1. THE HIP, PELVIS, AND THIGH
Chapter 14

2. THE HIP, PELVIS, and THIGH
Contain some of the strongest muscles in the body
The area is subject to very high demands

3. Flexion
Extension
Abduction
Adduction
Internal
Rotation
External
Circumduction

4. THE THIGH REGION Is the longest and strongest bone in the human body.
THE FEMUR:
Is the longest and strongest bone in the human body.
Designed to permit maximum mobility and support during locomotion.

5. THIGH MUSCULATURE

6. 1. Quadriceps (anterior):
Vastus Medialis
Vastus Lateralis
Vastus Intermedius
Knee extensors
Rectus Femoris
Knee extensor AND Hip flexor
sartorius
under

7. 2. Hamstrings (Posterior)
- Semitendinosus
Semimembranosus
Knee flexors
- Biceps Femoris
Knee flexors AND Hip extensors
Gluteus maximus

8. 3. Abdcutors (lateral) Tensor Fascia Latae (Tendon - IT Band)
Gluteus Medius
Gluteus Minimus

9. 3. Adductor Group (medial - groin)
Adductor Longus
Adductor Brevis
Adductor Magnus
Pectineus
Gracillis

10. Manual Muscle Testing Checking for bilateral equal strength Quadriceps
Hamstrings
Adductors
Abductors

11. Injuries

12. 1. CONTUSIONS “Charlie Horse”
Compression Injury
Signs and Symptoms
At the instant of trauma:
Pain
A transitory loss of function
Immediate capillary effusion (swelling)
Also called „Charlie Horse“ or „Dead Leg“, happen when being kicked, kneed, or stepped on

13. Treatment Ice and Compression with the knee flexed as far as possible
Crutches if necessary
Should be handled conservatively to prevent
Myositis Ossificans (bone grows within the muscle): 2-6 weeks after injury
Protective pad
don‘t rush ack to competition
M.O. = calcification of hematoma, appears as bony particles on X-ray(pic); usually poorly cared for contusion...attempt to „run it off“

14. 2. QUADRICEPS STRAINS:
The Rectus Femoris muscle can be strained by a sudden stretch (such as falling on a bent knee), or a sudden contraction (such as occurs during jumping or kicking).
Usually involves rectus femoris...other 3 are possible to strain, but less likely
Pic – torn rectus femoris

15. Similar as for thigh contusion
Signs and Symptoms
Similar as for thigh contusion

16. Same as for contusion, compression wrap instead of protective wrap
Treatment
Same as for contusion, compression wrap instead of protective wrap

17. The exact cause is not known.
3. HAMSTRING STRAIN:
The exact cause is not known.
There are many different speculations, most likely a strength difference between quads and hamstrings.

18. Hamstring strains can involve the muscle belly or bony attachment.
Signs and Symptoms
Hamstring strains can involve the muscle belly or bony attachment.
Pain and Point Tenderness
Swelling
Limited or Loss of Function
all dependent on the degree of injury

19. Treatment
PRICE
Reduce activity until soreness has been completely alleviated
Stretching and Strengthening
Compression Wrap for Comfort

20. Occur most often in the shaft rather than at the bones ends.
4. FEMORAL FRACTURES
Occur most often in the shaft rather than at the bones ends.

21. The middle third of the femur is vulnerable because of the anatomical curve - a natural weakness.

22. Signs and Symptoms Extreme Pain Deformity – External Rotation of Thigh
Shortened Thigh
Loss of Function
Shock

23. Treatment Keep in position found in and CALL 911
Monitor and Care for Shock
DO NOT move the fractured leg
Sharp Bone ends can cut femoral artery and/or nerve

24. 5. FEMORAL STRESS FX
Femoral stress fractures are becoming more prevalent because of the increased popularity of repetitive, sustained activities such as distance running.

25. Signs and Symptoms
Extreme Pain
Loss of Function
Treatment
Rest or alternate activity, e.g. Aquatic therapy

26. PELVIS

27. The pelvis is formed by Ilium, Ischium, Pubis, Sacrum, and Coccyx.

28. The function of the pelvis is to support the spine and the trunk,as well as to transfer the weight to the lower limbs.

