Athletic Training Ch 8 Hip and Pelvis Objectives

Athletic Training Ch. 8 Hip and Pelvis

Objectives Standards – 2. 2, 2. 7, 2. 8, 5. 5, 6. 1, 6. 5, 6. 6, 6. 7 1. SWBAT label the bones of the hip and pelvis 2. SWBAT label the ligaments of the hip and pelvis 3. SWBAT label the joints of the hip and pelvis 4. SWBAT label the muscles of the hip and pelvis and state the function of each 5. SWBAT label the arteries of the hip and pelvis 6. SWBAT measure the ROM of the hip, pelvis and torso and state the average value of each 7. SWBAT demonstrate special tests of the hip and pelvis and state the purpose of each 8. SWBAT define common injuries of the hip and pelvis 9. SWBAT state the MOI of common injuries of the hip and pelvis 10. SWBAT describe treatments used for common injuries of the hip and pelvis 11. SWBAT describe protective devices used for common injuries of the hip and pelvis 12. SWBAT demonstrate taping and wrapping techniques for the hip and pelvis 13. SWBAT state the Purpose and Position of each taping and wrapping technique

Pelvis anatomy • Other bony prominences- see handout • • • Greater Trochanter Ilium Iliac crest Ischium Pubis ASIS – anterior superior iliac spine PSIS – posterior superior iliac spine Acetabulum Pubic Tubercle Pubic Symphysis Sacrum – 5 fused vertebrae Coccyx – 4 fused vertebrae

Circulation Femoral Artery

Hip & Pelvis Ligaments

Range-of-motion Hip- • Adduction – moving leg toward midline in frontal plane • Abduction - moving leg away from midline in frontal plane • Flexion – to decrease the angle between the anterior thigh and abdomen through the sagittal plane • Extension – to increase the angle between the anterior thigh and abdomen through the sagittal plane • Internal Rotation – rotation of the femur toward the midline of the body • External Rotation – rotation of the femur away from the midline of the body

Range-of-motion Torso • Flexion – moving the torso forward through the sagittal plane • Extension – moving the torso backward through the sagittal plane • Lateral Flexion – moving the torso laterally in the frontal plane • Rotation – rotating the torso in the transverse plane

Common Injuries Hip Pointer – contusion of the iliac crest MOI – direct blow Tx – PRICES, rehab program

Common Injuries Pubic Symphysis Sprain Osteitis Pubis – non-infectious inflammation of the symphysis pubis MOI – exercise, running, trauma Tx – rest, heat, ice, correct pelvic imbalance

Common Injuries Fracture of pelvis MOI – usually a direct blow Tx – immobilize, EMS transport

Avulsion Fracture

Common Injuries Fracture of femur MOI – usually a direct blow Tx – immobilize, EMS transport • Femur fracture can be a life-threatening condition • Hip extended, leg externally rotated

Common Injuries Hip dislocation MOI - twisting or traction Tx – EMS transport, rehab program • Hip flexed, leg internally rotated

Common Injuries Coccyx MOI – direct blow, falling on a hard surface Tx – PRICES. Fracture possible in severe cases

Common Injuries IT band friction syndrome MOI – IT band rubbing over lateral femoral condyle. Tx – rest or modified activity, shoe inspection, US, massage, cryotherapy, stretch, gait and posture exam, strengthen hips, orthotics, NSAIDS

Common Injuries Thigh Contusion MOI – direct blow Tx – rest, cryotherapy, NSAIDS, monitor for Myositis Ossificans. Don’t apply heat or return to exercise too quickly in severe cases!

Common Injuries Muscle Strain – 4 main groups • Quadriceps • Hamstrings • Adductors - groin • Abductors – TFL/gluteus medius and IT band MOI – overstretch, eccentric pull Tx – PRICES, heat, massage, stretch, strengthen. These can result in stress fractures or avulsion fractures

Common Injuries Tendonitis – usually at ASIS or ischium MOI – overuse Tx – rest or decrease activity, US, cross-friction massage, stretch, cryotherapy, NSAIDS, Kinesiotape

Common Injuries Piriformis Syndrome – sciatic nerve is pinched by the piriformis muscle MOI – congenital, overuse, strain Tx – rest, stretch, strengthening, massage, NSAIDS, sometimes require surgery

Common Injuries Ligament sprain – 3 degrees of sprain • First degree (grade I) – stretch of ligaments • Second degree (grade II) – partial tear of ligaments • Third degree (grade III) – complete tear of ligaments MOI – twisting leg or twisting body with foot fixed, compression Tx – rest, ice, crutches or cane, rehab

Hip & Pelvis Ligaments

Common Injuries Trochanteric Bursitis MOI – overuse, running form, poor shoes, direct blow Tx – rest or decrease activity, US, cryotherapy, NSAIDS, heat

Common Injuries Athlete Pubalgia (Sports Hernia) chronic inflammation of the pubis MOI – overuse Tx – Heat, ice, rest or decrease activity, alter training program – fewer ab exercises

Common Injuries Labrum tear - a tear of the cartilage rim that surrounds the hip socket. MOI - FAI (femoral-acetabular impingement), twisting, falling. Tx- surgery

Common Injuries Genital trauma MOI – direct blow or twisting of testicles Tx – ice, check for swelling

Protective Devices Athletic Supporter with Cup

Protective Devices Back brace

Protective Devices Low back brace/support

Protective Devices Sport specific pads – FB, sliders for SB and Bsb

Protective Devices Sports compression girdle

Walking Gait Lab Feet • • • Toes point straight/in/out? Land on heel and roll toward big toe? Pronation (flat foot/pes planus)? Supination (high arch/pes cavus)? Achilles tendon curves? Ankle PF/DF?

Walking Gait lab Knees • Valgus/Varus alignment? • Patellas point forward/medially/laterally? • Knee reaches full extension?

Walking Gait lab Hips/Pelvis • Pelvis tilts to one side? • Pelvis rotates excessively? • Pelvis tilts anteriorly/posteriorly?

Walking Gait lab Miscellaneous • Limping? • Favor one side? • Major difference side-to-side?

Taping and Wrapping Techniques Kinesio taping

Taping and Wrapping Hip Flexor Wrap Purpose – limit hip extension, compression Position – standing, hip flexed 30° - 45°, feet shoulder width Procedure – 1. Wrap around upper thigh pulling laterally 2. Wrap around pelvis staying above the iliac crest 3. “Tab” the wrap 4. Continue around thigh and pelvis 5. Anchor wrap

Taping and Wrapping Hip Adductor Wrap Purpose – limit hip abduction, compression Position – standing, hip flexed 20° - 30°, leg adducted to midline Procedure – 1. Wrap around upper thigh pulling medially 2. Wrap around pelvis staying above the iliac crest 3. “Tab” the wrap 4. Continue around thigh and pelvis 5. Anchor wrap

Taping and Wrapping Hip Pointer Taping Purpose – Protection of iliac crest Position – standing, slight lateral flexion of the waist Procedure – see handout 1. Two vertical anchor strips 2. X-pattern overlapping by ½ width covering the injured area 3. Horizontal strips – superior to inferior 4. Foam pad (with donut hole) 5. Circle with elastic wrap

Taping and Wrapping Techniques Hip pointer taping – Can use Kinesiotape or wrap padding with a hip spica wrap