1. The Hip http://www.youtube.com/watch?v=wdxIz3 iqxaQ

2. Bones of the Hip Coxal Bone – hip boneCoxal Bone – hip bone composed of 3 fused bones: 1. Ilium iliac crest – serves as attachment point for abdominal muscles 2. Ischium ischial tuberosity – hamstring attachment 3. Pubis pubic symphysis The 3 bones fuse at the acetabulum – receives the head of the femur

3. Coxal Bones – hip bonesCoxal Bones – hip bones consists of 3 fused bones - ilium - ischium - pubis Pelvis – 2 hip bones and the sacrumPelvis – 2 hip bones and the sacrum Pelvic girdle – the paired coxal bonesPelvic girdle – the paired coxal bones

5. The FemurThe Femur Greater Trochanter and Lesser Trochanter are sites for muscle attachments The hip joint is a ball and socket jointThe hip joint is a ball and socket joint that is designed for STABILITY and not for MOBILITY

6. Motions of the Hip Joint Hip Flexion Hip Extension Hip Abduction Hip Adduction Rotation

7. Muscles of the Hip Joint Hip Flexors:Hip Flexors: 1. Iliopsoas - Iliacus - Psoas Major 2. Rectus Femoris (one of the Quad m.) a hip flexor as well as a knee extensor Exercises that work the Hip Flexors include: Sit-upsHanging leg raises Leg raisesResisted hip flexion Exercises that work the Hip Flexors include: Sit-upsHanging leg raises Leg raisesResisted hip flexion

8. Exercises that work the hip flexors: - situps - leg raises - hanging leg raises

9. Hip Extensor Muscles Gluteus Maximus – main hip extensorGluteus Maximus – main hip extensor Hamstring muscles – can not flex the knee and extend the hip fully at the same timeHamstring muscles – can not flex the knee and extend the hip fully at the same time

12. Hip Adductors Adductor LongusAdductor Longus Adductor BrevisAdductor Brevis Adductor MagnusAdductor Magnus GracilisGracilis PectineusPectineus

13. Hip Abductors Gluteus MediusGluteus Medius Gluteus MinimusGluteus Minimus 2 parts of the same muscle 2 parts of the same muscle

14. Tensor Fascia Lata Muscle – inserts into the Iliotibial Band. Helps to stabilize the hip joint

15. The Femoral Triangle Borders:Borders: 1.Inguinal Lig 2.Sartorius 3.Adductor longus Contents: 1. Femoral Vein 2. Femoral Artery 3. Femoral Nerve

18. Injuries to the Hip Injuries to the Hip

19. Sacral Fractures - MOI: fall in a sitting position or direct contact - MOI: fall in a sitting position or direct contact -Displacement can injure nerves and the urinary bladder -Bed rest, only surgery for severe displacement

20. Coccyx Fractures MOI – fall in a sitting positionMOI – fall in a sitting position Sitting is almost impossibleSitting is almost impossible Treatment aimed at pain relief, sitting “forward” on the ischial tuberositiesTreatment aimed at pain relief, sitting “forward” on the ischial tuberosities Return to athletics as soon as comfortableReturn to athletics as soon as comfortable

21. Acetabular Fractures Rare, results from severe traumaRare, results from severe trauma MOI – direct, violent force that passes through femoral neck into the acetabulumMOI – direct, violent force that passes through femoral neck into the acetabulum Immediate pain, inability to walk on legImmediate pain, inability to walk on leg Shortening of extremityShortening of extremity Bed rest, possible surgery, followed by ROM exercisesBed rest, possible surgery, followed by ROM exercises Best treatment may still result in osteoarthritis of the hipBest treatment may still result in osteoarthritis of the hip

22. Acetabular Fractures

23. Dislocations of the Hip Posterior dislocations most commonPosterior dislocations most common - 95% of all hip dislocations - Why? Anterior hip capsule is strong, and MOI occurs more commonly in athletics - MOI: hip and knee flexed at 90 0, force exerted through shaft of femur, driving it posteriorly “dashboard injury” - S & S: severe pain, inability to move, hip flexed and internally rotated, shortened extremity - Complications: fractures, sciatic nerve problems, avascular necrosis, arthritis

25. Dislocations of the Hip Anterior Hip DislocationAnterior Hip Dislocation - less than 5% of hip dislocations - MOI: forceful ABDuction and external roation - S & S: immediate pain, limb is ABDucted and externally rotated, palpable mass in groin - Complications: avascular necrosis, compression of femoral vein which can lead to a thrombus

27. Fractures of the Femur Strength of femur is very good in young athletesStrength of femur is very good in young athletes Severe trauma causes the injurySevere trauma causes the injury

28. Femoral Fractures

29. Femoral Neck Fractures

30. Slipped Capital Femoral Epiphysis Occurs in growing athleteOccurs in growing athlete More common in boys, usually between ages of 11 – 15, short, heavy boys more commonMore common in boys, usually between ages of 11 – 15, short, heavy boys more common MOI: not always identifiableMOI: not always identifiable S & S: pain, may be referred to knee, common to have coach “run it out”S & S: pain, may be referred to knee, common to have coach “run it out” Common to see glutues medius limp Treament depends on degree of slippage

32. Hip Pointer

33. Avulsion of Lesser Trochanter of Femur Forceful Strain of Ilioposas muscleForceful Strain of Ilioposas muscle

34. Avulsion of Ischial Tuberosity Forceful stretch of Hamstring musclesForceful stretch of Hamstring muscles

35. Avulsion of Anterior Superior Iliac Spine (ASIS) Origin of the Sartorius muscleOrigin of the Sartorius muscle

37. Avulsion of Crest of Ilium Forceful contraction of the abdominal muscleForceful contraction of the abdominal muscle

38. Osteitis Pubis

39. Snapping Hip Syndrome

40. Legg-Calve-Perthes Disease

41. Slipped Capital Femoral Epiphysis

42. Quadriceps Contusion

43. Myositis Ossificans

44. Iliotibial Band Syndrome

45. Piriformis Syndrome

46. The Abdominal Muscles 1.Rectus Abdominus trunk flexion 2.Internal Oblique rotates trunk to same side 3.External oblique rotates trunk to opposite side