1. Hip, Thigh, and Knee

2. ILIUM

4. Acetabulum

5. Pubis
Ischium
Ischial Tuberosity

7. Greater Trochanter
Lesser Trochanter
Medial Condyle
Lateral Condyle

8. Lateral Condyle
Patella

9. Anterior Cruciate Ligament
Posterior Cruciate Ligament

11. Medial Meniscus
Lateral
Collateral
Ligament
Lateral Meniscus
Medial Collateral
Ligament

12. Anatomy
Buttocks
Gluteus
Medius,
Minimus,
Maximus
Piriformis

13. Anatomy
Hip Flexors
Psoas Major, Minor
Iliacus

14. Anatomy Quadriceps Rectus femoris Vastus lateralis Vastus medialis
Vastus intermedius
Abductor Complex
Sartorius
Tensor Fascia Lata
Hamstrings
Semimembranosus
Semitendinosus
Biceps femoris
Adductor Complex
Adductor
Brevis
Longus
Magnus
Gracilis

15. Quadriceps Rectus Femoris O: Anterior inferior iliac spine
I: Patella and Tibial Tuberosity
A: flexion of hip, knee extension

16. Vastus Lateralis O: greater trochanter
I: lateral patella, lateral femoral condyle and rectus femoris tendon
A: extension of knee

17. Quadriceps Vastus Intermedius O: proximal 2/3 of anterior femur
I: inferior aspect of patella and tendons of vastus lateralis and medialis
A: extension of knee

18. Vastus Medialis O: Between the Greater and Lesser Trochanter
I: medial tibial condyle, medial patella and medial aspect of rectus femoris tendon
A: extension of knee
Vastus Medialis Oblique
O: Tendon of Adductor Magnus
I: Patellar Tendon/ Tibial Tuberosity
A: stabilize patella

20. ABductors Sartorius Tensor Fascia Latae
O: Anterior superior iliac spine
I: inferior to medial condyle of tibial
A: Flexion, Abduction, and External Rotation of hip; flexion of knee,
Tensor Fascia Latae
O: Outer lip of iliac crest and between anterior superior and anterior inferior iliac spine
I: Greater trochanter of femur, and (as iliotibial band) lateral condyle of tibia
A: Abduction

21. Adductors Adductor Longus Brevis Magnus O: pubic bone
I: Middle 1/3 of Femur
A: adduction
Brevis
I: proximal 1/3 of femur
Magnus
O: pubic bone and ischial Tuberosity
I: distal 1/3 of femur

23. Adductors Gracilis O: pubic symphisis and pubic bone
I: distal to medial tibial condyle
A: adduction, flexion, and internal rotation of hip, flexion of knee; (Cross legs)

24. Iliopsoas O: Thorasic and Lumbar Vertebrae (front of spine) and Ilium
I: Lesser Trochanter
A: Flexion of hip

25. Hamstrings Biceps Femoris O: ischial Tuberosity
I: head of fibula and lateral tibial condyle
A: extension of hip; flexion of knee

28. Hamstrings Semimembranosus Semitendinosus O: ischial Tuberosity
I: medial tibial condyle
A: hip extension, knee flexion
Semitendinosus
I: medial condyle of tibia
A: hip extension, knee flexion M T

29. T M

30. Gluteuses Gluteus Minimus Gluteus Medius O: Ilium
I: Anterior Greater Trochanter
A: Abducts and Internal Rotation
Gluteus Medius
I: Lateral Greater Trochanter
A: Abduction and Internal Rotation

31. Gluteus Maximus O: Ilium Sacrum
I: Posterior Greater Trochanter and IT Band
A Extension and External Rotation

32. Hip/Thigh Movements Abduction Adduction Extension Flexion
Internal Rotation
External Rotation
What muscles do these movements?

