Athletic Training: Hip & Thigh injuries

Explain some key anatomical features of the pelvic girdle by labeling the following image

1. Sacrum - continuation of spine

2. Ilium: (1 + 2 = sacro-iliac joint); Anterior superior Iliac spine (see arrow)

3. Ischium (2-4 make up the hip (pelvic girdle))

4. Pubis

5. Pubic Symphysis: btwn pubic bones

6. Acetabulum: articulation w femoral head

What are the 3 muscles of the hamstrings

• Biceps femoris; short and long heads (lateral)

• Semitendinosus (medial)

• Semimembranosus (medial)

Explain this injury: Iliac Crest Contusion

• AKA "hip pointer"

• MOI: Direct blow to bony iliac crest

  • Bone or muscle (oblique's)

• S/S: Hematoma formation w ecchymosis, extremely painful & debilitating

Explain this injury: Piriformis Syndrome

• spasm or tightening of piriformis muscle

• pressure on sciatic nerve

• Entrapment neuropathy

• S/S: point tender, sciatica

• Treatment: rest and stretching

Explain this injury: Femoro-acetabular Impingement (FAI) and Labral tears

• Bony abnormalities

  • CAM: head/neck of femur

  • Pincer: acetabulum

  • Mixed: both

• Pain Patterns

  • FABER: flexion, abduction, and ER

  • FADIR: flexion, adduction, and IR

• Causes: inflexibility and hypomobility or hypermobility

• Labral tears: catching or clunking sensation

Explain this injury: Athletic Pubalgia "sports hernia”

• MOI: Twisting w foot planted: sudden change of directions

• S/S: nagging deep groin pain, pain w hip flexion, valsalva

• Imaging: MRI, Treatment: conservative or surgical

• Hard to determine source of problem

  • Oblique's (green)

  • Rectus abdominus (red)

  • Inguinal ligament and canal (black)

  • Adductor muscles (violet)

Explain this Injury: Osteitis Pubis

• Pubic symphysis (immovable joint): fibrocartilage

• MOI: Repetitive stress (compression and shear), common in distance runners

• S/S: chronic deep groin pain, point tender over joint, pain w weight-bearing movements

Explain this injury; Hip flexor strain

• Rectus femoris: upper third (tendon region)

• MOI: eccentric loading

• Management: stretching, strengthen (low load, high rep), wrapping

Explain this Injury: Hamstring Strain

• Origin: Ischial tuberosity (red); Insettion on tibia/fibula (blue circles)

• Smaller than quads, can't handle as much load

• Prevalence:

  • 2/3rd biceps femoris (shortest group, most angulated

  • 1/3rd semitendinosus

• Intramuscular tendon/CT issues

• Very high recurrence rate: acute on chronic

• MOI: sprinting, hip flexed while knee extended, eccentric loading

• S/S: thigh swollen and discolored (ecchymosis), fiber disruption, hematoma w edema

• Middle of the hamstring usually acute; Distal and proximal often overuse tendon injury from from running or cycling

• Management: PRICE, restore strength and flexibility, neoprene sleve or ACE bandage

Explain this injury: Quadriceps Contusion

• Direct blow to muscle (external force); penetrates deeper when muscle relaxed

  • Bleeding w resultant loacalixed hematoma

  • Classified as mild, moderate, or severe

• S/S: Limited ROM, stiff and firm on palpation, extremely tender, and sore, difficulties in ambulation (walking)

• Can cause myocitis ossificans

• Management:

  • Acute: PRICE, Ice w stretch,

  • Post acute: heat once inflammation is neutralized, stretching

  • Long term care: protection, prevent repeated trauma, padding with hard shell covering