1. The Hip
Sports Med 2

2. The Hip A ball and socket joint
Hip transmits the load from the foot to the spine and vice versa

3. Blood & Nerve Supply Femoral artery Common Iliac Vein Femoral Nerve
Sciatic Nerve
Largest nerve in the body
Innervates thigh and lower leg

4. Bursae
Iliopsoas and deep trochanteric bursae
Most important ones

5. Injury Trochanteric Bursitis MOI:
Common at the greater trochanter, high in women w/ increased Q angle, or leg length discrepancy
Inflammation of bursa, or insertion of gluteus medius, or IT band
S/S:
c/o pain on lateral hip
Radiating pain down to the knee
Tenderness over greater trochanter
TX:
PRICE, NSAIDS, ROM, PREs, no inclined running
Special Tests: Obers,

6. Ober’s Test Athlete lays on unaffected side Knee flexed at 90 degrees
Lift top leg into abduction, slight hip extension
Allow the affected leg to drop into adduction
If leg does NOT drop = + tight IT band

7. Bones Sacrum, Coccyx Pelvis Ilium, Ischium, Pubis
Innominate bones: ossify and fuse early in life
Pelvis
Support the spine and trunk
Transfer their weight to the lower limbs
Placement for bony attachment
Ilium, Ischium, Pubis
Make up pelvis

8. Injuries Hip Pointer (contusion) MOI S/S TX
blow to inadequately protected iliac crest
Most handicapping injury in sports, difficult to manage
S/S
Immediate pain, spasms, transitory paralysis of soft structures
Unable to rotate the trunk or to flex the thigh with out pn TX
RICE, referral, x-ray, ice massage, ultrasound, injection
Doughnut pad for return to play

9. Hip dislocation

10. Injuries Hip Dislocation pg 727 fig. 21-30 MOI S/S TX
Rarely occur during sports
Femur is adducted and flexed
S/S
Flexed, adducted, and internally rotated thigh
Deformity, nerve damage TX
Immobilization, ice, analgesics

11. Injury Avulsion Fracture MOI:
Most common: 1) ischial tuberosity (hamstrings), 2)AIIS(rectus femoris), ASIS (sartorius)
Sudden acceleration/deceleration
S/S:
Sudden local pain
Limited movement
TX:
X ray, PRICE, crutches, ROM, PREs
Special Tests: Hip MMTs

12. Injury Osteitis Pubis MOI:
Seen in running sports (XC, football, soccer, wrestling
Repetitive stress on pubis symphysis by surrounding muscles
S/S:
Groin pain while running, squats, sit ups
TX: rest, oral antiinflammatory agents, gradual return to play
Special Tests: running, sit up, squats

13. Articulations Sacroiliac Joint Joint Capsule Hip Joint
Supported by ligaments
Connects sacrum to ilium
Joint Capsule
The acetabulum is cushioned by the labrum
Hip Joint
Made of femur head and acetabulum
Padded at the center by a mass of fatty tissue, ligaments and capsule

14. Ligaments Iliofemoral Pubofemoral Y ligament of Bigelow
Strongest ligament of body
Prevents hyperextension
Pubofemoral
Prevents excessive abduction

15. Ligaments Ischiofemoral Ligamentum Teres
Prevents internal rotation and adduction
On posterior aspect
Ligamentum Teres
Ligament to the head of the femur
A bridge to allow blood vessels and nerves to enter the head of the femur

16. Injuries Hip Sprain MOI S/S TX
Strong, therefore best protected, seldom injured
Violent twisting produced by opponent, foot firmly planted and trunk forced in opposing direction
S/S
Athlete is unable to circumduct the thigh
pain TX
X-rays to rule out fx
RICE, analgesics, limit wt. bearing, pain free ROM
Special Tests: active circumduction of thigh, IR, ER

17. Injuries Sacroiliac Joint Sprain (S.I. Joint) MOI S/S TX
Twists with both feet on the ground
Stumbles forward, falls backward, steps in hole
S/S
Pain over joint, muscle guarding, radiating pain down back of gluteus and hamstring
Asymmetrical ASIS/PSIS or leg length difference TX
Modalities, brace, stability exercises
Special Test: FABERS/Patricks

18. FABERs /Patrick Test
Procedure: Place foot on the opposite extended knee of the painful SI joint
Apply pressure downward on the bent knee.
Positive test: Pain felt in hip or SI jt. = SI joint dysfunction

