1. Chapter 17: The Thigh, Hip, Groin, and Pelvis
© 2007 McGraw-Hill Higher Education. All rights reserved.

2. ASIS and AIIS – Sartorius and Rectus Femoris Attachments

3. Ischial Tuberosity – Hamstring Attachments

7. Muscles and Movements Hip flexion Hip Extension Normal ROM
120 degrees knee bent bent
Iliacus and psoas major (major flexors)- __________________________ - knee bent
_________________ (function when knee is extended and with kicking the ball)
Sartorius
Hip Extension
Normal ROM 10 – 20 degrees
________________________________

8. Muscles and Movements (2)
Abduction
Normal ROM
45 degrees
________________
Adduction
30 degrees
Adductor magnus, longus, brevis, and gracilis

9. Muscles and Movements (3)
Internal Rotation or Medial Rotation
Normal ROM
45 degrees
_____________________________________________________
External Rotation or Lateral Rotation
6 deep external rotators- piriformis

10. RROM testing Hip Flexion Hip Extension Hip Abduction Hip Adduction
Hip Internal Rotation
Hip External Rotation
Knee Extension
Knee flexion

11. Special Tests
Thomas test
Test for hip contractures-______________
Straight Leg Raise
Test for hamstring tightness or
Can also be used to assess sciatic nerve irritation from swelling, bulging/herniated disk or SI joint dysfunction

12. Special Test Cont
Kendall
Pelvic Rock
Trendelenburg’s Test

13. Prevention of Thigh Injuries
Thigh must have maximum strength, endurance, and extensibility to withstand strain
Dynamic stretching programs may aid in muscle preparation for activity
Strengthen programs can also help in preventing injuries
Squats, lunges, leg press
Core strengthening

14. Recognition and Management of Thigh Injuries
Quadriceps Contusions
Cause of Injury
Constantly exposed to traumatic blows
Signs of Injury
Pain, transitory loss of function, immediate bleeding of affected muscles
Early detection and avoidance of internal bleeding are vital – increases recovery rate and prevents muscle scarring

15. Care RICE and NSAID’s ___________________________
________________________________________________________________
Heat, massage and ultrasound to prevent myositis ossificans
Padding may be worn for additional protection upon return to play

16. Myositis Ossificans Cause of Injury Signs of Injury Care
_________________________________________________________________
Signs of Injury
_______________________________________________________
Pain, weakness, swelling, decreased ROM
Tissue tension and point tenderness
Care
Treatment must be conservative
May require __________________ if too painful and restricts motion
If condition is recurrent it may indicate problem with blood clotting

18. Quadriceps Muscle Strain
Cause of Injury
____________________________________________________________________
Associated with weakened or over constricted muscle
Signs of Injury
Peripheral tear causes fewer symptoms than deeper tear
Pain, point tenderness, spasm, loss of function and little discoloration
Complete tear may leave athlete w/ little disability and discomfort but with some deformity; more discoloration; edema will settle in back of knee, calf and ankle
Care – Fit for crutches if necessary
_____________________________________________
Determine extent of injury early
Neoprene sleeve may provide some added support

19. Hamstring Muscle Strains
Cause of Injury
Multiple theories of injury
Hamstring and quad contract together
Change in role from hip extender to knee flexor
Fatigue, posture, leg length discrepancy, lack of flexibility, strength imbalances,
Signs of Injury
Muscle belly or point of attachment pain
Capillary hemorrhage, pain, loss of function and possible discoloration
Grade 1 - soreness during movement and point tenderness
Grade 2 - partial tear, identified by sharp snap or tear, severe pain, and loss of function

20. Signs of Injury (continued)
Grade 3 - Rupturing of tendinous or muscular tissue, involving major hemorrhage and disability, edema, loss of function, ecchymosis, palpable mass or gap
Care
RICE
Restrict activity until soreness has subsided
Ballistic stretching and explosive sprinting should be avoided initially
Fit for crutches if necessary

21. Recognition and Management of Specific Hip, Groin, and Pelvic Injuries
Groin Strain
Cause of Injury
One of the more difficult problems to diagnose
Often seen in early part of season due to poor strength and flexibility
Occurs from running , jumping, twisting w/ hip external rotation or severe stretch
Signs of Injury
Sudden twinge or tearing during active movement
Produce pain, weakness, and internal hemorrhaging

22. Groin Strain (continued)
Care
______________________________________________________________
Determine exact muscle or muscles involved
______________________
_______________________________________________________________
Refer to physician if severe groin pain is experienced
Fit for Crutches if necessary

23. Sprains of the Hip Joint
Cause of Injury
Result of violent twist due to forceful contact
___________________________________________________________________________________
Signs of Injury
Signs of acute injury and inability to circumduct hip
Pain in hip region, w/ hip rotation increasing pain
Care
X-rays or MRI should be performed to rule out fx
RICE, NSAID’s and analgesics
Depending on severity, crutches may be required
ROM and PRE are delayed until hip is pain free

24. Piriformis Syndrome Cause of Condition Signs of Injury
__________________________________________________________________
_________________________________
Signs of Injury
Pain, numbness and tingling in butt – may extend below knee and into foot
Pain may increase following periods of sitting, climbing stairs, walking or running
Care
Stretching and massage
NSAID’s may be prescribed
Cessation of aggravating activities will be prescribed
Corticosteroid injection may also be suggested
Surgery is sometimes an option as well

25. Hip Problems in Adolescent Athletes
Legg Calve’-Perthes Disease
Cause of Condition
Avascular necrosis of the femoral head in child ages 4-10
Articular cartilage becomes necrotic and flattens
Signs of Condition
Pain in groin that can be referred to the abdomen or knee
Limping is also typical
Varying onsets and may exhibit limited ROM

27. Legg-Calve’-Perthes Disease (continued)
Care
Bed rest to reduce chance of chronic condition
Brace to avoid direct weight bearing
Early treatment and head may reossify and revascularize
Complication
If not treated early, will result in ill-shaping and osteoarthritis in later life

28. Slipped Capital Femoral Epiphysis
Cause of Condition
May be growth hormone related
25% of cases are seen in both hips
________________________________________________________________________________________________
___________________________________
Signs of Condition
Pain in groin that comes on over weeks or months
Hip and knee pain during passive and active motion; limitations of abduction, flexion, medial rotation and a limp
Management
W/ minor slippage, rest and non-weight bearing may prevent further slippage
Major displacement requires surgery
If undetected or surgery fails severe problems will result

30. Iliac Crest Contusion (hip pointer)
Cause of Injury
__________________________________________________________________
____________________________
Signs of Injury
Pain, spasm, and transitory paralysis of soft structures
_________________________________________________________________________
Care
RICE for at least 48 hours, NSAID’s,
Bed rest 1-2 days in severe cases
Referral must be made, X-ray
Padding should be used upon return to minimize chance of added injury

31. Avulsion Fractures Cause of Injury
_________________________________________________________________
Pulling of tendon away and off of bony insertion
Common sites include ASIS (________), AIIS (___________________), ischial tuberosity (___________)
Signs of Injury
Sudden localized pain w/ limited movement
Pain, swelling, point tenderness
Care
Rest, limited activity and graduated exercise