Unit 5: Lower Extremity

Article of the week 15 notecards for unit

Hip/Pelvis and thigh

Anatomy Pelvis formed by 2 innominate bones Function: Sacrum and coccyx Function: Support the spine/trunk and transfer their weight to the lower limbs Attachment for trunk and thigh muscles Protect viscera Hip – articulation of femur and acetabulum Femur- thigh bone

Femur

Ligaments, Joint capsule, and synovial membrane Glenoid labrum- fibrocartilage surrounding the rim of the acetabulum Ligaments Pubofemoral Iliofemoral (Y ligament of Bigelow) Strongest ligament Ischiofemoral Articular capsule- encloses hip joint All help reinforce the hip joint and provide stability

Hip musculature Anterior Posterior Iliacus Psoas muscles (major and minor) Posterior Tensor fascia latae (TFL) Gluteals (maximus, medius, minimus) 6 deep outward rotators (piriformis, gemellus superior, gemellus inferior, obturator internus, obturator externus, quadratus femoris)

Anterior

Posterior

Muscle Action Iliopsoas Flexes the thigh and trunk on femur Gluteus maximus Extends and externally rotates thigh Gluteus minimus and medius Abducts and medially rotates thigh Piriformis Rotates the thigh laterally and assists in extending and abducting thigh Superior gemellus, Inferior gemellus, Obturator internus, Obturator externus, Quadratus femoris Rotates thigh laterally Tensor fascia latae (TFL) Assists in flexion, abduction, and medial rotation of thigh

Thigh muscular Anterior thigh Posterior thigh Sartorius Quadriceps Rectus femoris Vastus lateralis Vastus medialis Vastus intermedius Posterior thigh Popliteus Hamstrings Biceps femoris Semimembranosus Semitendinosus Medial thigh (groin) Gracilis Pectineus Adductors (magnus, longus, brevis)

Anterior and medial

Posterior

Anterior Muscle Action Sartorius Flexes the thigh and leg and laterally rotates thigh Quadriceps (vastus lateralis, vastus medialis, vastus intermedius, rectus femoris) Extends the leg Rectus also flexes the thigh

Posterior Muscles Actions Hamstrings (semitendinosus, semimembranosus, biceps femoris) Flexes the leg and extends the thigh Popliteus Flexes the leg and rotates tibia medially

Medial Muscles Actions Adductors (magnus, longus, brevis) Adducts and laterally rotates the thigh Pectineus Gracilis Adducts and flexes the thigh

Evaluation- History Known to have referred pain Distinguishing… What caused the problem The kind of pain and where it is coming from How it started Past history – other medical problems, have they had similar injuries

Evaluation- Observation Posture Nutation – forward tilt Counternutation- posterior tilt Upslip- one side higher than the other Inflare and Outflare Bruising Swelling Limping/gait

Evaluation- Palpation Bony Iliac crest** ASIS** PSIS** Greater trochanter** Ischial tuberosity Sacrum Coccyx SI joint Muscles- hip flexors, glutes, quads, hamstrings, adductors, hip abductors https://www.youtube.com/watch?v=uojwg0Wu6CY

Evaluation- Special tests Muscle testing Adductors Hamstrings Quadriceps Hip Abductors Hip External Rotators Hip Internal rotators Hip flexors Hip Extensors

Range of motion Motion Normal ROM Hip flexion 110-130 degs. Extension ABDuction 45-50 degs. ADDuction 20-30 degs. Internal rotation 40 degs. External rotation 45 degs.

Evaluation- Special tests What it tests for… Video Patricks/FABER SI joint https://www.youtube.com/watch?v=V1a0E0ssTqA Compression https://www.youtube.com/watch?v=XyalSBVkXVs Distraction Trendelenburg’s test Glute medius weakness https://www.youtube.com/watch?v=1iZ09aJ3bpI Thomas Hip flexor contracture https://www.youtube.com/watch?v=JVnW3x5j5yw Ober’s test IT band https://www.youtube.com/watch?v=A0C0WBw4l4s Nobles https://www.youtube.com/watch?v=4KFYKaqUD4Q

Injuries Hip contusion Hamstring strain Quad strain Groin strain Dislocated hip Snapping hip Hip pointer Stress fracture

Injuries Hip contusion MOI: impact to a relaxed thigh Signs and symptoms: Pain Loss of function Bruising Weakness Treatment Light stretch, rest, and ice

Hip injuries Quad strain MOI: sudden, violent, forceful contraction of the hip and knee into flexion Overstretch Signs and symptoms: Pain Swelling Loss of knee flexion Treatment: RICE, pain free ROM, rehab

Hip injuries Hamstring Strain Most common injury to thigh MOI: change from role of knee stabilization to hip extension Signs and symptoms: Bruising Pain Loss of function Varies some with grade of injury Treatment: REST RICE NSAIDS rehab

Hip injuries Groin strain MOI: running, jumping, or twisting with external rotation Signs and symptoms: Pain Weakness Internal hemorrhage Nagging pain Treatment: RICE NSAIDS REST best treatment rehab

Hip injuries Dislocated hip MOI: traumatic force along the axis of the femur Most common: posterior (to acetabulum) with femoral shaft adducted and flexed Signs and symptoms: Palpation reveals that head of femur has moved posterior to acetabulum May result in tearing of capsule and ligaments; fracture; nerve damage Treatment: immobilize and medical attention

Hip injuries Snapping hip Treatment: Commonly seen in dancers, gymasts, hurdlers, and sprinters Due to muscle imbalance IT band snapping over the great trochanter iliofemoral ligaments snapping over femoral head Long head of biceps femoris over ischial tuberosity Treatment: Decrease inflammation and pain with ice, anti-inflammatories, and modalities

Hip injuries Hip pointer Iliac crest contusion Due to fall on the iliac crest Handicapping injury and hard to treat Signs and symptoms: Immediate pain, spasms, and transitory paralysis of soft structures Treatment: RICE Severe- bed rest and refer to doctor for x-ray

Hip injuries Stress fracture Most common in distance runners Due to repetitive forces on the hip while running Signs and symptoms: Rest Refer to doctor – may need xray and/or MRI May cross train when allowed

Rehab In small groups come up with a 3 day ankle/lower leg rehab program Show progression through the program Pick one of these injuries: IT band syndrome Groin strain Hamstring strain Hip dislocation (recovery)

Rehab Exercises for hip rehab… Fire hydrants Band shuffles Glute squeezes Lunges Nordic hamstring Leg extension machines 4 way hip