19. Muscles Anterior Iliacus Psoas (major and minor) Sartorius
Triangular shaped, flexes the hip
Psoas (major and minor)
Flexes the hip
Sartorius
Crosses medially across the
anterior aspect of the thigh
Hip flexion, and external
rotation
Rectus Femoris
Hip flexion and knee extension

20. Muscles Lateral Posterior Tensor fascia latae 3 gluteal muscles
Hip abduction
Posterior
3 gluteal muscles
Gluteus Maximus: extension,
adduction, helps us get up from
a sitting position
Gluteus Medius: abduction
Gluteus Minimus: abduction
Hamstrings: hip extension, knee flexion
Biceps Femoris, Semitendinosis, Semimembranosus

21. Muscles Medial All act as adductors and rotators of the hip Gracilis
Adducts, flexes, external
rotation
Pectineus
Adducts, flexes, external rotation
Adductor longus, brevis and magnus
Adducts, external rotation

22. Injuries Groin Strain (adductor/Hip flexor strain) Special Tests: MMTs
MOI
The groin is the area between the thigh and the abdominals
Torn during twist or pull while running or jumping
S/S
Felt as sudden twinge or feeling of tearing during an AROM, or may feel it the next day
Pain, weakness, internal bleeding TX
PRICE, analgesics, ROM and strengthening exercises
Rest has been the best treatment, protective spica
Special Tests: MMTs

23. Thomas Test Procedure: Athletes lies supine legs together
ATC places on hand under athletes lumbar curve
One thigh is brought to the chest flattening the spine.
Return bent leg to extended position, lumbar curve should return.
Positive Test: Extended thigh should be flat on the table, if not = tight hip flexor

24. Kendall test Procedure: Athlete lies supine with knees off table
Athlete brings one leg to their chest
Positive Test: If thigh comes off the table = tight hip flexor

25. Injury Quad Contusion MOI TX: flx w/ice pack ,PRICE,NSAIDS, crutches
Direct blow to the thigh
TX: flx w/ice pack ,PRICE,NSAIDS, crutches
Grade 1
Superficial bruise
Mild hemorrhage, mild pain, no swelling, mild pt tenderness
No game restrictions
Grade 2
deeper
Pain, swelling, cannot flex knee more then 90 degrees
Grade 3
Moderate pain and swelling, limping, cannot flex knee
Severe/Grade 4
Disability, may split the fasciae
Severe pain, limited ROM, limp

26. Injury Myositis Ossificans Traumatica MOI: S/S: TX: Special Tests:
Severe blow or repeated blows to thigh, usually the quadriceps
Can lead to ectopic bone production (myosositis ossificans)
S/S:
Pain, swelling, decreased function
TX:
Conservative, surgery one year later
Special Tests:
AROM knee flexion/ext

27. Injury Hamstring Strain MOI S/S TX Special test: MMTs
Most common injury to thigh, exact cause is not known
Possible MOI: muscle fatigue, faulty posture, leg length discrepancy, tight hamstrings
S/S
Hemorrhage, pain, loss of function.
3 grades of strain TX
PRICE, NSAIDS, very conservative, PREs
Special test: MMTs

28. Hamstring MMT

29. Injury Snapping Hip: MOI: S/S: TX:
Excessive repetitive movement in dancers, gymnasts, hurdlers, sprinters
MOI:
Imbalance in muscle
IT band moves over the greater trochanter
S/S:
c/o of snapping with pain
TX:
Ice, NSAIDS, ultrasound, then stretching

30. Trendelenburg’s test
Procedure: Athlete stands, foot on the unaffected side is lifted
Look at the iliac crest to see if it stays level
Positive test: if unaffected side is lowers OR
If standing on leg and affected hip moves into abduction
= Weak abductors

31. Measuring for Leg length
2 main ways:
Anatomical discrepancy
Functional discrepancy

32. Anatomical discrepancy (true method)
ASIS
(actual bone is shortened)
Athlete lies supine with legs straight
Measurement is taken between the medial malleoli and ASIS
Bilaterally compare
Malleoli

33. Functional discrepancy
Due to pelvic tilt or deformity
Athlete lies supine, legs straight
Measurement is taken from umbilicus to the medial malleoli
Bilaterally compare