Sports Medicine Camp
The Thigh and Hip Muscles
Anatomy, Injuries and Assessment
Quadriceps Muscles
•
•
•
•
Vastus Medialis
Vastus Intermedius
Vastus Lateralis
Rectus Femoris
Ely’s Test or Prone Knee Bend
• Rectus Femoris tightness
– Athlete prone
– Passive knee flexion
– Positive test indicated by hip flexion
Quadriceps MMT
• Manual Muscle Test
– Athlete seated
– Examiner apply resistance at lower leg
Rectus Femoris Strain
• Mechanism of Injury
– Sudden stretch
– Sudden contraction
• Signs and Symptoms
–
–
–
–
–
Pain
Point tenderness
Spasm
Loss of function
Deformity
• Treatment
–
–
–
–
–
RICE
NSAIDS
Modalities
Stretching
Strengthening
Thigh Contusion
Hamstrings Muscles
• Lateral side
– Biceps Femoris Long Head
– Biceps Femoris Short head
• Medial side
– Semitendinosus
– Semimembranosus
Hamstrings MMT
• Medial hamstrings
–
–
–
–
Semitendinosus
Semimembranosus
Internally rotate tibia
(foot points in)
• Lateral Hamstring
– Biceps Femoris
– Externally rotate tibia
– (foot points out)
Hamstring Strains
• Mechanism of Injury
– Unknown
– 1st Theory
• Hamstrings contract same time as quadriceps
• Deficiency in complementary action of opposing muscles
– 2nd Theory
• Quick change of function from
– Role as knee stabilizer
– To
– Hip extensor
– Possible reasons
•
•
•
•
•
•
•
Muscle fatigue
Faulty posture
Leg length discrepancy
Tight hamstrings
Improper form
Imbalance of strength between hamstrings
Hamstring strength ratio to quads normal 60 - 70 %
Hamstring Strains
• 1st Degree injury
– Muscle soreness during
movement
• Due to muscle spasm rather
then tearing of tissue
• Fewer then 20% fibers torn
– Point tenderness
– Stiffness after cool down
• 2nd Degree injury
–
–
–
–
–
Partial tear
Fewer then 70% fibers torn
Sudden snap or tear of muscle
Severe pain
Loss of function
Hamstring
Strains
• 3rd Degree injury
–
–
–
–
–
–
–
Rupture of tendon
Tear of > 70% fibers
Severe swelling
Tenderness
Loss of function
Discoloration
Palpable mass or gap
Hamstring Strains
– Treatment
• Grade 2 & 3
– Extremely conservative
• RICE
– Grade 2: 24 - 48 hrs.
– Grade 3: 48 - 72 hrs.
• Stretching
• Strengthening
– Emphasize eccentric exercise
– Complications
• Recurrent as result of
– Inelastic fibrous scar tissue
Hip Flexors
– Iliopsoas
• Psoas Major
• Psoas Minor
• Iliacus
– MMT
Thomas Test
–
–
–
–
–
Normal length of hip flexors
With low back flat
Posterior thigh touches table
Knee flexes approximately 80°
The pelvis is in 10 ° posterior tilt
– Abnormal length of hip flexors
– With low back flat
– Posterior thigh does not touch
table
– Knee flexes < 80°
Hip Flexor Support
Adductor Muscles
•
•
•
•
•
•
•
•
•
MMT Adduction
Athlete sidelying
Examiner supports top leg
Give resistance above knee joint
Adductor Magnus
Adductor Longus
Adductor Brevis
Pectineus
Gracilis
Adductor Support
8-4
Hip Pointer
• Mechanism of injury
– Direct impact
• Signs and Symptoms
–
–
–
–
–
One of the most handicapping injuries
Immediate pain
Muscle spasm
Transitory paralysis
Inability to
• rotate trunk
• Flex thigh
– Discoloration
– Swelling
• Treatment
– PRICE
• Bed rest as needed
• Crutches as needed
– ROM exercises
– Strength exercises
– Severe cases MD referral
21-34