33. Palpation Hip ASIS Soft Tissue Iliac Crests IT Band PSIS
Greater Trochanter
Soft Tissue
IT Band

34. What muscles do these movements?
List out the muscles that do each movement:
Abduction
Adduction
Hip Flexion
Hip Extension
External Rotation

35. Observation Symmetry- hips, pelvis tilt (anterior/posterior)
Lordosis or flat back
Lower limb alignment
Knees, patella, feet
Genu Valgum/ Genu Varum
Pelvic landmarks (ASIS, PSIS, iliac crest)
Standing on one leg
Pubic symphysis pain or drop on one side
Ambulation
Walking, sitting - pain will result in movement distortion

36. Observation Anteversion (A) and Retroversion (B)
Think in terms of the Greater Trochanter

37. Observation Leg Length Discrepancy Anatomical Functional
Actual bone length difference
Functional
Rotation of pelvis
Muscle tightness
1/8 inch or greater = discrepancy

38. Special Tests
Fracture
Range of Motion
Passive
Active
Resistive

39. Thigh Injuries Quadriceps Contusion Mechanism Symptoms Treatment
Blow to quads.
Symptoms
Pain
Swelling
Bruising
Loss of function
Treatment
RICE
Ice bent position

40. The red is hemorrhaging within the compartment
Increased swelling = Increased pressure = decreased healing/ function
If hemorrhage gets too large will have to do a compartment release which is done by cutting the fascia to allow the expansion

41. Thigh Injuries Myositis Ossificans
Myo= muscle itis = irritation oss = bone
Mechanism
Blow to thigh  Hemorrhage  hematoma
Symptoms
Pain Hard “bump”
Musc weakness - Swelling
Loss of function
Treatment
At first can use Ultrasound
Surgical Removal

42. Practice it! Quad Compression Wrap Start slightly above patella
Begin just like all other ACE wrapping techniques.
Continue up the thigh halfway overlapping alternating angling up and angling down.
Practice it!

43. Thigh Injuries Hamstring Strain
Mechanism
Overloading of HS muscles
Over stretching
Symptoms
Pain - swelling - G2 or 3 = palpate deformity
Loss of function - “popping”
Treatment
RIC
ROM
stretching
Compression wrap same as Quad Contusion

44. Hip Injuries Groin Strain Symptoms Treatment Straining of Adductors
Over stretching of the muscle
Symptoms
Pain in medial hip
Pain referred to knee
Treatment
RIC light stretching
NSAIDs - Strengthening
ROM exercises - Compression wrap

45. Groin wrap Start with roll on lateral side of leg
Start ACE at an angle
2 times around with “dog ear”
Apply extra tension going medially as to pull the leg into ADduction.
Continue your spica until out of wrap.
- Athlete should fee leg being pulled in and slightly forward.
****Anytime doing a hip wrap you will pull in the direction that the injured muscles does.

46. Hip Flexor Strain Rectus Femoris/ Iliopsoas Strain
Often due to explosive activities (sprinting)
Symptoms
“Pop” - Loss of function
Pain
Treatment
Light stretches - rest
Compression wrap pulling forward
strengthening

47. Hip Special Tests Kendall / Thomas test Positioning Test Positive
Athlete lies supine with ½ of femur off the table
Test
Athlete hugs opposite knee to chest
Positive
Knee Extends = Rectus Femoris tightness
Hip Flexes = Hip Flexor Contracture

49. Hip Injuries Contusion (Hip Pointer) Mechanism Symptoms Treatment
Blow to iliac
Symptoms
Bruising
Pain
Loss of function
Treatment
RICE

50. IT Band IT Band Tendonitis Mechanism Symptoms Treatment
Repetitive friction over greater trochanter or lateral femoral condyle
Pes cavus, Genu varum
Symptoms
pain at greater trochanter or lateral femoral condyle
Positive Ober and Nobles tests
Treatment
Stretch tendon - Ice
Strengthen Abductors - Rest

51. IT Band Tightness Noble’s Test Position – Test – Positive –
athlete supine
athlete’s knee is
flexed to 90 degrees
Test –
Pressure is applied to lateral femoral condyle while knee is extended
Positive –
Pain at lateral femoral condyle
IT Band Tendinitis

52. IT Band Tightness Ober’s Position Test Positive
Athlete is lying on side opposite of affected side
Tester is behind the athlete at the hip
Test
Tester holds ankle and knee (flexed to 90)
Tester allows knee to adduct.
Positive
Pain or tightness
No drop of the knee

