1. Thigh, Hip and Pelvis Joints are rarely injured in sport
Soft tissue is commonly injured
Bony Structure
Femur
Pelvis
Sacrum and Coccyx

2. Pelvis Iliac Crest ASIS and PSIS Ischial tuberosity
Innominate Bone- Consist of:
Ilium
Ischium
Pubis

3. Hip Joint Ball and Socket Joint Head of the femur- Convex
Acetabulum of the pelvis- Concave
Highly Stable from a bony perspective; several very strong ligaments that aid in keeping the head of femur in the acetabulum
Bursae
Iliopsoas bursa
Deep trochanteric bursa

4. Nerves and Blood Supply
Nerve supply
Lumbar plexus (L1 – L4) - forms the femoral nerve
Sacral Plexus (L4 – S4) – forms the sciatic nerve
Blood supply
Femoral artery

5. Muscles and Movements Hip flexion Hip Extension Normal ROM
80 degrees knee straight
120 degrees knee bent bent
Iliacus and psoas major (major flexors)- both form the illiopsoas- knee bent
Rectus femoris (function when knee is extended and with kicking the ball)
Sartorius
Hip Extension
Normal ROM 10 – 20 degrees
Hamstrings, gluteus maximus

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

7. Muscles and Movements (3)
Internal Rotation or Medial Rotation
Normal ROM
45 degrees
Glueteus Minimus and Tensor Fascia Latae
External Rotation or Lateral Rotation
6 deep external rotators- piriformis

8. Quadriceps Contusions
MOI: direct blow
HOPS
Pain, swelling and ecchymosis
Walk with a limp
Palpable hematoma, with heat Tx
Ice in stretched position, crutches if needed, wrap, See field strategy 10.2 (pg. 352), refer for x-ray

9. Myositis Ossificans
Accumulation of mineral deposits (bone) in muscle tissue
MOI: Single severe blow, repeated blows to muscle, mismanagement of contusion
HOPS
Firm swollen area in muscle
Palpable mass
Limited knee flexion
Active contraction of muscle difficult Tx
Refer to physician (surgery may be needed)

10. Hip Pointer Contusion caused by direct compression to the iliac crest
MOI: Direct blow
Hops
Pn with rotation, trunk flexion
Ecchymosis, pain, swelling,
Point tender over illiac crest TX
RICE, refer for x-ray, donut pad and hard outer shell, to protect

11. Bursitis Most common = trochanteric bursitis MOI: overuse HOPS: TX
Deep achy pain in lateral thigh
Pn with resisted abduction TX
Heat, stretch abductors, Ultrasound
If condition does not resolve: refer to physician

12. Hip Sprains/ Dislocations
MOI: violent twisting/ severe trauma; rare in sports
HOPS: S/S  with degree and type
Intense pain,
Inability to walk or move hip
Hip flexed and internally rotated – Fig 10-12 TX
Symptomatic with mild to moderate sprains
Medical emergency, summon EMS, check distal neurovascular status; treat for shock

13. Muscle Strains
Hamstring strains more probable than Quadriceps strains; Adductor strains are more common than Abductor
Hamstring Strains are most common
Precursors
muscle imbalances, tight muscles, improper warm-up, overuse, fatigue, dynamic overload

14. Muscle Strains (2) HOPS-In isolated region in question
“twinge” or “pull”
Weakness on RROM testing
Limping; Ecchymosis
Pop is heard when severe; Palpable defect
Pain with passive stretch, and resistive motion
Treatment- Hip Flexor or Hip Adductor Wrap; RICE, E-Stim, Strengthening/Stretching, NSAID’s; crutches if necessary

15. Muscle Strength Testing
5 (normal) full strength against resistance
4 (good) partial strength against resistance
3 (fair) ability to move the body part no resistance
2 (poor) able to contract muscle
1 (trace) no evidence of contractility

16. Legg-Calve-Perthes Disease
Avascular necrosis (decreased blood supply to the head of femur) of the proximal femoral epiphysis-Fig 10-13
Precursors: young males 3-8 years old
HOPS:
Gradual onset of pain in hip/groin or knee with no explanation
Gradual onset of a limp;
Decreased range of motion in the hip- AB, EX, ER
TX: refer to physician if unexplained hip, thigh or knee pain last for more than a week.

17. Avulsion Fractures (1) Precursors: Locations:
Individuals who perform rapid acceleration/ deceleration
Locations:
ASIS: Sartorius
AIIS: Rectus Femoris
Ischial tuberosity: hamstrings

18. Avulsion Fractures (2) HOPS TX Sudden acute localized pain
Pain, swelling, discoloration over area
Pain with resisted stretching of the involved muscle TX
Hip Spica Wrap if able
Fit for crutches
Refer to physician

19. Slipped Femoral Epiphysis
Epiphyseal/ Growth Plate fracture- Fig 10-15
Precursor: Adolescent boys ages 8 – 15, obese or slender rapidly growing boys
HOPS:
Painful limp
Pain in the groin, anterior thigh or knee
Unable to internally rotate femur
Unable to stand on injured leg
TX: Refer to physician, surgery

20. Stress Fractures Precursor: Box 10-3 Common locations HOPS
Pubis
Femoral neck
Proximal 1/3 of femur
HOPS
Aching pain in groin or thigh during WB
Pn relieved by rest
Night pain
TX: Refer to physician

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

22. Measuring for Leg Length
ASIS
Medial Malleolus
Patient Position:
Lying on table, pelvis square and balanced
Legs parallel
Heels approximately 6-8 inches apart

23. Special Tests Thomas Test = Hip flexion contractures
Kendall Test = Hip flexion contractures (Rectus Femoris)
Straight Leg Raise=Disc Lesions or tight hamstrings
Pelvic Rock Test=Pelvic Fracture/SI Joint Sprain
Trendelenburg’s Test

24. Specialized Rehab SLR’s- all 4 planes Quad Sets/Glute Sets/Ham Sets
Stretching
Strengthening
Electrical Stimulation, US, Massage