Pelvis/hip/thigh injuries. Hip Pointers Mechanism – direct blow to the iliac crest Mechanism – direct blow to the iliac crest Occurs most often in contact/collision

Pelvis/hip/thigh injuriesPelvis/hip/thigh injuries

Hip PointersHip Pointers MechanismMechanism – – direct direct

blow to the iliac crestblow to the iliac crest Occurs most often in Occurs most often in

contact/collision sports like contact/collision sports like football because of football because of improperly fitting (or improperly fitting (or absent) hip padsabsent) hip pads

One of the most One of the most handicapping injuries in handicapping injuries in sportssports

Hip PointersHip Pointers Signs and Signs and

symptoms symptoms include…include… Point tenderness, Point tenderness,

swelling, ecchymosisswelling, ecchymosis Antalgic gain with Antalgic gain with

shortened swing phaseshortened swing phase Immediate painImmediate pain Muscle spasmsMuscle spasms Transitory paralysis of the Transitory paralysis of the

soft tissue structures - soft tissue structures - Athlete may not be able Athlete may not be able to rotate trunk or flex to rotate trunk or flex their thigh without paintheir thigh without pain

Hip PointersHip Pointers Management/Care and treatment by Management/Care and treatment by

the ATC the ATC Immediate application of ice and compression (as Immediate application of ice and compression (as

tolerated by the athlete)tolerated by the athlete) In severe cases, bed rest may be necessary for 24-48 In severe cases, bed rest may be necessary for 24-48

hours after injuryhours after injury Referral to a physician if you suspect a fractureReferral to a physician if you suspect a fracture Ice massage and ultrasound after the acute phaseIce massage and ultrasound after the acute phase Protective, hard-shell padding upon return to activity in Protective, hard-shell padding upon return to activity in

1-3 weeks1-3 weeks

Thigh Contusion Thigh Contusion (Quadriceps)(Quadriceps)

Mechanism – Direct Blow, usually develop as the result of being hit by someone or something, while thigh muscles were relaxed forcing the soft tissues against the hard surface of the femur – helmets, pads, elbows

The extent of the force and the degree of thigh relaxation usually determines the depth of the injury and amount of structural and functional disruption that occurs

Thigh ContusionThigh Contusion Early detection is

essential to a quick recovery for the athlete

Signs and Symptoms weakness with muscle

testing Transitory paralysis or

loss of function (dead leg)

A circular, swollen area at the location of the injury with point tenderness

Limited AROM due to pain;

Thigh ContusionThigh Contusion Care and treatment for contusions by the ATC

includes management in 3 stages… Stage 1

Application of ice, compression, and elevation Isometric quad contractions Crutches for 2nd and 3rd degree cases Gentle passive stretching w/cold application

Stage 2 Recovery of ROM through the use of warm whirlpool

or moist heat packs, ultrasound, ice, and stretching Stage 3

Recovering full function through PRE’s and gradual return to activity

Thigh contusionsThigh contusions

Care and rehabilitation of thigh contusions should be handled relatively conservatively Exercises should not be used if pain is present Never use deep, penetrating therapies and

manual therapies until you are convinced swelling and bleeding have stopped

Once an athlete has suffered an injury like this, care should be taken to insure that the athlete is not re-injured by providing protective padding, etc.

Myositis OssificansMyositis Ossificans

What is it : An inflammation of muscle leading to bone formation

Mechanism of Injury: Severe and repeated blows to the same area of the

thigh can result in ECTOPIC BONE FORMATION Usually occurs after bleeding into the quadriceps/thigh

and formation of a hematoma (blood tumor) This causes a disruption in the tissues, which may result

in inflammation This irritation, in turn, cause tissue formation resembling

cartilage or bone


Myositis OssificansMyositis Ossificans S/S

Warm, firm, swollen thigh; 2-4 cm larger Hard lump in muscle tissue Limited ROM - Palpable, painful mass may limit passive

knee flexion to 20 – 30 degrees Previous quadriceps contusion

Myositis OssificansMyositis Ossificans The most common cause of this condition is improper care

of a thigh contusion The following are classic ways in which this condition

can be caused or aggravated… or Attempting to “run off” the quad contusion

Management Limit the swelling and bleeding – compression wrap Preserve elasticity – gentle stretching Physical therapy Donut padding to prevent repeated blows to the area Referral to physician:

