1. Hip and Pelvis Chapter 19

2. Hip & Pelvis  Strongest articulation in body  Most stable articulation  Well protected & surrounded by muscle on all sides  Muscles of back, abdomen, hamstrings, quadriceps, abductors, adductors, and gluteals attach  Freely moveable, ball-and-socket

3. Function of Pelvis  Transmit weight from axial skeleton to LE when standing or to ischial tuberosities when sitting  Provides attachments for various muscles that insert onto and control LE  House parts of digestive and urinary tract  Houses reproductive systems

4. Pelvis—Skeletal Structure  Ilium  Iliac crest  Greater sciatic notch  Iliac fossa  Sacrum  Ischium  Obturator foramen  Pubis  Pubic Symphsis  Coccyx

5. Pelvis—Skeletal Structure  Anterior Superior Iliac Spine (ASIS)  Anterior Inferior Iliac Spine (AIIS)  Posterior Superior Iliac Spine (PSIS)  Ischial Tuberosity  Greater Sciatic Notch  Obturator Foramen

6. Pelvis—Skeletal Structure

8. Ischial Tuberosity

10. Comparison of Male & Female Pelvis  Male  More dense  Muscle attachments more sharply defined  Female  Smaller  Shorter  Wider

11. Male versus Female MaleFemale

12. Hip—Skeletal Structure

14. Hip—Ligaments  Iliofemoral  Pubofemoral  Ischiofemoral

15. Primary Muscles of the Pelvis, Hip & Thigh  Gluteal muscles  Gluteus medius  Gluteus minimus  Gluteus maximus  Hip flexors  Iliopsoas  Psoas Major/Minor  Sartorius  Pectineus  Rectus femoris  Adductors  Adductor longus  Adductor brevis  Adductor magnus  Hamstrings  Biceps femoris  Semimembranosus  semitendinosus

16. Primary Muscles of the Pelvis, Hip & Thigh

17. Gluteal Muscles  Hip extension  Internal rotation  External rotation  Abduction

18. Hip Flexor Muscles

20. Adductor Muscles

21. Iliotibial Band  Thickening of the fascia  Runs up outside of thigh  Top of hip & crosses knee  Holds our leg straight when we stand, giving the larger thigh muscles a chance to rest  Tensor Fasciae Latae (TFL)

24. Common Injuries and Conditions Of The Hip and Thigh

25. Bursitis  Most frequent location is over lateral hip  Greater trochanteric bursitis  Tenderness lateral hip  Made worse by walking, running, or twisting hip  Insufficient stretching or warm-up  Treatment:  Limit activity  Stretching exercises  Ice & ice massage  NSAIDs

26. Fracture  3 classifications:  Femoral neck  Intertrochanteric  Subtrochanteric  Causes:  Falling (elderly)  Extreme trauma (car accidents)  Impact injury (athletics)  Signs & Symptoms  Leg may appear abnormally rotated  Cannot move hip without pain  X-ray to confirm  Treatment  Depends on fracture type and medical condition

27. Fracture

28. Quad & Hip Flexor Strain  Common in those sports that require jumping, kicking, or repetitive sprinting  Quad: rectus femoris  Hip Flexor: rectus femoris and/or iliopsoas  Treatment  Ice  Compression  NSAIDs  Rehab  Progressive  Sport specific

29. Hamstring Strain  Causes  Sudden, explosive starts and stops  Chronic overuse  Making quick start or stop when leg extended  Overtraining (fatigued hamstring muscles)  Muscle imbalance (quad muscles overdeveloped)  Inflexibility  Overstretched  Insufficient warm-up, stretching, or conditioning  Direct blow while muscles contracted  Signs & Symptoms  Sharp pain (most common in belly of muscle)  Bruising  Swelling  Loss of strength  Feel or hear “pop”

30. Hamstring Strain  Treatment  RICE  Medication  Physical therapy/rehab  Crutches  Massage  Rehabilitation  Progressive  Weight-training  Preventative  Proper stretching  Recovery Time  Mild: 2-10 days  Moderate: 10 days-6 weeks  Severe: 6-10 weeks

31. Adductor Strain  MOI: sudden sideways change in direction  Skating  Soccer  Track & field  Tennis  Adductor longus  Treatment:  Difficult to treat  Risk of re-injury is high  Rest, ice, anti-inflammatory meds  Stretching & strengthening exercises

32. Treatment  Lateral knee pain  Pain worse after running  Especially after climbing hills/stairs  Often not present until mid- way through run  Associated with “snapping hip”  Attributed to:  Over-training  Doubling mileage  Increase in hill repeats  Running on uneven roads  Tight indoor tracks  Poor running shoes  Address faulty pelvic mechanics  Reduce or stop running  Cross-train  Ice  Stretch Gluteals and TFL  Self-massage outside thigh and/or gluteals  Address faulty foot mechanics, running shoes, or orthotics  Return to running gradually Iliotibial Band Syndrome

33. Quadriceps Contusion  Direct blow to thigh from helmet or knee  Football, rugby, soccer, basketball  Limit motion  Affect gait  Severity graded by ROM at time of injury  Treatment  Immediate compression, ice, NWB  Massage contraindicated  Recovery Time: 2 days to 6 months  Complication: Myositis Ossificans

34. Myositis Ossificans Signs & SymptomsTreatment  Hard, painful mass in soft tissue  Progressive loss of knee flexion  X-ray at four weeks  Heat  Limit joint motion  Rehab exs limit pain  Discouraged 6months:  Passive stretching  Vigorous exercise  Calcium reabsorbtion may take 3-6 months  Ossifying mass (calcium deposit) forms within the muscle  Result of recurrent trauma to quad muscle that was not properly protected after mild injury

35. Myositis Ossificans

36. Iliac Crest Contusion  “hip pointer”  Caused by direct blow to hip  Common in football due to improperly fitted hip pads  Signs & Symptoms:  Extreme tenderness  Swelling  Ecchymosis  Treatment  Ice, compression  Pad injured area  RTP: dictated by athlete’s pain level

37. Iliac Crest Contusion

39. Overuse Injuries  MOI: cumulative effects of very low levels of stress  Repetitive action of running  Chronic muscle strains  Stress fractures  Tendonitis  Overuse/overload fatigue within the tendon  Snapping hip  Iliopsoas tendon snapping over the head of the femur  Bursitis  CROSS-TRAINING

40. Stress Fractures  Pelvis: occur most often in runners & dancers  Femur: occur usually in runners  Signs/Symptoms:  Chronic, ill-defined pain over groin and thigh  Initially diagnosed with muscle strain  Symptoms do not resolve with rest & rehab  Treatment:  Rest  Non-weight-bearing endurance exercises

41. Stress Fractures