The Hip and Pelvis
The Hip and Pelvis
 The hip, one of the most stable joints in the body, is a
freely movable, ball-and-socket joint

Most hip injuries result from smaller muscles being overused or
pushed too hard
 The pelvis transmits weight from the axial skeleton to the
lower limb when standing or to the ischial tuberosities
when sitting


Pelvis provides attachments for various muscles
Houses parts of the digestive, urinary, and reproductive systems
 Female bone structure


Slightly less dense than the male’s and is smaller, shorter and wider
Bone protrusions for muscle attachments are not sharply defined
Bones of the Hip and Pelvis Joints
 Hip Joint
 Where the spherical head of
the femur fits into the
acetabulum of the pelvis
 Pelvis
 The bones of the pelvis are
the ilium, ischium and
pubis
 Connects with the sacrum
and coccyx of the vertebral
column posteriorly

Sacroiliac (SI) joint
Pelvis ~ Skeletal Structure
 Ilium

Broad, flared portion that constitutes the upper and lateral sections
of the pelvis
Iliac crest is the upper ridge
 Greater sciatic notch allows the sciatic nerve to pass through the leg
below

 Ischium


Bears weight when sitting and is attached to the pubis anteriorly, the
ilium laterally and to the back
Large opening in the ischium is the obturator foramina, where blood
vessels and nerves pass into the legs.
 Pubis


Makes up the front of the pelvis bones and located in the front and
below the bladder
The pubis symphysis, located in the center of the pubis, is where the
two sides fuse
Sacroiliac Joint
 Sacrum
 Composed of 5 fused
vertebrae and connects
directly to the ilium
posteriorly
 Coccyx
 Composed of 3-5 vertebrae
and is connected to the
lower portion of the
sacrum

Susceptible to shock
fracture, as might be
induced from a fall
Hip and Pelvis Musculature
 Primary Muscles of the Hip and Pelvis
 Gluteals
 Hip Flexors
 Hip Adductors
 Quadriceps
 Hamstrings
Gluteal Muscles
 Gluteal muscles are the largest group
 Gluteus Maximus


Performs hip extension
Gluteus Minimus and medius

Perform internal and external rotation and abduction
Hip Flexors and Adductors
 Hip Flexors
 Muscles that assist in hip
flexion
Iliopsoas
 Sartorius
 Pectineus
 Rectus Femoris

 Hip Adductors
 Muscles that assist in hip
adduction
Adductor Longus
 Adductor Brevis
 Adductor Magnus

Quadriceps and Hamstrings
 Quadriceps
 Perform hip flexion
Vastus Medialis
 Vastus Lateralis
 Vastus Intermedius
 Rectus Femoris

 Hamstings
 Perform hip extension
Biceps Femoris
 Semitendinonsus
 Semimembranosus

Common Injuries of the Hip and Thigh
 Injuries to the hip and thigh are very common in
athletics
 Major injuries and conditions are








Bursitis
Hip fracture
Strains
IT Band syndrome
Quadriceps contusions
Myositis ossificans
Iliac Crest contusions
Stress fractures
Bursitis
 Bursitis is most commonly located over the outside of the
hip at the trochanteric bursa

Most common among athletes who do not sufficiently stretch and
warm up in this area
 Symptoms

Tenderness over outer portion of hip

Worsens by walking, running,
or twisting the hip
 Treatment




Initially treated with heat
Followed by stretching exercises
Ice massage
NSAIDS are also helpful
Hip Fracture
 Refers to a break in the proximal portion of the femur,
most common types




In young patients, extreme trauma, is usually necessary for a hip
fracture
Femoral neck fractures
Intertrochanteric fractures
Subtrochanteric fractures
 Symptoms



Severe hip pain
Abnormally rotated leg
Increase pain with movement
 Treatments

May vary and must be
discussed with surgeon
Quadriceps and Hip Flexor Strain
 Common in sports that require jumping, kicking and
repetitive sprinting

Common muscles involved are the rectus femoris and/or
iliopsoas muscles.
 Treatment
 Icing
 Compression wrap
 Anti-inflammatory medications
 Rehab
 Should be progressive
and sport-specific
Hamstrings Strain
 Most frequently affect the long head of the biceps femoris


Can range from microtears in a small area to a complete tear in the
muscle or its tendons (usually called a hamstring tear)
Causes
Insufficiently warming up
 Developing quads more than hamstrings
 Inflexibility
 Direct blow to back of leg

 Symptoms




Sharp pain in back of thigh
Bruising
Swelling
Loss of strength in upper leg
Hamstrings Strains ~ Treatment and Rehab
 Treatment
 RICE
 Medication (asprin/ibuprofen)
 Physical Therapy
 Crutches and massage can be recommended
 Rehab
 Should begin soon after the injury occurs
 Progress into weight-training program to focus on balancing
strength between the quads and hamstrings
Adductor (Groin) Strains
 Common in sports that require sideways changes in
direction

Most involved muscles in the adductor longus
 Symptoms


Most strains are Grade I or II
Characterized by groin pain when running or kicking
 Treatment





Can be difficult and risk of
re-injury is high
Rest
Ice
Anti-inflammatory meds
Adductor stretching and
strengthening is common
Iliotibial Band Syndrome
 Involves inflammation of the IT Band

Thick band of fibrous tissue that runs down the outside of the leg,
beginning at the hip an extending to the outer side of the tibia just
below the knee
 Symptoms


Irritation and pain when knee is moved
Increasing pain with movement
 Treatment





Analysis of the athlete’s gait and
training program to rule out mechanical
problem or training errors
Using proper footwear
Icing
Stretching
Reduce activity until symptoms subside
Quadriceps Contusions
 Usually caused by a direct blow to the thigh from a
helmet or knee

Common in football, rugby, soccer and basketball
 The injury can limit motion and affect gait

Severity of the contusion is determined by the range of motion in the
hip when evaluated
 Treatment




Immediate compression
Ice
Use of crutches
Massage is contraindicated

May cause more damage
Myositis Ossificans
 A very painful condition in which an ossifying mass may form
within the muscle

Usually the result of recurrent trauma to a quadriceps muscles that was not
properly protected after the initial injury
 Symptoms
 Hard, painful mass is the soft tissue of thigh
 Loss of ROM
 Ultimately diagnosed with x-ray

About 4 weeks after injury
 Treatment
 acute, with heat
 Limit ROM
 Rehab
 Passive stretching and vigorous exercise discouraged for first 6
months
 Surgical excision may be necessary if pain and limited motion
persist beyond year
Iliac Crest Contusion
 Also called a hip pointer
 Very painful injury caused by a direct blow to the hip
 Symptoms (all over iliac crest)
 Extreme tenderness
 Swelling
 Eccymosis
 Treatment
 Application of ice
 compression
 protection
Overuse Injuries
 Common among one-sport athletes
 Caused by cumulative effects of very low levels of stress
 Examples:
 Chronic muscles strains
 Stress fractures
 Tendonitis
 Snapping hip
 Bursitis
 Athletes with these problems should rest from the
sport and use cross-training techniques
Stress Fractures
 Occur most often in runners and dancers

Femur stress fractures are common in runners
 Symptoms


Chronic, ill-defined pain over groin and thigh
If symptoms do not resolve with rest and rehab, athlete should be
exaimined by specialist using x-rays and bone scans
 Treatment



Rest
Non-weight bearing endurance exercises
Running in water or swimming