1. Injuries to the Hip and Pelvis

2. Skeletal anatomy of the hip/pelvis
1. Ilium – upper, lateral section of pelvis 2. Iliac crest – upper ridge of ilium 3. ASIS (Anterior Superior Iliac Spine) – identifies anterior end point for iliac crest 4. Ischium/Ischial tuberosity - weight bearing portion when seated 5. Acetabulum – concave surface of pelvis, articulation site of pelvis and femur

3. Review of anatomy of the hip and pelvis
6. Femoral neck – narrowed portion of proximal femur, leading to femoral head
7. Greater trochanter – larger protrusion on superior portion of femur
8. Lesser trochanter – smaller protrusion located on inferior/medial portion of femoral neck
9. Trochanter bursa – fluid filled sac that protects against friction along lateral aspect of hip

4. Muscular Anatomy of the Hip/Pelvis#
Muscle
Function 1
Psoas major
Flexes, rotates thigh medially 2
Gluteus maximus
Extends, rotates thigh laterally 3
Gluteus medius
Abducts, rotates thigh medially 4
Gluteus minimus 5
Tensor fascia lata
Assists with abduction, rotation

5. Muscular Anatomy of the Hip/Pelvis#
Muscle
Function 6
Abductor brevis
Abducts, rotates thigh 7
Adductor magnus
Adducts, extends thigh 8
Hamstrings
Knee flexion, assist with hip extension 9
Quadriceps
Knee extension, can assist with hip flexion

6. Hip Injuries and their Special Tests

7. Bursitis
Basic Info: inflammation of bursa from excessive or repeated friction over greater trochanter; usually occurs from insufficient stretching/warm-up
S/S: pt. tenderness over lateral hip, made worse by walking/running
Tx: limit activity, rehab, ice massage, nsaids
Rehab/RTP: will include LOTS of stretching and strengthening focused on mechanics/posture/gait; RTP- determined by PT, but dictated by symptoms

9. Fractures
Basic Info: can occur to pelvic bone or to proximal femur, though not common in athletics; if does occur in athletics, will likely require EMS activation
S/S: severe pain, abnormal rotation of leg, any movement will be painful
Tx: Immediate referral to EMS, immobilization
Rehab/RTP: Extremely slow progressing, will require ROM and functional strengthening prior to any sport specific training

11. Labral Tear
Basic Info: Tear to “ring” of cartilage that edges the acetabulum; occurs from either injury or structural defect/abnormality
S/S: pain in anterior / lateral hip; clicking, catching, locking feeling
Tx: removal from play and referral to physician; ice, nsaids
Rehab/RTP: extensive, slowly progressing rehab (very similar to fractures)

12. Hip Scouring Test Patient Position: Supine
Examiner Position: At side of patient, fully flexing patient’s hip and knee
Action: Apply downward pressure (axial loading); Internally and externally rotate femur at multiple angles of hip flexion
Indication: Pain or reproduction of symptoms indicates possible labral tear
Notes: none

13. Muscle Strains
Basic Info: commonly occur to hip flexors, hamstrings, adductors, and groin; classified as either Grade I, II, or III
S/S: pain, especially at end ROM; bruising over specific site; weakness with AROM and functional movements
Tx: PRICE; NSAIDS
Rehab/RTP: Critical to reduce risk of re-injury; will focus on strengthening; can take up to 10 weeks in severe cases.

14. Iliotibial Band Friction Syndrome (ITBS)
Basic Info: Inflammation of the IT-band; usually result of muscle imbalance and with distance athletes.
S/S: Pain can occur at either lateral hip or lateral knee; pain increases with activity and resolves with rest
Tx: Ice, NSAIDS, reduction in activity level
Rehab/RTP: will usually include gait analysis to find and correct mechanical errors causing problem; RTP usually only dictated by symptoms

15. IT Band Friction Syndrome

16. Ober’s Test
Patient Position: Sidelying, affected side up; bottom hip/knee flexed to 90; affected side knee flexed to 90
Examiner Position: Standing behind patient, one hand stabilizing pelvis, opposite hand holding medial aspect of affected side knee
Action: Passively abduct and extend hip; allow hip to passively adduct toward table
Indication: Amount of adduction toward table indicates level of ITB tightness
Notes: VERY IMPORTANT to maintain pelvic stabilization to avoid false-negative

17. Iliac Crest Contusion (aka Hip Pointer)
Basic Info: Injury caused by direct trauma to the lateral hip; more common in contact sports
S/S: extreme pt. tenderness, swelling, ecchymosis over iliac crest
Tx: Ice and compression
Rehab/RTP: usually fairly quick, dictated by symptoms; RTP will usually involve padding area

19. Trendelenberg Test
Patient Position: Standing, weight evenly distributed between both feet, hands high on waist
Examiner Position: Behind patient
Action: Patient lifts leg (opposite of side affected) directly in front of them
Indication: Lowering of pelvis on non-weight bearing side indicates glute weakness
Notes: Test used mostly to determine patient’s risk or injury or to evaluate contributing factors v. any specific structural deficiency.

20. Ely’s Test Patient Position: Lying prone
Examiner Position: Standing on affected side
Action: Examiner passively flexes knee on affected side
Indication: Hip flexion, causing it to lift off table indicates tightness of rectus femoris
Notes: Test used mostly to determine patient’s risk or injury or to evaluate contributing factors v. any specific structural deficiency.

21. Thomas Test
Patient Position: Lying supine, with lower leg off end of table (knees bent)
Examiner Position: Standing on unaffected side
Action: Examiner passively flexes leg on unaffected side
Indication: Leg lifts off table = iliopsoas tightness; Leg extends at knee = rectus femoris tightness
Notes: Test can be modified to isolate iliopsoas with body fully on table