In most cases the bony growth will have to be surgically removed, after which a recovery of up to one year can be expected


Examples of ossified tissues removed from patients suffering from Myositis Ossificans

Thigh Strains - QuadricepsThigh Strains - Quadriceps

Quadriceps muscle strains Mechanism of Injury

The quad is often strained with a sudden contraction or stretching of the muscle

A tear of the rectus femoris muscle (the most commonly torn muscle) may cause partial or complete disruption of the muscle fibers

These tears can occur in the belly of the muscle or at the ends of the muscle, most typically towards the distal aspects at the muscle-tendon junction

Thigh Strains - QuadricepsThigh Strains - Quadriceps Quadriceps muscle strains

S/SswellingPain when muscle is used or the inability to use the muscleBruisingPoppingIndentation in the muscle

Thigh Strains - QuadricepsThigh Strains - Quadriceps

Quad contusion

Thigh Strains – QuadricepsThigh Strains – Quadriceps

Care & Treatment of Quad Strains Immediately application of ice, compression,

and elevation Crutches (if necessary) After swelling and inflammation have ended,

whirlpool and/or ultrasound may be used Isometric muscle contraction as tolerated,

progressing to PRE’s to restore muscle strength

Gentle stretching as tolerated Elastic wrapping for support

https://www.youtube.com/watch?v=aFKALofVRpg

https://www.youtube.com/watch?v=ReYVJ_k7j2Q

https://www.youtube.com/watch?v=6-5Ay-Z4Wsw







Thigh Strains - HamstringThigh Strains - Hamstring Hamstring strains

Hamstrings are the muscles most likely to be injured in the thigh

Mechanism of Injury The exact cause of hamstring strains is unknown

It is believed that it most often has to do with a quick change in the functions of the muscle from that of a knee stabilizer to a hip flexor

This thought stems from the fact that most hamstring injuries are the result of “explosive starts”

Hamstrings should be 60-70% as strong as the quadriceps muscles

A greater difference may also play a role in causing hamstring injury

Thigh Strains - HamstringThigh Strains - Hamstring

Hamstring strains As with the quads, strains about the hamstring can

occur in the belly of the muscle or more distally towards the muscle attachments or muscle-tendon junctions

The extent of the injury can very from a simple tearing of a few muscle fibers to a complete rupture of the muscle or tendons

General signs and symptoms include… Bleeding or bruising Pain and point tenderness Immediate loss of function

All of these will vary depending on severity

Thigh Strains - HamstringThigh Strains - Hamstring

Thigh strains – hamstringThigh strains – hamstring

Degrees of hamstring strains 1st Degree

Muscle soreness with movement Point tenderness Sometimes difficult to detect because symptoms often do

not appear until well after the athlete has cooled down 2nd Degree

Partial tearing of the muscle fibers Identified by a sudden snap or tear accompanied by severe

pain and loss of strength with knee flexion 3rd Degree

A complete rupture of the tendon or muscle Major disability and bleeding

Thigh strains - hamstringThigh strains - hamstring

Care and Treatment by the ATC… Immediate application of ice, compression, and

elevation Decreased or stopped activity until soreness subsides NO ballistic stretching or explosive sprinting Whirlpools, ultrasound, e-stim, massage, etc, after

inflammation and bleeding have subsided Gentle stretching, either passive or active Isometric muscle exercise progressing to PRE’s as

tolerated Gradual return to activity with jogging, etc. Elastic wrapping for support

Thigh strains - hamstringThigh strains - hamstring

Remember… Hamstring strains often recur in athletes Care must be taken in instructing the athlete

about daily warm-ups and stretching to prevent recurring injury

The psychological factors of this injury must also be considered by the ATC

Often athletes who suffer hamstring strains develop concerns and “worries” about re-injury which may affect their future performance

Hip sprains/strainsHip sprains/strains

Mechanism of Injury Usually seen as a result of a violent

twisting of the hip Involves the various ligaments that hold

the hip in place Professional athletes with this injury:

