hip and pelvis chapter 19. hip & pelvis strongest articulation in body most stable...
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Hip and Pelvis
Chapter 19
Hip & Pelvis Strongest articulation in body Most stable articulation Well protected & surrounded by muscle on all
sides Muscles of back, abdomen, hamstrings,
quadriceps, abductors, adductors, and gluteals attach
Freely moveable, ball-and-socket
Function of Pelvis Transmit weight from axial skeleton to LE
when standing or to ischial tuberosities when sitting Provides attachments for various muscles that
insert onto and control LE House parts of digestive and urinary tract Houses reproductive systems
Pelvis—Skeletal Structure
Ilium Iliac crest Greater sciatic notch Iliac fossa
Sacrum Ischium Obturator foramen Pubis
Pubic Symphsis Coccyx
Pelvis—Skeletal Structure Anterior Superior
Iliac Spine (ASIS) Anterior Inferior Iliac
Spine (AIIS) Posterior Superior
Iliac Spine (PSIS) Ischial Tuberosity Greater Sciatic Notch Obturator Foramen
Pelvis—Skeletal Structure
Pelvis—Skeletal Structure
Pelvis—Skeletal Structure
Ischial Tuberosity
Ischial Tuberosity
Comparison of Male & Female Pelvis
Male More dense Muscle attachments
more sharply defined Female
Smaller Shorter Wider
Male versus Female
Male Female
Hip—Skeletal Structure
Hip—Skeletal Structure
Hip—Ligaments
Iliofemoral Pubofemoral Ischiofemoral
Primary Muscles of the Pelvis, Hip & Thigh
Gluteal muscles Gluteus medius Gluteus minimus Gluteus maximus
Hip flexors Iliopsoas Psoas Major/Minor Sartorius Pectineus Rectus femoris
Adductors Adductor longus Adductor brevis Adductor magnus
Hamstrings Biceps femoris Semimembranosus semitendinosus
Primary Muscles of the Pelvis, Hip & Thigh
Gluteal Muscles Hip extension Internal rotation External rotation Abduction
Hip Flexor Muscles
Hip Flexor Muscles
Adductor Muscles
Iliotibial Band Thickening of the
fascia Runs up outside of
thigh Top of hip & crosses
knee Holds our leg straight
when we stand, giving the larger thigh muscles a chance to rest
Tensor Fasciae Latae (TFL)
Common Injuries and ConditionsOf The Hip and Thigh
Bursitis Most frequent location is
over lateral hip Greater trochanteric
bursitis Tenderness lateral hip Made worse by walking,
running, or twisting hip Insufficient stretching or
warm-up Treatment:
Limit activity Stretching exercises Ice & ice massage NSAIDs
Fracture 3 classifications:
Femoral neck Intertrochanteric Subtrochanteric
Causes: Falling (elderly) Extreme trauma (car
accidents) Impact injury
(athletics)
Signs & Symptoms Leg may appear
abnormally rotated Cannot move hip
without pain X-ray to confirm
Treatment Depends on fracture
type and medical condition
Fracture
Quad & Hip Flexor Strain Common in those
sports that require jumping, kicking, or repetitive sprinting
Quad: rectus femoris Hip Flexor: rectus
femoris and/or iliopsoas
Treatment Ice Compression NSAIDs
Rehab Progressive Sport specific
Hamstring Strain Causes
Sudden, explosive starts and stops
Chronic overuse Making quick start or stop
when leg extended Overtraining (fatigued
hamstring muscles) Muscle imbalance (quad
muscles overdeveloped) Inflexibility Overstretched Insufficient warm-up,
stretching, or conditioning Direct blow while muscles
contracted
Signs & Symptoms Sharp pain (most
common in belly of muscle)
Bruising Swelling Loss of strength Feel or hear “pop”
Hamstring Strain Treatment
RICE Medication Physical
therapy/rehab Crutches Massage
Rehabilitation Progressive Weight-training Preventative
Proper stretching
Recovery Time Mild: 2-10 days Moderate: 10 days-6
weeks Severe: 6-10 weeks
Adductor Strain MOI: sudden sideways change in direction
Skating Soccer Track & field Tennis
Adductor longus Treatment:
Difficult to treat Risk of re-injury is high Rest, ice, anti-inflammatory meds Stretching & strengthening exercises
Treatment Lateral knee pain Pain worse after running
Especially after climbing hills/stairs
Often not present until mid-way through run
Associated with “snapping hip”
Attributed to: Over-training
Doubling mileage Increase in hill repeats
Running on uneven roads Tight indoor tracks Poor running shoes
Address faulty pelvic mechanics
Reduce or stop running Cross-train
Ice Stretch Gluteals and TFL Self-massage outside thigh
and/or gluteals Address faulty foot
mechanics, running shoes, or orthotics
Return to running gradually
Iliotibial Band Syndrome
Quadriceps Contusion Direct blow to thigh from helmet or knee
Football, rugby, soccer, basketball Limit motion Affect gait Severity graded by ROM at time of injury Treatment
Immediate compression, ice, NWB Massage contraindicated
Recovery Time: 2 days to 6 months Complication: Myositis Ossificans
Myositis Ossificans
Signs & Symptoms Treatment
Hard, painful mass in soft tissue
Progressive loss of knee flexion
X-ray at four weeks
Heat Limit joint motion Rehab exs limit pain Discouraged 6months:
Passive stretching Vigorous exercise
Calcium reabsorbtion may take 3-6 months
Ossifying mass (calcium deposit) forms within the muscle
Result of recurrent trauma to quad muscle that was not properly protected after mild injury
Myositis Ossificans
Iliac Crest Contusion “hip pointer” Caused by direct blow to hip Common in football due to improperly fitted
hip pads Signs & Symptoms:
Extreme tenderness Swelling Ecchymosis
Treatment Ice, compression Pad injured area
RTP: dictated by athlete’s pain level
Iliac Crest Contusion
Overuse Injuries MOI: cumulative effects of very low levels of
stress Repetitive action of running
Chronic muscle strains Stress fractures Tendonitis
Overuse/overload fatigue within the tendon Snapping hip
Iliopsoas tendon snapping over the head of the femur Bursitis
CROSS-TRAINING
Stress Fractures Pelvis: occur most often in runners & dancers Femur: occur usually in runners Signs/Symptoms:
Chronic, ill-defined pain over groin and thigh Initially diagnosed with muscle strain Symptoms do not resolve with rest & rehab
Treatment: Rest Non-weight-bearing endurance exercises
Stress Fractures
Stress Fractures