53. Gluteus Medius and Adductor Weakness
*Weakness in these muscle groups can lead to IT band tendonitis, bursitis, and other hip problems.
Trendelenburg
Position
Patient stands with feet together
Test
Tester stands behind the athlete
Athlete lifts knee as to march
Positive
Drop in the non weight bearing
side PSIS/ Iliac Crest

54. Hip Injuries Trochanteric Bursitis Cause Symptoms Special Test
Excessive repetitive irritation at Greater Trochanter
Symptoms
Hip instability
Snapping sensation
Pain/ inability to walk
Treatment
ICE - Stretching
NSAIDs - Strengthening
Ultrasound (not the kind you see a baby with)
Compression wrap
Special Test
- Range of Motion reproduces the pain

55. Hip Injuries Dislocated Hip Mechanism Signs and Symptoms Special Tests
Result of traumatic force
Signs and Symptoms
Flexed, adducted and internally rotated hip
Palpation reveals displaced femoral head posteriorly
Other
Soft tissue, neurological damage and possible fx
Special Tests
none
Management
EMERGENCY ROOM!
2 weeks immobilization and crutch use for at least one month

56. Knee Observation Patellar positioning Knee Positioning Swelling Alta
Baja
Knee Positioning
Genu varum
Genu valgum
Genu Recurvatum
Swelling
Intracapsular
Extracapsular

57. Observation Patella Alta Patella Baja High Patella Low Patella –
tight quad muscles,
places extra stress on patellar tendon,
causes extra friction on Femoral condyles
Patella Baja
Low Patella –
shorter patellar tendon,

58. Soft Tissue of the Knee

59. Observation Genu Varum Genu Valgum Genu Recuvatum Bow legged
Stresses lateral structures
Genu Valgum
Knock kneed
Stresses medial structures
Genu Recuvatum
Hyper-extended knees

60. Meniscus and Ligaments

61. Palpation Knee Soft Tissue Medial and Lateral Condyle
Tibial Tuberosity
Patella
Soft Tissue
Medial Collateral Ligament (MCL)
Lateral Collateral Ligament (LCL)
Patellar Tendon
IT Band
Meniscus (med & lat)
Animation

62. Knee Injuries MCL or LCL sprain Mechanism Symptoms Treatment
Lateral (mcl) or medial (lcl) force knee
Symptoms
Pain
laxity
Treatment
RICE
Taping

63. Knee Special Tests Practice it Valgus and Varus Stress tests
Tests MCL (Valgus) or LCL (Varus)
Positioning
Athlete sitting or lying down in relaxed position
Test
Apply a medial (varus) or lateral (valgus) pressure to joint line while pulling lower leg in the opposite direction
Perform this at 0 degrees and 30 degrees
Positive
Pain (1st or 2nd degree sprain)
Laxity (2nd or 3rd degree sprain
Practice it

64. Knee Injuries ACL sprain Treatment Mechanism Symptoms RICE
Plant and twist
Symptoms
Joint laxity (give way)
1-2 pain
Locking
swelling
Treatment
RICE
quad strengthening
Swelling control
ROM
SURGERY

65. Special Tests Practice it Anterior Drawer Tests ACL Position Test
Athlete supine on table with knee bent to 90 degrees
Tester sits on foot to stabilize lower leg
Place thumbs on the tibial plateau (tibial joint line)
Test
Pull lower leg anteriorly in line with thigh in a jerking motion
Positive
Pain or laxity
Note: if the athlete does have an ACL injury it is likely that you will only have one chance to correctly do this test because they may guard against you after that.
Practice it

66. Special Tests Practice it Lachman Drawer Test
This test is less painful and more precise after a knee injury
Position
Athlete is supine on the table with legs straight
Tester places their knee under femur in order to bend the knee to 30 degrees
Test
Tester pulls the tibia directly upward and presses the femur downward in a jerking motion
Positive
Pain (1st and 2nd degree tear)
Laxity (2nd and 3rd degree tear)
Practice it

67. ACL Surgery

68. Post. Cruciate Lig. sprain
Mechanism
Blow to anterior tibia
Symptoms
Pain
Swelling
Joint laxity
Treatment
Strengthening
RICE
Surgery

