Hip Evaluation Advanced Sports Medicine

Evaluating the Hip/Pelvis  Major Complaint(s) (History)  Needs to be carefully conducted  The athlete should be questioned extensively about…  The specific site and type of pain  The extent of their disability  When and how the injury first occurred

Evaluating the Hip/Pelvis  Observation  The athlete should be observed for postural asymmetry while standing on one leg and while walking  Do they do any of the following when you are observing…  Limp or favor one leg over the other?  Does their hip/pelvis look crooked?  Do they stand crooked, leaning to one side or the other?  Place their hand on one hip or the other in an “abnormal” fashion?

Evaluating the Hip/Pelvis  Bony Palpation  SPECIAL NOTE!  Care should be taken to insure patient privacy and comfort when you start to do “hands on” evaluation of the hip/pelvis.  This is a sensitive area of the body for most people because of the male and female genitalia that are also located in this area  ATCs should always have a witness present when examining an athlete in this area, regardless of the sex of the athlete and should attempt to do the exam in area that is private from the other areas of the training room

Evaluating the Hip/Pelvis  Palpate the following areas for pain and deformity:  The anterior hip/pelvis  Anterior superior iliac spine  Iliac crest  Greater trochantor  Pubic tubercles

Evaluating the Hip/Pelvis  Palpate the following areas for pain and deformity:  The posterior hip/pelvis  Posterior superior iliac spine  Ischial tuberosity  Sacroiliac joint

Evaluating the Hip/Pelvis  Soft tissue palpation should include the following…  Groin area  Lymph nodes  Adductor muscles  Femoral nerves and blood vessels  Buttocks area  Gluteal muscles  Lateral hip musculature  Sciatic nerve  When palpating these areas the ATC should be looking for pain, swelling, fiber disruption, discoloration, etc.

Evaluating the Hip/Pelvis  Functional Evaluation and Special Tests  Range of motion  The athlete should be led through all all possible hip movements first actively; then passively; then with manual resistance (where appropriate)  Hip/Pelvis ROMs include…  Flexion (120 deg)  Extension (30 deg)  ADduction (20-30 deg)  ABduction (45-50 deg)  Internal Rotation (35 deg)  External Rotation (45 deg)  Various combinations of the above such as Flexion and Adduction (crossing the legs)

Evaluating the Hip/Pelvis Hip Flexion

Evaluating the Hip/Pelvis Hip Extension

Evaluating the Hip/Pelvis Hip Adduction

Evaluating the Hip/Pelvis Hip Abduction

Evaluating the Hip/Pelvis Hip Internal/External Rotation

Evaluating the Hip/Pelvis  Special Tests for the hip/pelvis  There are several special tests that ATCs can and do use to evaluate the hip and pelvis  These tests are intended to help the ATC determine a specific injury to a specific muscle or area of the hip or pelvis  These special tests include the following…

Evaluating the Hip/Pelvis Thomas Test Tests for muscle contracture in the hip

Evaluating the Hip/Pelvis  Trendelenberg Test  Designed to evaluate the strength of the gluteus medius muscle

Evaluating the Hip/Pelvis  Leg Length Discrepancy  Involves simply observing and measuring the legs for differences in length

Evaluating the Hip/Pelvis  Leg Length Discrepancy, continued…

Evaluating the Hip/Pelvis  Ober Test  Test designed to identify contraction of the iliotibial band (IT Band)

A final note…  Hip/Pelvic evaluations can be difficult to do and can be very time consuming  It is extremely important, however, to do a complete evaluation  It is never inappropriate to refer to a text or evaluation manual when evaluating an athlete with a hip or pelvic injury in order to insure that a complete evaluation has been done