Lecture # 12

Thigh , Hip and Pelvis

Thigh , Hip and Pelvis

since the hip and pelvis have a sturdy anatomical composition, they are seldom injured in sports participation , however the soft tissue of the thigh may be frequently injured

compressive forces may lead to contusions , which should not be serious unless they are mismanaged

many injuries are the result of inflexibility and muscle imbalances of the quads and hamstrings

Hip injuries commonly involve collision sports or forceful movements

Hip and pelvic injuries more common in older active people

Approx 1% of general active population , 5-9 % of high school , however 15 % of runners ( stress fractures to femoral neck )

Structure of the Hip

the femur of the thigh is a major weight bearing bone – it is the longest, largest and strongest bone in the body

its weakest component is the femoral neck the hip joint is the articulation between the

concave acetabulum of the pelvis and the head of the femur

it is a ball and socket joint , which provides considerable stability

ligamentus teres, blood supply to the head and acetabulum

strong ligamentus support from the iliofemoral, pubofemoral and ishiofemoral

plus a number of strong muscles cross the hip, enhancing its stability( RF, IP,ADD’s)

Structure of the Pelvis

the pelvis of pelvic girdle consists of a protective bony ring formed by 4 fused bones

the pelvis protects the enclosed inner organs , transmits loads between the trunk and lower extremity and provides a site for a number of major muscle attachments

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Muscular support of the Hip and Pelvis Flexion - iliopsoas, rectus femoris and

sartorius Extension- glut max, hamstring, Abduction

- glut med & min Adduction- pectinus, adductor brevis,

longus, magnus and gracilis

lnt Rot - glut min, TFL Ext Rot - piriformis, glut max

Muscles of the Thigh - all muscle of the above, plus the Quads -

RF, VI, VM , VL

Common Injuries of the Thigh, Hip and Pelvis

Quad Contusions AKA Charlie horse most common site for

contusion is the antero-lateral thigh, which almost always damages muscle tissue

severity of injury is almost always underestimated and under treated

l st, 2nd & 3 rd degree - depends on severity of S&S

s/s - immediately after impact pain and swelling may be extensive, ROM will be limited due to severity

if severe the individual may not be able to bear weight and not able to fully flex the knee

there may be a palpable firm hematoma with in 24 hours – resulting in the inability to contact the quads

First Aid Care Immediately apply ice,

compression and elevate Can apply a pad, keep it in

place with a elastic wrap. Have athlete rest , use crutches Athlete must get plenty of rest

and time to permit healing . should be iced in a flexed

position DO NOT HEAT

Myositis ossificans is an abnormal ossification involving bone deposits within muscle tissue

may result from a single traumatic blow or several repeated blows to the area

examination reveals a warm, firm , swollen thigh nearly 2 to 4 cm larger than unaffected leg

a palpable mass may limit flexion this individual must see a

physician and if mass does not reabsorb with 6 to 12 months, surgery may be necessary

Risk Factors Continuing to play after injury Early massage or hydrotherapy Passive stretching Too rapid of progression of therapy Premature return to play Reinjury of same area

Strains muscular strains to the thigh and hip are

frequent in sports, Rectus Femoris, Adductors and hamstrings

hamstrings are the most commonly strained muscle in the body

individual may report a snapping or tearing during an explosive action , followed by immediate pain and loss of function , with local tenderness and possibly a palpable defect

usually caused by rapid contraction or a violent stretch

hamstring strain has the reputation of being a chronic and reoccurring problem

Hamstring Strain

Risk factors Poor flexibility Poor posture Muscle imbalance Improper warm up Muscle fatigue Previous injury Overuse Improper technique

First Aid Care Immediately apply ice, compression and

elevate Can apply a pad, keep it in place with a

elastic wrap. Have athlete rest , use crutches Have athlete evaluated by medical

personnel

Dislocated Hip Joint

rare b/c of support and a wide range of motion available at the hip

injury usually occurs with violent twisting or catastrophic trauma when knee is driven into a stationary object, ie the dashboard of a car

severe sprains or dislocations result in immediate intense pain and an inability to walk or even move the hip

a dislocated hip is an emergency situation – call an ambulance and stabilize

Major complication is the damage to the femoral head and loss of blood supply causing avascular necrosis of the femoral head, this may lead to chronic pain , instability and eventually a total hip replacement

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First Aid Care Treat for shock Immobilize the athlete and transport to

nearest medical centre, where it will be reduced

Can apply a pad, keep it in place with a elastic wrap.

Care should be given to monitor blood flow to rest of leg at all times .

Hip Pointer are contusions to

the unprotected iliac crest and the muscles that insert there, generally a fall or contact with objects or equipment

any movement of the trunk will be painful , including coughing , laughing and breathing

Localized pain at iliac crest immediate pain ands spasm will prevent the

individual from rotating the trunk or laterally flexing

protect from re-injury with a doughnut pad, when they return to play

First Aid Care Immediately apply ice to injured area Have athlete rest , possibly use crutches Avoid activity that involves bending

stretching etc. Can try icing in a stretched position

Bursitis an inflammation of the bursa found most often in the trochanteric bursa occurs with running ( friction between

trochanter and ITB) or as a result of a contusion

usually presented as a deep burning , or aching feeling

Rx – PIER , NSAIDS, stretching to relieve pressure

Piriformis Syndrome Compression or irritation

of the sciatic nerve Found in runners and

women especially if tight hip flexors and weak gluteals,

Tight piriformis Sciatic nerve

s/s tight piriformis -pain in butt or down

posterior leg Numbness or burning in butt or down

posterior leg pain with internal rotation General loss of strength of hip General treatment , lots of rest , stretching

and strengthening

First Aid Care Can try icing Stretch of glutes Refer to therapist for attention