Derek Jeter, Kobe Bryant, Greg Norman

Hip Sprains/StrainsHip Sprains/Strains

S/S Pain Swelling Decrease ROM Ecchymosis –

discoloration Felt/heard pop inability to inability to

circumduct the circumduct the thighthigh

Management RICE Crutches Gentle stretching Physical therapy –

for electrical stim, ultrasound, etc

Referral to physician if symptoms do not resolve

https://www.youtube.com/watch?v=TLPc1pM9458

https://www.youtube.com/watch?v=nzrHvkiCMeU






Hip strains - groinHip strains - groin Mechanism of injury

Usually caused by an overstretching of the muscles within the groin area

Activities such as running, jumping, and twisting with external rotation can cause these types of injuries

Runners, jumpers (soccer, football)

Hip strains - groinHip strains - groin

These injuries are often some of the most difficult to care for in athletics

They can occur suddenly or appear gradually over time

Signs & symptoms include… Pain Weakness Popping or snapping felt Decrease in motion – adduction, external

rotation Internal hemorrhage (discoloration))

Hip strains - groinHip strains - groin Care and treatment by

the ATC should include… Ice, compression,

elevation, and rest for the first 48-72 hours after the injury is discovered

Warm whirlpools, moist heat packs, and/or ultrasound (after initial 2-3 days)

Reduced participation until athlete is pain free

Rehab should emphasize flexibility with graduated stretching and range of motion exercises

Groin should be wrapped for support using a hip spica

Hip strains - groinHip strains - groin

Special Note… Care should be taken if a

distance runner presents in the athletic training room complaining of severe groin pain

Pelvic stress fractures often first appear as groin strains and exhibit similar signs and symptoms

If there is no logical cause or explanation for their injury and pain, they should be referred to a physician for evaluation

BursitisBursitis

Iliopsoas Iliopsoas Pain medial and Pain medial and

anterior to joint; cannot anterior to joint; cannot be easily palpatedbe easily palpated

Increase pain with Increase pain with passive hip rotation; passive hip rotation; resisted hip flexion, resisted hip flexion, abduction, adduction abduction, adduction and external rotationand external rotation

Ischial bursitisIschial bursitis Pain aggravated by Pain aggravated by

prolonged sitting and prolonged sitting and uphill runninguphill running

Point tenderness Point tenderness directly over ischial directly over ischial tuberositytuberosity

Increase pain with Increase pain with passive and resisted hip passive and resisted hip extensionextension

Management: Standard acute; deep friction massage, NSAIDS, stretching program for involved muscles, ongoing prevention, biomechanical analysis

Trochanteric bursitisTrochanteric bursitis

Trochanteric BursitisTrochanteric Bursitis Relatively common Relatively common

condition involving condition involving the greater the greater trochanter of the trochanter of the femur, surrounding femur, surrounding muscles, and muscles, and ligamentsligaments

Most commonly seen Most commonly seen in female runnersin female runners

Trochanteric bursitisTrochanteric bursitis

Trochanteric Bursitis, continued…Trochanteric Bursitis, continued… Care and treatment by the ATC should Care and treatment by the ATC should

include…include… Elimination of running on inclined surfacesElimination of running on inclined surfaces Correction of leg-length discrepancies and Correction of leg-length discrepancies and

faulty running formfaulty running form Cold packs/ice massage in combination with Cold packs/ice massage in combination with

restrest Anti-inflammatory medications with physician Anti-inflammatory medications with physician

approval or direction approval or direction

Hip Stress fractureHip Stress fracture MOI

Once most commonly affected military personnel who marched and ran all day after day. Now hip stress fx are more common in athletes. Esp distance runners.

a) Femoral neck stress fracture

primarily in endurance athletes, overuse injury

Hip stress fractureHip stress fracture

S/S presence with groin

or anterior thigh pain, often a deep ache relived with cessation of activity.

antalgic gait, painful ROM, especially with internal and external rotation

Management: RICE, Referral to Physician Plain radiographs taken early

may be negative- Further imaging may be required- (i.e.) MRI/ Bone Scan.

