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