Chapter 17: The
Thigh, Hip,
Groin, and
Pelvis
© 2007 McGraw-Hill Higher Education. All rights reserved.
© 2007 McGraw-Hill Higher Education. All rights reserved.
© 2007 McGraw-Hill Higher Education. All rights reserved.
© 2007 McGraw-Hill Higher Education. All rights reserved.
© 2007 McGraw-Hill Higher Education. All rights reserved.
© 2007 McGraw-Hill Higher Education. All rights reserved.
Muscles and Movements
• Hip flexion
– Normal ROM
• 120 degrees knee bent bent
– Iliacus and psoas major (major flexors)__________________________ - knee bent
– _________________ (function when knee is
extended and with kicking the ball)
– Sartorius
• Hip Extension
– Normal ROM 10 – 20 degrees
– ________________________________
© 2007 McGraw-Hill Higher Education. All rights reserved.
Muscles and Movements (2)
• Abduction
– Normal ROM
• 45 degrees
– ________________
• Adduction
– Normal ROM
• 30 degrees
– Adductor magnus, longus, brevis, and
gracilis
© 2007 McGraw-Hill Higher Education. All rights reserved.
Muscles and Movements (3)
• Internal Rotation or Medial Rotation
– Normal ROM
• 45 degrees
– ________________________________
_____________________
• External Rotation or Lateral Rotation
– Normal ROM
• 45 degrees
– 6 deep external rotators- piriformis
© 2007 McGraw-Hill Higher Education. All rights reserved.
Assessment of the Thigh
• History
– Onset (sudden or slow?)
– Previous history?
– Mechanism of injury?
– Pain description, intensity, quality, duration,
type and location?
• Observation
– Postural symmetry?
– Size, deformity, swelling, discoloration?
– Skin color and texture?
– Is athlete in obvious pain?
– Is the athlete willing to move the thigh?
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Palpation
– Soft tissue of the thigh (anterior,
posterior, medial, lateral) should be
palpated for pain and tenderness
– Bony palpation should also be
performed to locate areas of
pain/discomfort
– Utilize palpation to assess body
symmetry
© 2007 McGraw-Hill Higher Education. All rights reserved.
RROM testing
• Hip Flexion
• Hip Extension
• Hip Abduction
• Hip Adduction
• Hip Internal Rotation
• Hip External Rotation
• Knee Extension
• Knee flexion
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Special Tests
– Thomas test
• Test for hip
contractures______________
– Straight Leg Raise
• Test for hamstring
tightness or
• Can also be used
to assess sciatic
nerve irritation
from swelling,
bulging/herniated
disk or SI joint
dysfunction
© 2007 McGraw-Hill Higher Education. All rights reserved.
Special Test Cont
• Kendall
• Pelvic Rock
• Trendelenburg’s Test
© 2007 McGraw-Hill Higher Education. All rights reserved.
Prevention of Thigh Injuries
• Thigh must have maximum strength,
endurance, and extensibility to
withstand strain
• Dynamic stretching programs may
aid in muscle preparation for activity
• Strengthen programs can also help in
preventing injuries
– Squats, lunges, leg press
– Core strengthening
© 2007 McGraw-Hill Higher Education. All rights reserved.
Recognition and
Management of Thigh
Injuries
• Quadriceps Contusions
– Cause of Injury
• Constantly exposed to traumatic blows
– Signs of Injury
• Pain, transitory loss of function, immediate
bleeding of affected muscles
• Early detection and avoidance of internal
bleeding are vital – increases recovery rate
and prevents muscle scarring
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Care
– RICE and NSAID’s
– ______________
_____________
– ______________
______________
______________
______________
________
• Heat, massage and
ultrasound to prevent
myositis ossificans
– Padding may be worn
for additional
protection upon
return to play
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Myositis Ossificans
– Cause of Injury
• _________________________________
________________________________
– Signs of Injury
• _________________________________
______________________
• Pain, weakness, swelling, decreased ROM
• Tissue tension and point tenderness
– Care
• Treatment must be conservative
• May require __________________ if too
painful and restricts motion
• If condition is recurrent it may indicate
problem with blood clotting
© 2007 McGraw-Hill Higher Education. All rights reserved.
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Quadriceps Muscle Strain
– Cause of Injury
• ___________________________________
_________________________________
• Associated with weakened or over
constricted muscle
– Signs of Injury
• Peripheral tear causes fewer symptoms than deeper tear
• Pain, point tenderness, spasm, loss of function and little
discoloration
• Complete tear may leave athlete w/ little disability and
discomfort but with some deformity; more discoloration;
edema will settle in back of knee, calf and ankle
– Care – Fit for crutches if necessary
• _____________________________________________
• Determine extent of injury early
• Neoprene sleeve may provide some added support
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Hamstring Muscle Strains
– Cause of Injury
• Multiple theories of injury
– Hamstring and quad contract together
– Change in role from hip extender to knee
flexor
– Fatigue, posture, leg length discrepancy, lack
of flexibility, strength imbalances,
– Signs of Injury
• Muscle belly or point of attachment pain
• Capillary hemorrhage, pain, loss of
function and possible discoloration
• Grade 1 - soreness during movement and
point tenderness
• Grade 2 - partial tear, identified by sharp
snap or tear, severe pain, and loss of
function
© 2007 McGraw-Hill Higher Education. All rights reserved.