If suspected, keep on crutches nonweight bearing until diagnosis confirmed

nondisplaced fracture on the compression (inferior) side consists of non-weightbearing/modified bed rest until the patient is completely pain free

displaced fractures and nondisplaced tension side fractures - ORIF

Fractures - femurFractures - femur

Femoral Fractures In athletics, most often occur in the shaft of the femur Usually caused by an outside force like falling from a

height, being hit, etc Shock generally accompanies a femur fracture as a

result of the extreme pain and bleeding associated with the injury

This is a TRUE medical emergency There will usually be deformity and displacement of the

bone ends as a result of the quad muscles contracting This can also cause internal lacerations to muscle tissues

Fracture - femurFracture - femur


Signs and Symptoms of Femoral Fractures include… Deformity with the thigh turned inward Shortening of the thigh Loss of function Severe pain and point tenderness Swelling of the soft tissues


Care & Treatment by the ATC…Care & Treatment by the ATC… Immediate application of manual traction Activation of EMS system Splinting with a TRACTION SPLINT

If a traction splint is not available, then manual traction should be maintained until EMS arrives

Application of ice to the area of fracture Treatment for shock Monitoring of vital signs

Hip dislocationsHip dislocations

Mechanism: Rarely seen in athletics When they do occur, it is usually the result of massive

traumatic forces along the long axis of the femur Generally hip dislocations occur with the knee in a

flexed position Displacement will occur posteriorly with the femoral

shaft adducted and in a flexed position This is a very serious injury, requiring emergency care,

because of the severe damage that can be caused to surrounding soft tissues in the hip


Dislocation of the Hip Joint, Dislocation of the Hip Joint, continued…continued… Bi-lateral hip dislocation with x-ray Bi-lateral hip dislocation with x-ray

imageimage


S/SS/S Intense painIntense pain Inability to move Inability to move

hiphip

ManagmentManagment Immediate request for EMS Immediate request for EMS

assistanceassistance Monitor vital signs especially Monitor vital signs especially

distal vascular integritydistal vascular integrity treat for shocktreat for shock Stabilization of the hip and Stabilization of the hip and

athlete in the position found. athlete in the position found. Best way to splint this type of Best way to splint this type of injury is by placing the athlete injury is by placing the athlete on a backboard and then on a backboard and then stabilizing the hip in the stabilizing the hip in the position found with pillows, position found with pillows, blankets, etc.blankets, etc.


After reduction the athlete will usually be confined After reduction the athlete will usually be confined to bed rest for approximately 2 weeks, followed by to bed rest for approximately 2 weeks, followed by 1-2 months of assisted ambulation with a crutch or 1-2 months of assisted ambulation with a crutch or canecane

Also during this time the athlete will probably Also during this time the athlete will probably receive physical therapy to restore the hip to receive physical therapy to restore the hip to normal functionnormal function

Complications that can arise from this injury Complications that can arise from this injury include…include…

Muscle paralysis as a result of damage to various nerves Muscle paralysis as a result of damage to various nerves including the including the sciatic nervesciatic nerve

Osteoarthritis in the hip jointOsteoarthritis in the hip joint

Legg- Calve’-Perthes Legg- Calve’-Perthes DiseaseDisease

Legg-Perthes Disease (Coxa Plana)Legg-Perthes Disease (Coxa Plana) Definition:Definition:

An An avascular necrosis avascular necrosis of the femoral headof the femoral head Caused by a loss or disruption of blood flow to Caused by a loss or disruption of blood flow to

femoral headfemoral head Osteochondrosis of femoral headOsteochondrosis of femoral head Occurs more often in boys than in girls and is Occurs more often in boys than in girls and is

generally seen between the ages of 3 and 12generally seen between the ages of 3 and 12

Legg-Perthes DiseaseLegg-Perthes Disease

S/SS/S Gradual onset of limp and

mild hip or knee pain of several months in duration

Pain is activity related Decrease ROM in hip

abduction, extension, and external rotation due to spasm in hip flexors and adductors

