Hip and Pelvis

Chapter 19

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

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

Pelvis—Skeletal Structure

Ilium Iliac crest Greater sciatic notch Iliac fossa

Sacrum Ischium Obturator foramen Pubis

Pubic Symphsis Coccyx

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

Pelvis—Skeletal Structure

Pelvis—Skeletal Structure

Pelvis—Skeletal Structure

Ischial Tuberosity

Ischial Tuberosity

Comparison of Male & Female Pelvis

Male More dense Muscle attachments

more sharply defined Female

Smaller Shorter Wider

Male versus Female

Male Female

Hip—Skeletal Structure

Hip—Skeletal Structure

Hip—Ligaments

Iliofemoral Pubofemoral Ischiofemoral

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

Primary Muscles of the Pelvis, Hip & Thigh

Gluteal Muscles Hip extension Internal rotation External rotation Abduction

Hip Flexor Muscles

Hip Flexor Muscles

Adductor Muscles

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)

Common Injuries and ConditionsOf The Hip and Thigh

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

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

Fracture

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

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”

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

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

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

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

Myositis Ossificans

Signs & Symptoms Treatment

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

Myositis Ossificans

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

Iliac Crest Contusion

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

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

Stress Fractures

Stress Fractures