Thigh , Hip and Pelvis

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Lecture 12

• Thigh , Hip and Pelvis

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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

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• 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 )

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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

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• 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,ADDs)

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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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21-10
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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

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• 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

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Common Injuries of the Thigh, Hip and Pelvis
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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
  SS

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• 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

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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

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• 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

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• 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

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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

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Hamstring Strain

• usually caused by rapid contraction or a violent
  stretch
• hamstring strain has the reputation of being a
  chronic and reoccurring problem

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

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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

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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

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• 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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21-33
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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 .

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Hip Pointer

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

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• 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

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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

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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

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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

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• 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

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First Aid Care

• Can try icing
• Stretch of glutes
• Refer to therapist for attention