29. HIP AND PELVIS
The pelvis serves as a place of attachment for the trunk and thigh muscles and as protection for the pelvic viscera (internal organs).

30. The HIP JOINT is formed by articulation of the femur and acetabulum (hip bone).

31. Muscles of the Hip:
1. Anterior
Hip Flexors
Rectus Femoris
Illiospoas
2. Posterior
Gluteus Maximus, Biceps Femoris

32. 3. Lateral
Abductors
Gluteus Medius
Tensor fasciae latae
4. Medial
Adductors (Groin)
Magnus, Longus, Brevis
Pectineus, Gracilis

33. * * * * *
Tensor fascia latae *
Posterior
Anterior

34. INJURIES of HIP, GROIN, PELVIS

35. The adductor group is more often torn than the hip flexors
1. GROIN STRAIN
The adductor group is more often torn than the hip flexors
Presents one of the most difficult injuries to care for in sport.

36. Signs and Symptoms
Pain, Swelling, Limited/Loss of Function
Treatment for Groin Strains
PRICE
Limit activity until pain free
Wrap

37. Rarely occurs in sports
2. DISLOCATED HIP
Rarely occurs in sports
If it happens, the hip usually dislocates posteriorly
Possible Sciatic Nerve Damage

39. Signs and Symptoms
Extreme Pain
Internal Rotation of the Hip
Posssible Disruption of Blood Supply and Shock
Treatment for Hip Dislocations
Call 911

41. 3. CONTUSION (HIP POINTER)
Iliac crest contusion is one of the most HANDICAPPING injuries in sport and one that is difficult to manage.

43. Signs and Symptoms
Pain, Swelling, Point Tenderness
Unable to rotate the trunk
Unable to flex the thigh without pain.
Extremely handicapping since numerous muscles (abs, hipflexors) attach to the iliac crest

44. Treatment for a Hip Pointer:
Ice and Compression
Rest until pain tolerated
Protective pad to prevent repetitive trauma

46. 4. FRACTURES of the PELVIS:
The pelvis is extremely strong structure and fractures from sports activities are rare.
Those that do occur are either a result of a direct trauma oravulsion fractures.

48. Signs and Symptoms
Pain, Point Tenderness
Shock and Loss of Function
Treatment for Pelvic Fracture
Stabilize and Call 911

49. Special Tests

50. Ober’s Test for IT band Tightness
Patient: lies on unaffected side; knees flexed to 90 degrees
EX: one hand stabilizes pelvis while other hand passively abducts and extends leg; finally allow leg to drop into adduction
Positive: thigh will be held in abduction by tight IT Band

52. Thomas Test for hip contractures
Patient: lies supine on table with legs together and fully extended
EX: one hand under lumbar curve, other hand brings knee to chest – should flatten the spine, other leg should remain extended
Positive – extended leg rises = hip contracture

54. Weakness of hip abductors (Gluteus Medius)
Trendelenburg
Weakness of hip abductors (Gluteus Medius)
Patient: Standing with hands on hips and raises leg of unaffected side
EX: observes Iliac Crests on posterior side.
Positive: iliac crest on unaffected side drops

56. Tests for pathological conditions of hip and SI joint
Patient: lies supine; heel on affected side is placed on opposite knee
EX: apply pressure to flexed knee towards the table
Positive: Pain in SI joint
FABER / Patrick
Flexion, Abduction, External Rotation

58. Ely’s Rectus Femoris Tightness
Patient: lies prone, flex knee on affected side
EX: one hand stabilizes pelvis, other hand
Positive: Hip will flex – elevate from table

60. Piriformis Piriformis Tightness
Patient: Lies on unaffected side with affected hip flexed to 60 degrees
EX: one hand stabilize hips, other hand applies pressure downward
Positive: Pain or tightness

62. SI Compression & SI Distraction
PT: laying supine
EX: heel of hands (arms crossed) on inside of ASIS
Push ASIS away from each other
Positive - pain
Distraction
EX: heel of hands on outside of ASIS
Push ASIS towards each other