© 2007 McGraw-Hill Higher Education. All rights reserved. Chapter 17: The Thigh, Hip, Groin, and Pelvis © 2007 McGraw-Hill Higher Education. All rights

© 2007 McGraw-Hill Higher Education. All rights reserved.

Chapter 17: The Chapter 17: The Thigh, Hip, Thigh, Hip, Groin, and Groin, and

PelvisPelvis








Muscles and MovementsMuscles and Movements• Hip flexion

– Normal ROM• 120 degrees knee bent bent

– Iliacus and psoas major (major flexors)- __________________________ - knee bent

– _________________ (function when knee is extended and with kicking the ball)

– Sartorius• Hip Extension

– Normal ROM 10 – 20 degrees– ________________________________


Muscles and Movements (2)Muscles and Movements (2)• Abduction

– Normal ROM• 45 degrees

– ________________

• Adduction– Normal ROM

• 30 degrees

– Adductor magnus, longus, brevis, and gracilis


Muscles and Movements (3)Muscles and Movements (3)• Internal Rotation or Medial Rotation

– Normal ROM• 45 degrees

– _____________________________________________________

• External Rotation or Lateral Rotation– Normal ROM

• 45 degrees

– 6 deep external rotators- piriformis


RROM testingRROM testing• Hip Flexion• Hip Extension• Hip Abduction• Hip Adduction• Hip Internal Rotation• Hip External Rotation• Knee Extension• Knee flexion


• Special Tests– Thomas test

• Test for hip contractures-______________

– Straight Leg Raise• Test for hamstring

tightness or• Can also be used to

assess sciatic nerve irritation from swelling, bulging/herniated disk or SI joint dysfunction


Special Test ContSpecial Test Cont• Kendall

• Pelvic Rock

• Trendelenburg’s Test


Prevention of Thigh InjuriesPrevention of Thigh Injuries• Thigh must have maximum strength,

endurance, and extensibility to withstand strain

• Dynamic stretching programs may aid in muscle preparation for activity

• Strengthen programs can also help in preventing injuries– Squats, lunges, leg press– Core strengthening


Recognition and Recognition and Management of Thigh Management of Thigh

Injuries Injuries • Quadriceps Contusions

– Cause of Injury• Constantly exposed to traumatic blows

– Signs of Injury • Pain, transitory loss of function, immediate

bleeding of affected muscles• Early detection and avoidance of internal

bleeding are vital – increases recovery rate and prevents muscle scarring


• Care– RICE and NSAID’s– ______________________

_____– ______________________

__________________________________________

• Heat, massage and ultrasound to prevent myositis ossificans– Padding may be worn for

additional protection upon return to play


• Myositis Ossificans– Cause of Injury

• _________________________________________________________________

– Signs of Injury• _______________________________________________________• Pain, weakness, swelling, decreased ROM• Tissue tension and point tenderness

– Care• Treatment must be conservative• May require __________________ if too painful and restricts

motion • If condition is recurrent it may indicate problem with

blood clotting



• Quadriceps Muscle Strain– Cause of Injury

• ____________________________________________________________________

• Associated with weakened or over constricted muscle

– Signs of Injury• Peripheral tear causes fewer symptoms than deeper tear• Pain, point tenderness, spasm, loss of function and little discoloration• Complete tear may leave athlete w/ little disability and discomfort but with

some deformity; more discoloration; edema will settle in back of knee, calf and ankle

– Care – Fit for crutches if necessary• _____________________________________________• Determine extent of injury early• Neoprene sleeve may provide some added support


• Hamstring Muscle Strains– Cause of Injury

• Multiple theories of injury– Hamstring and quad contract together– Change in role from hip extender to knee flexor– Fatigue, posture, leg length discrepancy, lack of flexibility, strength

imbalances,

– Signs of Injury • Muscle belly or point of attachment pain• Capillary hemorrhage, pain, loss of function and possible

discoloration• Grade 1 - soreness during movement and point tenderness • Grade 2 - partial tear, identified by sharp snap or tear,

severe pain, and loss of function


– Signs of Injury (continued)• Grade 3 - Rupturing of tendinous or muscular

tissue, involving major hemorrhage and disability, edema, loss of function, ecchymosis, palpable mass or gap

