The Hip
Sports Med 2
The Hip

A ball and socket joint
 Hip transmits the load
from the foot to the
spine and vice versa
Blood & Nerve Supply
 Femoral
artery
 Common Iliac Vein
 Femoral Nerve
 Sciatic Nerve


Largest nerve in the body
Innervates thigh and lower leg
Bursae
 Iliopsoas

and deep trochanteric bursae
Most important ones
Injury
 Trochanteric




Bursitis
MOI:
• Common at the greater trochanter, high in women w/
increased Q angle, or leg length discrepancy
• Inflammation of bursa, or insertion of gluteus medius, or IT
band
S/S:
• c/o pain on lateral hip
• Radiating pain down to the knee
• Tenderness over greater trochanter
TX:
• PRICE, NSAIDS, ROM, PREs, no inclined running
Special Tests: Obers,
Ober’s Test
-Athlete
lays on unaffected
side
-Knee flexed at 90 degrees
-Lift top leg into abduction,
slight hip extension
-Allow the affected leg to
drop into adduction
-If
leg does NOT drop = +
tight IT band
Bones

Sacrum, Coccyx


Pelvis




Innominate bones:
ossify and fuse early in
life
Support the spine and
trunk
Transfer their weight
to the lower limbs
Placement for bony
attachment
Ilium, Ischium, Pubis

Make up pelvis
Injuries

Hip Pointer (contusion)

MOI
• blow to inadequately protected iliac crest
• Most handicapping injury in sports, difficult to manage

S/S
• Immediate pain, spasms, transitory paralysis of soft
structures
• Unable to rotate the trunk or to flex the thigh with out pn

TX
• RICE, referral, x-ray, ice massage, ultrasound, injection
• Doughnut pad for return to play
Hip dislocation
Injuries
 Hip

Dislocation pg 727 fig. 21-30
MOI
• Rarely occur during sports
• Femur is adducted and flexed

S/S
• Flexed, adducted, and internally rotated thigh
• Deformity, nerve damage

TX
• Immobilization, ice, analgesics
 Avulsion




Fracture
Injury
MOI:
• Most common: 1) ischial
tuberosity (hamstrings),
2)AIIS(rectus femoris), ASIS
(sartorius)
• Sudden acceleration/deceleration
S/S:
• Sudden local pain
• Limited movement
TX:
• X ray, PRICE, crutches, ROM,
PREs
Special Tests: Hip MMTs
Injury
 Osteitis




Pubis
MOI:
• Seen in running sports (XC,
football, soccer, wrestling
• Repetitive stress on pubis
symphysis by surrounding
muscles
S/S:
• Groin pain while running, squats,
sit ups
TX: rest, oral antiinflammatory
agents, gradual return to play
Special Tests: running, sit up,
squats
Articulations

Sacroiliac Joint



Joint Capsule


Supported by ligaments
Connects sacrum to ilium
The acetabulum is
cushioned by the labrum
Hip Joint


Made of femur head and
acetabulum
Padded at the center by a
mass of fatty tissue,
ligaments and capsule
Ligaments

Iliofemoral




Y ligament of Bigelow
Strongest ligament of
body
Prevents hyperextension
Pubofemoral

Prevents excessive
abduction
Ligaments

Ischiofemoral



Prevents internal
rotation and adduction
On posterior aspect
Ligamentum Teres


Ligament to the head
of the femur
A bridge to allow blood
vessels and nerves to
enter the head of the
femur
Injuries
 Hip

Sprain
MOI
• Strong, therefore best protected, seldom injured
• Violent twisting produced by opponent, foot firmly
planted and trunk forced in opposing direction

S/S
• Athlete is unable to circumduct the thigh
• pain

TX
• X-rays to rule out fx
• RICE, analgesics, limit wt. bearing, pain free ROM

Special Tests: active circumduction of thigh,
IR, ER
Injuries
 Sacroiliac

Joint Sprain (S.I. Joint)
MOI
• Twists with both feet on the ground
• Stumbles forward, falls backward, steps in hole

S/S
• Pain over joint, muscle guarding, radiating pain
down back of gluteus and hamstring
• Asymmetrical ASIS/PSIS or leg length difference

TX
• Modalities, brace, stability exercises

Special Test: FABERS/Patricks
FABERs /Patrick Test
Procedure: Place foot on
the opposite extended knee
of the painful SI joint
Apply pressure downward
on the bent knee.
Positive test: Pain felt in hip
or SI jt. = SI joint
dysfunction
Muscles
 Anterior

