2. Vocabulary Atrophic necrosis Ectopic bone formation Iliac crest contusion Legg-Perthes disease Osteitis pubis Trochanteric bursitis

3. Anatomy Quadriceps: hip flexion and knee extension vastus medialis vastus lateralis vastus intermedius rectus femoris Hamstrings: knee flexion Biceps femoris semitendinosus semimembranosus

4. Anatomy Cont. Groin : hip adduction Adductor magnus Adductor longus Adductor brevis pectineus Misc. Muscles: sartorius gracilis ilio tibial band Gluteus maximus, medius, minimus popliteus

5. Anatomy: Bones Hip/pelvis Iliac crest Anterior superior iliac spine: ASIS Greater Trochanter- femur

6. Injuries to the Thigh Hamstring strains -vs quad and hip flexor strains. Hamstring= most injured muscle in the thigh. Caused from deceleration Quad strain most common= rectus femoris Hamstring should be at least 60% 70% as strong as the quads.

7. Injuries cont. Hip pointer: contusion to the iliac crest Very point tender and loss of ROM in hip function, swelling, ecchymosis Thigh contusion:3 grades of contusions –1st degree= mild hemorrhage, point tender, full ROM –2nd degree= pain, swelling moderate pain, restricted ROM –3rd degree= muscle herniation, hematoma, severe pain, loss of ROM and limping

8. Misc. Injuries Ilio tibial band friction syndrome (ITB). Common with runners and bicyclists. Pain over the lateral surface of knee. Rx.= Rest, ice, NSAID’s ultrasound, and stretching/soft tissue. Trochanteric bursitis. Also common with runners affects origin of ITB.

9. Treatment of Thigh Injuries Strains- rice, NSAID’s, do not stretch unless painfree, TKE (terminal knee extensions ), soft tissue massage, progress to activity slowly Hip pointer - RICE, NSAID’s, gentle ROM, ultrasound, protective padding for competition Bursitis - RICE, NSAID’s, ultrasound, gentle stretching Stress fractures- non weight bearing, rest approx. 6 weeks, easy progression to sport

10. Stretching of lower extremity Gastroc./soleus Hamstring Quad Hip adductors Hip Abductors Low back

11. Rehabilitation Limited exercises: TKE (terminal knee extension), isometrics, SLR (straight leg raises), isotonic to isokinetics, PNF, pool exercises, stationary bike, rowing machine, stair climber, PNF D1/D2 flexion/ extensions patterns- rotational motions for the hip or manual resistance

12. Rehab. Cont. Close kinetic chain -vs- open chain exercises. First stages of rehab for knee and thigh will consist of closed kinetic chain exercises: PNF, balance, 1/4 squats, tubing, weight machines. Then open kinetic chain exercises: jogging, running, trampoline, jumping, defensive slide.