– Care• RICE • Restrict activity until soreness has subsided• Ballistic stretching and explosive sprinting should

be avoided initially• Fit for crutches if necessary


Recognition and Recognition and Management of Specific Hip, Management of Specific Hip,

Groin, and Pelvic InjuriesGroin, and Pelvic Injuries• Groin Strain

– Cause of Injury • One of the more difficult problems to diagnose• Often seen in early part of season due to poor

strength and flexibility• Occurs from running , jumping, twisting w/ hip

external rotation or severe stretch– Signs of Injury

• Sudden twinge or tearing during active movement• Produce pain, weakness, and internal hemorrhaging


• Groin Strain (continued)– Care

• ______________________________________________________________

• Determine exact muscle or muscles involved• ______________________• _________________________________________________

______________• Refer to physician if severe groin pain is

experienced• Fit for Crutches if necessary


• Sprains of the Hip Joint– Cause of Injury

• Result of violent twist due to forceful contact• ______________________________________________________

_____________________________– Signs of Injury

• Signs of acute injury and inability to circumduct hip• Pain in hip region, w/ hip rotation increasing pain

– Care• X-rays or MRI should be performed to rule out fx• RICE, NSAID’s and analgesics• Depending on severity, crutches may be required• ROM and PRE are delayed until hip is pain free


• Piriformis Syndrome– Cause of Condition

• __________________________________________________________________

• _________________________________

– Signs of Injury• Pain, numbness and tingling in butt – may

extend below knee and into foot• Pain may increase following periods of

sitting, climbing stairs, walking or running– Care

• Stretching and massage• NSAID’s may be prescribed• Cessation of aggravating activities will be prescribed• Corticosteroid injection may also be suggested• Surgery is sometimes an option as well


Hip Problems in Adolescent Hip Problems in Adolescent AthletesAthletes

• Legg Calve’-Perthes Disease • Cause of Condition

• Avascular necrosis of the femoral head in child ages 4-10

• Articular cartilage becomes necrotic and flattens– Signs of Condition

• Pain in groin that can be referred to the abdomen or knee• Limping is also typical• Varying onsets and may exhibit limited ROM



•Legg-Calve’-Perthes Disease Legg-Calve’-Perthes Disease (continued)(continued)

• Care– Bed rest to reduce chance of chronic

condition– Brace to avoid direct weight bearing– Early treatment and head may reossify

and revascularize

• Complication– If not treated early, will result in ill-

shaping and osteoarthritis in later life


• Slipped Capital Femoral Epiphysis– Cause of Condition

• May be growth hormone related• 25% of cases are seen in both hips• ______________________________________________________________

__________________________________• ___________________________________

– Signs of Condition• Pain in groin that comes on over weeks or months• Hip and knee pain during passive and active motion; limitations of

abduction, flexion, medial rotation and a limp– Management

• W/ minor slippage, rest and non-weight bearing may prevent further slippage

• Major displacement requires surgery• If undetected or surgery fails severe problems will result



• Iliac Crest Contusion (hip pointer)– Cause of Injury

• __________________________________________________________________

• ____________________________ – Signs of Injury

• Pain, spasm, and transitory paralysis of soft structures• ___________________________________________________________________

______– Care

• RICE for at least 48 hours, NSAID’s, • Bed rest 1-2 days in severe cases• Referral must be made, X-ray• Padding should be used upon return to minimize chance of added

injury


• Avulsion Fractures– Cause of Injury

• _________________________________________________________________

• Pulling of tendon away and off of bony insertion• Common sites include ASIS (________), AIIS

(___________________), ischial tuberosity (___________)

– Signs of Injury• Sudden localized pain w/ limited movement• Pain, swelling, point tenderness

– Care• Rest, limited activity and graduated exercise

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© 2007 McGraw-Hill Higher Education. All rights reserved. Chapter 17: The Thigh, Hip, Groin, and Pelvis © 2007 McGraw-Hill Higher Education. All rights