Iliacus
• Triangular shaped, flexes the hip

Psoas (major and minor)
• Flexes the hip

Sartorius
• Crosses medially across the
anterior aspect of the thigh
• Hip flexion, and external
rotation

Rectus Femoris
• Hip flexion and knee extension
Muscles
 Lateral

Tensor fascia latae
• Hip abduction
 Posterior

3 gluteal muscles
• Gluteus Maximus: extension,
adduction, helps us get up from
a sitting position
• Gluteus Medius: abduction
• Gluteus Minimus: abduction

Hamstrings: hip extension, knee flexion
• Biceps Femoris, Semitendinosis, Semimembranosus
Muscles
 Medial
All act as adductors and
rotators of the hip
 Gracilis

• Adducts, flexes, external
rotation

Pectineus
• Adducts, flexes, external
rotation

Adductor longus, brevis and
magnus
• Adducts, external rotation
Injuries

Groin Strain (adductor/Hip flexor strain)

MOI
• The groin is the area between the thigh and the abdominals
• Torn during twist or pull while running or jumping

S/S
• Felt as sudden twinge or feeling of tearing during an AROM, or
may feel it the next day
• Pain, weakness, internal bleeding

TX
• PRICE, analgesics, ROM and strengthening exercises
• Rest has been the best treatment, protective spica

Special Tests: MMTs
Thomas Test
Procedure: Athletes lies supine
legs together
ATC places on hand under
athletes lumbar curve
One thigh is brought to the
chest flattening the spine.
Return bent leg to extended
position, lumbar curve should
return.
Positive Test: Extended thigh
should be flat on the table, if
not = tight hip flexor
Kendall test
Procedure: Athlete
lies supine with
knees off table
Athlete brings one
leg to their chest
Positive Test: If
thigh comes off the
table = tight hip
flexor
Injury
 Quad

Contusion
MOI

• Moderate
pain and
swelling,
limping,
cannot flex
knee
Severe/Grade 4
• deeper
• Pain,
swelling,
cannot flex
knee more
then 90
degrees
Grade 3
• Superficial
bruise
• Mild
hemorrhage,
mild pain, no
swelling,
mild pt
tenderness
• No game
restrictions
Grade 2
Grade 1
• Direct blow to the thigh
• Disability,
may split the
fasciae
• Severe pain,
limited
ROM, limp
TX: flx w/ice pack ,PRICE,NSAIDS, crutches
Injury
 Myositis

Ossificans Traumatica
MOI:
• Severe blow or repeated blows to thigh, usually the
quadriceps
• Can lead to ectopic bone production (myosositis
ossificans)

S/S:
• Pain, swelling, decreased function

TX:
• Conservative, surgery one year later

Special Tests:
• AROM knee flexion/ext
Injury
 Hamstring

Strain
MOI
• Most common injury to thigh, exact cause is not
known
• Possible MOI: muscle fatigue, faulty posture, leg
length discrepancy, tight hamstrings

S/S
• Hemorrhage, pain, loss of function.
• 3 grades of strain

TX
• PRICE, NSAIDS, very conservative, PREs

Special test: MMTs
Hamstring MMT
Injury
 Snapping

Hip:
Excessive repetitive movement in dancers, gymnasts,
hurdlers, sprinters

MOI:
• Imbalance in muscle
• IT band moves over the greater trochanter

S/S:
• c/o of snapping with pain

TX:
• Ice, NSAIDS, ultrasound, then stretching
Trendelenburg’s test
Procedure: Athlete stands,
foot on the unaffected side
is lifted
Look at the iliac crest to
see if it stays level
Positive test: if unaffected
side is lowers
OR
If standing on leg and
affected hip moves into
abduction
= Weak abductors
Measuring for Leg length

2 main ways:


Anatomical
discrepancy
Functional
discrepancy
Anatomical
discrepancy
(true method)
(actual bone is
shortened)
Athlete lies supine with
legs straight
Measurement is taken
between the medial
malleoli and ASIS
Bilaterally compare
Functional
discrepancy
Due to pelvic tilt or
deformity
Athlete lies supine, legs
straight
Measurement is taken
from umbilicus to the
medial malleoli
Bilaterally compare