The Hip and Pelvis

The Hip and Pelvis

The hip, one of the most stable joints in the body, is a freely movable, ball-and-socket joint Most hip injuries result from smaller muscles being overused or

pushed too hardThe pelvis transmits weight from the axial skeleton to

the lower limb when standing or to the ischial tuberosities when sitting Pelvis provides attachments for various muscles Houses parts of the digestive, urinary, and reproductive systems

Female bone structure Slightly less dense than the male’s and is smaller, shorter and

wider Bone protrusions for muscle attachments are not sharply

defined

Bones of the Hip and Pelvis Joints

Hip Joint Where the spherical

head of the femur fits into the acetabulum of the pelvis

Pelvis The bones of the pelvis

are the ilium, ischium and pubis

Connects with the sacrum and coccyx of the vertebral column posteriorly Sacroiliac (SI) joint

Pelvis ~ Skeletal Structure

Ilium Broad, flared portion that constitutes the upper and lateral

sections of the pelvis Iliac crest is the upper ridge Greater sciatic notch allows the sciatic nerve to pass through the leg

below

Ischium Bears weight when sitting and is attached to the pubis anteriorly,

the ilium laterally and to the back Large opening in the ischium is the obturator foramina, where

blood vessels and nerves pass into the legs. Pubis

Makes up the front of the pelvis bones and located in the front and below the bladder

The pubis symphysis, located in the center of the pubis, is where the two sides fuse

Sacroiliac Joint

Sacrum Composed of 5 fused

vertebrae and connects directly to the ilium posteriorly

Coccyx Composed of 3-5

vertebrae and is connected to the lower portion of the sacrum Susceptible to shock

fracture, as might be induced from a fall

Hip and Pelvis Musculature

Primary Muscles of the Hip and Pelvis Gluteals Hip Flexors Hip Adductors Quadriceps Hamstrings

Gluteal Muscles

Gluteal muscles are the largest group Gluteus Maximus

Performs hip extension Gluteus Minimus and medius

Perform internal and external rotation and abduction

Hip Flexors and Adductors

Hip Flexors Muscles that assist in

hip flexion Iliopsoas Sartorius Pectineus Rectus Femoris

Hip Adductors Muscles that assist in

hip adduction Adductor Longus Adductor Brevis Adductor Magnus

Quadriceps and Hamstrings

Quadriceps Perform hip flexion

Vastus Medialis Vastus Lateralis Vastus Intermedius Rectus Femoris

Hamstings Perform hip extension

Biceps Femoris Semitendinonsus Semimembranosus

Common Injuries of the Hip and Thigh

Injuries to the hip and thigh are very common in athletics

Major injuries and conditions are Bursitis Hip fracture Strains IT Band syndrome Quadriceps contusions Myositis ossificans Iliac Crest contusions Stress fractures

Bursitis

Bursitis is most commonly located over the outside of the hip at the trochanteric bursa Most common among athletes who do not sufficiently stretch

and warm up in this areaSymptoms

Tenderness over outer portion of hip Worsens by walking, running, or twisting the hip

Treatment Initially treated with heat Followed by stretching exercises Ice massage NSAIDS are also helpful

Hip Fracture

Refers to a break in the proximal portion of the femur, most common types

In young patients, extreme trauma, is usually necessary for a hip fracture

Femoral neck fractures Intertrochanteric fractures Subtrochanteric fractures

Symptoms Severe hip pain Abnormally rotated leg Increase pain with movement

Treatments May vary and must be discussed with surgeon

Quadriceps and Hip Flexor Strain

Common in sports that require jumping, kicking and repetitive sprinting Common muscles involved are the rectus femoris

and/or iliopsoas muscles. Treatment

Icing Compression wrap Anti-inflammatory medications

Rehab Should be progressive and sport-specific

Hamstrings Strain

Most frequently affect the long head of the biceps femoris Can range from microtears in a small area to a complete tear

in the muscle or its tendons (usually called a hamstring tear) Causes

Insufficiently warming up Developing quads more than hamstrings Inflexibility Direct blow to back of leg

Symptoms Sharp pain in back of thigh Bruising Swelling Loss of strength in upper leg

Hamstrings Strains ~ Treatment and Rehab

Treatment RICE Medication (asprin/ibuprofen) Physical Therapy Crutches and massage can be recommended

Rehab Should begin soon after the injury occurs Progress into weight-training program to focus on

balancing strength between the quads and hamstrings

Adductor (Groin) Strains

Common in sports that require sideways changes in direction Most involved muscles in the adductor longus

Symptoms Most strains are Grade I or II Characterized by groin pain when running or kicking

Treatment Can be difficult and risk of re-injury is high Rest Ice Anti-inflammatory meds Adductor stretching and strengthening is common

Iliotibial Band Syndrome

Involves inflammation of the IT Band Thick band of fibrous tissue that runs down the outside of the

leg, beginning at the hip an extending to the outer side of the tibia just below the knee

Symptoms Irritation and pain when knee is moved Increasing pain with movement

Treatment Analysis of the athlete’s gait and training program to rule out mechanical problem or training errors Using proper footwear Icing Stretching Reduce activity until symptoms subside

Quadriceps Contusions

Usually caused by a direct blow to the thigh from a helmet or knee Common in football, rugby, soccer and basketball

The injury can limit motion and affect gait Severity of the contusion is determined by the range of

motion in the hip when evaluatedTreatment

Immediate compression Ice Use of crutches Massage is contraindicated

May cause more damage

Myositis Ossificans

A very painful condition in which an ossifying mass may form within the muscle Usually the result of recurrent trauma to a quadriceps muscles that was

not properly protected after the initial injury Symptoms

Hard, painful mass is the soft tissue of thigh Loss of ROM Ultimately diagnosed with x-ray

About 4 weeks after injury

Treatment acute, with heat Limit ROM Rehab

Passive stretching and vigorous exercise discouraged for first 6 months

Surgical excision may be necessary if pain and limited motion persist beyond year

Iliac Crest Contusion

Also called a hip pointer Very painful injury caused by a direct blow to the hip

Symptoms (all over iliac crest) Extreme tenderness Swelling Eccymosis

Treatment Application of ice compression protection

Overuse Injuries

Common among one-sport athletes Caused by cumulative effects of very low levels of

stressExamples:

Chronic muscles strains Stress fractures Tendonitis Snapping hip Bursitis

Athletes with these problems should rest from the sport and use cross-training techniques

Stress Fractures

Occur most often in runners and dancers Femur stress fractures are common in runners

Symptoms Chronic, ill-defined pain over groin and thigh If symptoms do not resolve with rest and rehab, athlete should

be exaimined by specialist using x-rays and bone scansTreatment

Rest Non-weight bearing endurance exercises Running in water or swimming