1. The Thigh and Hip Muscles Anatomy, Injuries and Assessment Sports Medicine Camp

2. Quadriceps Muscles Vastus Medialis Vastus Intermedius Vastus Lateralis Rectus Femoris

3. Ely’s Test or Prone Knee Bend Rectus Femoris tightness –Athlete prone –Passive knee flexion –Positive test indicated by hip flexion

4. Quadriceps MMT Manual Muscle Test –Athlete seated –Examiner apply resistance at lower leg

5. Rectus Femoris Strain Mechanism of Injury –Sudden stretch –Sudden contraction Signs and Symptoms –Pain –Point tenderness –Spasm –Loss of function –Deformity Treatment –RICE –NSAIDS –Modalities –Stretching –Strengthening

6. Thigh Contusion

7. Hamstrings Muscles Medial side –Semitendinosus –Semimembranosus Lateral side –Biceps Femoris Long Head –Biceps Femoris Short head

8. Hamstrings MMT Medial hamstrings –Semitendinosus –Semimembranosus –Internally rotate tibia –(foot points in) Lateral Hamstring –Biceps Femoris –Externally rotate tibia –(foot points out)

9. Hamstring Strains Mechanism of Injury –Unknown –1st Theory Hamstrings contract same time as quadriceps Deficiency in complementary action of opposing muscles –2nd Theory Quick change of function from –Role as knee stabilizer –To –Hip extensor –Possible reasons Muscle fatigue Faulty posture Leg length discrepancy Tight hamstrings Improper form Imbalance of strength between hamstrings Hamstring strength ratio to quads normal 60 - 70 %

10. Hamstring Strains 1st Degree injury –Muscle soreness during movement Due to muscle spasm rather then tearing of tissue Fewer then 20% fibers torn –Point tenderness –Stiffness after cool down 2nd Degree injury –Partial tear –Fewer then 70% fibers torn –Sudden snap or tear of muscle –Severe pain –Loss of function

11. Hamstring Strains 3rd Degree injury –Rupture of tendon –Tear of > 70% fibers –Severe swelling –Tenderness –Loss of function –Discoloration –Palpable mass or gap

12. Hamstring Strains –Treatment Grade 2 & 3 –Extremely conservative RICE –Grade 2: 24 - 48 hrs. –Grade 3: 48 - 72 hrs. Stretching Strengthening –Emphasize eccentric exercise –Complications Recurrent as result of –Inelastic fibrous scar tissue

13. Hip Flexors –Iliopsoas Psoas Major Psoas Minor Iliacus –MMT

14. Thomas Test –Normal length of hip flexors –With low back flat –Posterior thigh touches table –Knee flexes approximately 80° –The pelvis is in 10 ° posterior tilt –Abnormal length of hip flexors –With low back flat –Posterior thigh does not touch table –Knee flexes < 80°

15. Hip Flexor Support

16. Adductor Muscles Adductor Magnus Adductor Longus Adductor Brevis Pectineus Gracilis MMT Adduction Athlete sidelying Examiner supports top leg Give resistance above knee joint

17. 8-4 Adductor Support

18. 21-34 Hip Pointer Mechanism of injury –Direct impact Signs and Symptoms –One of the most handicapping injuries –Immediate pain –Muscle spasm –Transitory paralysis –Inability to rotate trunk Flex thigh –Discoloration –Swelling Treatment –PRICE Bed rest as needed Crutches as needed –ROM exercises –Strength exercises –Severe cases MD referral