– Signs of Injury (continued)
• Grade 3 - Rupturing of tendinous or
muscular tissue, involving major
hemorrhage and disability, edema, loss of
function, ecchymosis, palpable mass or
gap
– Care
• RICE
• Restrict activity until soreness has
subsided
• Ballistic stretching and explosive
sprinting should be avoided initially
• Fit for crutches if necessary
© 2007 McGraw-Hill Higher Education. All rights reserved.
Recognition and
Management of Specific Hip,
Groin, and Pelvic Injuries
• Groin Strain
– Cause of Injury
• One of the more difficult problems to diagnose
• Often seen in early part of season due to poor
strength and flexibility
• Occurs from running , jumping, twisting w/ hip
external rotation or severe stretch
– Signs of Injury
• Sudden twinge or tearing during active movement
• Produce pain, weakness, and internal hemorrhaging
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Groin Strain (continued)
– Care
• _________________________________
_____________________________
• Determine exact muscle or muscles
involved
• ______________________
• _________________________________
______________________________
• Refer to physician if severe groin pain is
experienced
• Fit for Crutches if necessary
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Sprains of the Hip Joint
– Cause of Injury
• Result of violent twist due to forceful
contact
• _________________________________
_________________________________
_________________
– Signs of Injury
• Signs of acute injury and inability to circumduct
hip
• Pain in hip region, w/ hip rotation increasing pain
– Care
• X-rays or MRI should be performed to rule out fx
• RICE, NSAID’s and analgesics
• Depending on severity, crutches may be required
• ROM and PRE are delayed until hip is pain free
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Piriformis Syndrome
– Cause of Condition
• ___________________________________
_______________________________
• _________________________________
– Signs of Injury
• Pain, numbness and tingling in butt – may
extend below knee and into foot
• Pain may increase following periods of
sitting, climbing stairs, walking or running
– Care
• Stretching and massage
• NSAID’s may be prescribed
• Cessation of aggravating activities will be prescribed
• Corticosteroid injection may also be suggested
• Surgery is sometimes an option as well
© 2007 McGraw-Hill Higher Education. All rights reserved.
Hip Problems in Adolescent
Athletes
• Legg Calve’-Perthes Disease
• Cause of Condition
• Avascular necrosis of the femoral head in child
ages 4-10
• Articular cartilage becomes necrotic and
flattens
– Signs of Condition
• Pain in groin that can be referred to the abdomen or
knee
• Limping is also typical
• Varying onsets and may exhibit limited ROM
© 2007 McGraw-Hill Higher Education. All rights reserved.
© 2007 McGraw-Hill Higher Education. All rights reserved.
•Legg-Calve’-Perthes Disease
(continued)
• Care
– Bed rest to reduce chance of chronic
condition
– Brace to avoid direct weight bearing
– Early treatment and head may reossify
and revascularize
• Complication
– If not treated early, will result in illshaping and osteoarthritis in later life
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Slipped Capital Femoral Epiphysis
– Cause of Condition
• May be growth hormone related
• 25% of cases are seen in both hips
• ___________________________________
___________________________________
__________________________
• ___________________________________
– Signs of Condition
• Pain in groin that comes on over weeks or months
• Hip and knee pain during passive and active motion;
limitations of abduction, flexion, medial rotation and
a limp
– Management
• W/ minor slippage, rest and non-weight bearing may
prevent further slippage
• Major displacement requires surgery
• If undetected or surgery fails severe problems will
result
© 2007 McGraw-Hill Higher Education. All rights reserved.
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Iliac Crest Contusion (hip pointer)
– Cause of Injury
• _________________________________
_________________________________
• ____________________________
– Signs of Injury
• Pain, spasm, and transitory paralysis of soft
structures
• _______________________________________
__________________________________
– Care
• RICE for at least 48 hours, NSAID’s,
• Bed rest 1-2 days in severe cases
• Referral must be made, X-ray
• Padding should be used upon return to minimize
chance of added injury
© 2007 McGraw-Hill Higher Education. All rights reserved.
• Avulsion Fractures
– Cause of Injury
• _________________________________
________________________________
• Pulling of tendon away and off of bony
insertion
• Common sites include ASIS (________),
AIIS (___________________), ischial
tuberosity (___________)
– Signs of Injury
• Sudden localized pain w/ limited movement
• Pain, swelling, point tenderness
– Care
• Rest, limited activity and graduated exercise
© 2007 McGraw-Hill Higher Education. All rights reserved.