The Hip and Pelvis

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 ischial tuberosities 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

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

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

Sacroiliac Joint Sacrum Coccyx Composed of 5 fused vertebrae and connects directly to the ilium posteriorly 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

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

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

Hip Flexors and Adductors Muscles that assist in hip flexion Iliopsoas Sartorius Pectineus Rectus Femoris Hip Adductors Muscles that assist in hip adduction Adductor Longus Adductor Brevis Adductor Magnus

Quadriceps and Hamstrings Perform hip flexion Vastus Medialis Vastus Lateralis Vastus Intermedius Rectus Femoris Hamstings Perform hip extension Biceps Femoris Semitendinonsus Semimembranosus

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 Myositis ossificans Iliac Crest contusions Stress fractures

Bursitis Bursitis is most commonly located over the outside of the hip at the trochanteric bursa 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

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

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

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

Hamstrings Strains ~ Treatment and Rehab 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

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

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

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

Myositis Ossificans 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

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

Overuse Injuries Common among one-sport athletes Examples: 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

Stress Fractures Occur most often in runners and dancers Symptoms 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 water or swimming