69. Special Tests Practice it Posterior drawer Tests PCL Position Test
Athlete supine on table with knee bent to 90 degrees
Tester sits on foot to stabilize lower leg
Place thumbs on the tibial plateau (tibial joint line)
Test
Push lower leg posteriorly in line with thigh in a jerking motion
Positive
Pain or laxity
Note: if the athlete does have an PCL injury it is likely that you will only have one chance to correctly do this test because they may guard against you after that.
Practice it

70. Special Tests Posterior Sag Test (Godfrey’s test) Positioning Test
Athlete is supine w/ both knees flexed to 90 degrees
Test
Lateral observation
to see if either tibia
has moved posteriorly

71. Meniscal Tears Mechanism Treatment Symptoms Cutting
Forcefully extended
Rotation
Treatment
Surgery
Bracing
Strengthening
ROM
Symptoms
Joint pain
locking
swelling
Loss of motion
giving way
cracking/popping

72. Meniscus and Ligaments

73. Special Tests Practice it McMurray’s Test
Used to determine displaceable meniscal tear
Position
Athlete is supine on table
Test
Leg is moved into flexion and extension while knee is internally and externally rotated in conjunction w/ valgus and varus stressing
Positive
clicking and popping are felt
Practice it

74. Special Tests B A D C

75. Special Tests Practice it Apley’s Compression Test
Athlete prone
Hard downward pressure is applied w/ rotation
Positive - Pain indicates a meniscal injury
Apley’s Distraction Test
Traction is applied w/ rotation
Pain will occur if there is damage to the capsule or ligaments
No pain will occur if it is
a meniscus tear
Practice it

76. Special Tests
Apley
Compression

77. Meniscus Tear Surgery
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78. Plica tear of the fascia under the patella
Mechanism
Excessive Shock
Symptoms
Snap/popping
Pain when sitting for long time
Treatment
Rest
Heat
NSAIDs
Surgery

79. Special Tests Practice it Patellar Compression test Position Test
Athlete seated or lying in a comfortable position
Test
Tester presses patella down into the femoral groove, then moves it up and down to feel for any abnormalities
Positive
Pain or grinding sensation
Practice it

80. Special Tests Practice it Patellar Grind Test Position Test Positive
Athlete supine either seated or lying
Test
Tester places Thumb web-space just above the patella
Tester then asks athlete to contract their quad forcefully
Positive
Pain and/or grinding.
Practice it

81. Patellofemoral Stress Syndrome
Chondromalacia or any condition associated with the patella on the femur
Chondro = Cartilage Malacia = softening of
Mechanism
Patella not tracking within femoral groove correctly.
Signs and Symptoms
Tenderness of lateral patella
Swelling
Dull ache in center of knee
Patellar compression will elicit pain and crepitus
Apprehension when patella is forced laterally
Management
RICE - Tape patella to aid in tracking
Stretch ITB - Strengthen Medial structures 81

82. Knee Injuries Patella Dislocation
Mechanism
Non-contact, quick forceful contraction of the lateral quads
Symptoms
Deformity - slightly flexed knee
Pain
Treatment
Straighten leg - Splint
I.C.E. - Send for x-rays
Can cause damage to cartilage or fracture patella

83. Patellar subluxation Apprehension Test Position Test Positive
Athlete supine and relaxed with knee extended
Test
Tester places a lateral stress on the patella
Positive
Athlete has pain or tightens quads in “fear” of dislocation

84. Osgood-Schlatter Disease
Mechanism
Begins as cartilage and develops a bony callus, enlarging the tubercle
Resolves w/ aging
Common cause = repeated avulsion of patellar tendon
Signs and Symptoms
Swelling Point tenderness
Pain w/ kneeling, jumping and running
Management
Reduce stressful activity (6-12 months)
Possible casting,
ice before and after activity
Isometerics 84

85. 85

86. Patellar Tendinitis (Jumper’s or Kicker’s Knee)
Mechanism
Jumping or kicking - placing tremendous stress and strain on patellar or quadriceps tendon
Sudden or repetitive extension
Signs and Symptoms
Pain and tenderness at inferior pole of patella
3 phases - 1)pain after activity, 2)pain during and after, 3)pain during and after (possibly prolonged) and may become constant
Management
Ice, ultrasound, heat
Exercise
Patellar tendon bracing
Transverse friction massage 86

87. 87