Pain in the groin area, often referred to the abdomen

ManagementManagement Complete bed restComplete bed rest Special bracing to avoid Special bracing to avoid

direct weight bearing direct weight bearing on the hipon the hip

Complications related to Complications related to this condition include…this condition include… Improper formation of Improper formation of

the femur leading to the femur leading to osteoarthritis later in osteoarthritis later in lifelife

http://www.youtube.com/watch?v=BpuMRphcxCo



Avascular NecrosisAvascular Necrosis

Avascular Necrosis of Avascular Necrosis of the Femoral Headthe Femoral Head Rarely seen in athletics Rarely seen in athletics

but can occur as the but can occur as the result of a severe blow to result of a severe blow to the hip jointthe hip joint

Lack of blood flow to the Lack of blood flow to the femoral head, causing femoral head, causing bone deathbone death

Most famous case was Most famous case was that of Bo Jacksonthat of Bo Jackson

Usually results in hip Usually results in hip replacement surgeryreplacement surgery

Snapping HipSnapping Hip

Snapping Hip Snapping Hip PhenomenonPhenomenon Commonly seen among Commonly seen among

dancers, gymnasts, and dancers, gymnasts, and hurdlershurdlers

Caused by habitual Caused by habitual movements which movements which cause certain muscles cause certain muscles surrounding the hip to surrounding the hip to become unbalanced in become unbalanced in terms of strengthterms of strength

Usually occurs when the Usually occurs when the athlete laterally rotates athlete laterally rotates and flexes the hipand flexes the hip

Snapping hipSnapping hip

Snapping Hip Snapping Hip PhenomenonPhenomenon The athlete will complain of The athlete will complain of

snapping, mainly when snapping, mainly when balancing on one legbalancing on one leg

Care and treatment by the Care and treatment by the ATC should include….ATC should include….

Encouraging the athlete Encouraging the athlete to avoid activities that to avoid activities that cause the snappingcause the snapping

StretchingStretching Muscle strengtheningMuscle strengthening If there is associated If there is associated

pain, the athlete may pain, the athlete may need to be referred to a need to be referred to a physician for evaluationphysician for evaluation

Osteitis pubisOsteitis pubis

Osteitis PubisOsteitis Pubis Most often seen Most often seen

in long distance in long distance runners, but can runners, but can also be seen in also be seen in football, soccer, football, soccer, and wrestling and wrestling athletesathletes


Osteitis Pubis, continued…Osteitis Pubis, continued… Chronic inflammatory condition of the Chronic inflammatory condition of the

pubic symphysis as a result of muscle pubic symphysis as a result of muscle pulling and repetitive stress on the bony pulling and repetitive stress on the bony structures of the pelvisstructures of the pelvis


Osteitis Pubis, continued…Osteitis Pubis, continued… Signs and symptoms include…Signs and symptoms include…

Pain in the groin area and over the pubic Pain in the groin area and over the pubic symphysissymphysis

Pain with movements such as running, sit-ups, Pain with movements such as running, sit-ups, and squatsand squats

Care and treatment by the ATC includes…Care and treatment by the ATC includes… Rest and anti-inflammatory medications per Rest and anti-inflammatory medications per

physician ordersphysician orders Gradual return to activity as toleratedGradual return to activity as tolerated

ThrombosisThrombosis

Other thigh conditionsOther thigh conditions Thrombosis

Blood clot in a vein or artery in the thigh Disrupts blood flow to the leg Needs to be referred to the emergency room or

a physician for immediate treatment Signs & Symptoms may include…

Swelling Pain Loss of function Loss of sensation

ThrombosisThrombosis

Deep thrombosis to the thighDeep thrombosis to the thigh

Thrombosis of the thighThrombosis of the thigh

Other thigh conditionsOther thigh conditions Very similar to compartment syndrome in

the lower leg Swelling in the thigh compartment that

leads to loss of sensation, loss of blood flow, etc.

Signs and Symptoms include thigh swelling, severe pain, loss of function, loss of sensation, etc.

This condition needs to be referred to a physician for evaluation and treatment, which may involve surgical intervention

Thigh compartment Thigh compartment syndromesyndrome

Documents

Pelvis/hip/thigh injuries. Hip Pointers Mechanism – direct blow to the iliac crest Mechanism – direct blow to the iliac crest Occurs most often in contact/collision