  Helping to close the growth plate with a surgical procedure

Growth Plate Fractures

Stress Fractures Femoral stress fractures do occur Femoral stress fractures do occur –Although uncommon –Do occur in running-oriented athletes Causes Causes –Repetitive stress  Result of the force of pounding the lower extremity while running –Causes femur to bend slightly repeatedly  Stretching one side, compressing the other  Small hairline fractures develop from bone tissue being repeatedly stretched  Causes a great deal of pain & discomfort Indications Indications –Reduce stress to the fracture site so it can heal  Rest  Alternative activity (i.e. aquatic therapy)

Stress Fractures Bone scan showing positive right femoral neck stress fracture

Stress Fractures MRI showing inferior femoral neck stress fracture

Femur Fractures Largest bone in the body Largest bone in the body Extreme stress required to fracture it Extreme stress required to fracture it Signs & Symptoms Signs & Symptoms –Severe pain –Loss of function –Internal bleeding –Swelling –Tearing of muscles, tendons, nerves & arteries –Athlete unable to move the leg –Often causes leg to externally rotate

Femur Fractures View from front View from side

Femur Fractures Initial treatment Initial treatment –Immobilization –Transportation to the hospital by EMS  They will often use a traction splint  Gently pulls the femur –Helps reduce leg pain & spasm

Hip Dislocations Extreme stress can cause a dislocation Extreme stress can cause a dislocation Most occur posterior Most occur posterior Usually accompany other trauma Usually accompany other trauma –Such as a fracture Severe damage can occur in this area Severe damage can occur in this area –Due to nerve & vascular structures Signs & Symptoms Signs & Symptoms –Athlete in extreme pain –Leg is often internally rotated

Hip Dislocation Head of femur should be here

Hip Dislocations Initial treatment Initial treatment –Ambulance called immediately –Transported to the hospital ASAP Only a physician should reduce a hip dislocation Only a physician should reduce a hip dislocation Significant follow-up treatment required Significant follow-up treatment required –Before the athlete can return to activity Rehabilitation Rehabilitation –Begins with establishing normal ROM & strength –Gait training will be necessary  Learning how to walk normally  This is a long process

Other Common Injuries Thigh contusion Thigh contusion –Common injury in contact sports Legg-Calve’-Perthes Disease Legg-Calve’-Perthes Disease –Another injury trainers must always keep in mind –Especially with younger athletes

Hip & Thigh Muscle Contusions Deep thigh contusion are common Deep thigh contusion are common –Predominately to the quads –Especially in collision sports –Can cause disability Severe contusions can cause Severe contusions can cause –Tissue tearing –Extensive bleeding If not managed appropriately serious thigh contusions If not managed appropriately serious thigh contusions –Cause a condition known as myositis ossificans  Formation of bone tissue within the muscle  Disability & loss of function is a typical consequence

Hip & Thigh Muscle Contusions Deep contusion in the hamstrings

Myositis Ossificans Radiograph of tibia and fibula showing periosteal new bone formation from a subperiosteal hematoma and, separately from it, an area of ossification within the muscle due to myositis ossificans. It would look very similar in the quadriceps of the thigh.

Hip & Thigh Muscle Contusions When treating a thigh contusion (quads) When treating a thigh contusion (quads) –Proceed with the PRICE technique  With knee in a flexed position during ice application –Trainer may put athlete in a hinged knee immobilizer  With it locked into flexion  Limits the total loss of flexibility due to the injury Moderate to severe contusion Moderate to severe contusion –Place athlete on crutches –Minimize stress to the area –Refer to team physician

Hip & Thigh Muscle Contusions Early rehabilitation Early rehabilitation –Must restore mobility  Effective methods –Active rest –Use of ice –Gentle stretching routines –Ultrasound  Used to –Resolve the blood that collects internally –Break up the bony tissue deposits Upon return to activity Upon return to activity –Trainer places a protective pad over the contusion  Repeated contusions to the area can create myositis ossificans

Legg-Calve’-Perthes Disease Disruption of blood flow to the head of the femur Disruption of blood flow to the head of the femur Causes the tissue at the head of the femur to die Causes the tissue at the head of the femur to die Often seen in children & teens who are still growing Often seen in children & teens who are still growing Signs & Symptoms Signs & Symptoms –Groin or knee pain –Walking with a limp If trainer suspects this If trainer suspects this –Refer athlete to physician immediately

Legg-Calve’-Perthes Disease The head of these femurs shows a flat white area on radiograph and a dark area on the MRI. This represents dead bone or bone that no longer has any blood supply. RadiographMRI