1. The Hip and Pelvis Hip is one of the most stable joints in the body. Hip is one of the most stable joints in the body. It is the strongest joint in the body. It is the strongest joint in the body. What kind of joint is the hip? What kind of joint is the hip?

2. The Hip and Pelvis The muscles of the back, abdomen, hamstrings, quadriceps, adductors and gluteals all attach here.

3. Muscle Groups Gluteal Muscles are the largest. Gluteal Muscles are the largest. Hip Flexors Hip Flexors Hip Adductors Hip Adductors Quads and Hamstrings Quads and Hamstrings

4. The Hip and Pelvis Gluteal Muscles- Gluteus medius- hip abduction, hip internal rotation hip abduction, hip internal rotation Gluteus maximus- hip extension hip extension

5. The Hip and Pelvis Adductor Muscles Adductor Muscles Adductor magnus Adductor magnus Adduct/extend Adduct/extend Adductor Brevis Adductor Brevis adductor adductor

6. The Hip and Pelvis The pelvis is made up of flat bones that support the skeleton. The pelvis is made up of flat bones that support the skeleton. It has 3 function: Attachment for muscles that control the lower limbs Attachment for muscles that control the lower limbs House parts of digestive and urinary tract House parts of digestive and urinary tract House reproductive systems House reproductive systems

7. Skeletal structure There are 5 main parts of the pelvis: Ilium Ilium Ischium Ischium Pubis Pubis Coccyx Coccyx Sacrum Sacrum

8. Skeletal Structure Ilium-flared bone that is the lateral and upper part of the pelvis Iliac Crest-upper ridge Iliac Crest-upper ridge Greater sciatic notch- allows sciatic nerve to pass to legs Greater sciatic notch- allows sciatic nerve to pass to legs Iliac Fossa-inner surface of ilium. Iliac Fossa-inner surface of ilium.

9. Skeletal Structure Ischium-bears the weight when sitting. Ischial tuberosity- boney point of your butt.

10. Skeletal Structure Pubis-front of the pelvis, in front of the bladder. Pubis symphysis-where the two pubis are fused.

11. Skeletal Structure Sacrum-5 vertebrae fused together to form a single bone. It is between lumbar and coccyx.

12. Skeletal Structure Coccyx- contains 3-5 rudimentary vertebrae. Susceptible to shock from a fall and damage can effect the nerves of the lower body.

13. Muscles of the Pelvis Hip Thigh The head of the femur is covered with cartilage which helps absorb shock and fits into the acetabulum. The head of the femur is covered with cartilage which helps absorb shock and fits into the acetabulum. The synovial fluid further cushion the joint. The synovial fluid further cushion the joint. Several Ligaments to support the joint. Page 397 Several Ligaments to support the joint. Page 397

14. Injuries to the Hip and Thigh Greater Trochanteric Bursitis- inflammation of the greater trochanteric bursa. Greater Trochanteric Bursitis- inflammation of the greater trochanteric bursa. Cause- to little stretch/warm up Cause- to little stretch/warm up Pain over lateral hip, gets worse with walking, running, twisting Pain over lateral hip, gets worse with walking, running, twisting Limit activity, stretch, ice massage and NSAID Limit activity, stretch, ice massage and NSAID

15. Injuries to the Hip and Thigh Fracture to the Femur- mostly in the elderly due to a fall. Fracture to the Femur- mostly in the elderly due to a fall. Treatment- surgery to pin or replace hip. Treatment- surgery to pin or replace hip.

16. Injuries to the Hip and Thigh Hip Dislocation- not very common, usually rather traumatic. Hip Dislocation- not very common, usually rather traumatic. If you do not get it back quickly the muscles will prevent it from going in without sedation. If you do not get it back quickly the muscles will prevent it from going in without sedation.

17. Sacroiliac Injuries They may be acute or chronic. They may be acute or chronic. Pain is less in the morning and gets worse as the day goes on. Pain is less in the morning and gets worse as the day goes on. Warm up will help with pain Warm up will help with pain during activity, but it will return after cooled down. during activity, but it will return after cooled down.

18. Sacroiliac Joint The joint where the The joint where the sacram meets the sacram meets the Illium on either side is Illium on either side is the sacroiliac joint. the sacroiliac joint.

19. Sacroiliac Special Test Patrick/Fabere Test- Patient is supine and in figure 4 position. Pain in hip with position indicates iliopsoas, or hip joint abnormalities with pressure indicates SI problem. Patrick/Fabere Test- Patient is supine and in figure 4 position. Pain in hip with position indicates iliopsoas, or hip joint abnormalities with pressure indicates SI problem.

20. Sacroiliac Special Tests Compression Test- with patient in supine compress the hips at ASIS. Compression Test- with patient in supine compress the hips at ASIS. Distraction Test- with patient in supine push apart the hips at the ASIS. Distraction Test- with patient in supine push apart the hips at the ASIS.

21. Injuries to the Hip and Thigh Strains Strains Quadriceps Quadriceps Hip Flexor Hip Flexor Hamstring Hamstring Adductor-Groin Adductor-Groin

22. Injuries to the Hip and Thigh Quadriceps Contusion Quadriceps Contusion Blow to the Quad region of the thigh Blow to the Quad region of the thigh Treatment should include ice in a flexed knee position to facilitate healing, and crutches. Treatment should include ice in a flexed knee position to facilitate healing, and crutches.

23. Thigh Injuries Myositis Ossificans-ossifying mass (calcium deposit) forms within a muscle due to recurrent trauma or improper injury care. Myositis Ossificans-ossifying mass (calcium deposit) forms within a muscle due to recurrent trauma or improper injury care. After a contusion never heat, stretch excessively, or continue play that is highly painful. After a contusion never heat, stretch excessively, or continue play that is highly painful. May show up in xray/MRI 4-6 weeks after injury. May show up in xray/MRI 4-6 weeks after injury.

24. Hip Injuries Iliac Crest Contusion (Hip Pointer)- Extreme pain, swelling at iliac crest caused by a direct blow. Iliac Crest Contusion (Hip Pointer)- Extreme pain, swelling at iliac crest caused by a direct blow. Treatment is ice and padding around contusion. Treatment is ice and padding around contusion.