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Chapter 14
Injuries to the Hip and
Pelvis
Hip Motions
• Ball-and-socket joint
• Allows for a wide range of motions
• Musculature surrounding joint aids in stability
• Hip motions
• Flexion (0 – 120°)
• Extension (0 – 20°)
• Internal rotation (0 – 40°)
• External rotation (0 – 50°)
• Abduction (0 – 50°)
• Adduction (0 – 25°)
• Cicrumduction
Major Bones of the Hip
More Bones
Anatomy Review
• Functions of the pelvis include:
• Attachment of lower extremities.
• Protection of internal organs.
• Muscle attachments.
• Birth process, in females.
• Joints
• Femoroacetabular (hip joint)
• Femur inserts/articulates into/with the
acetabulum
• Sacroiliac
• Pubic symphysis
Anatomy Review
Primary hip structures
• Femur
• Pelvic bones
• Ilium
• Ischium
• Pubis
• Sacrum
• Coccyx
Nervous System
Major Nerves
• Femoral
• Sciatic
Hip Flexion
• Rectus femoris, iliopsoas (made up of the
psoas major and iliacus), sartorius
• These are the major contributors
• Adductor longus, adductor brevis, pectineus,
gracilis, tensor fascia latae
• These are considered assistors
• Flexion (0 - 120°)
Hip Extension
• Hamstring muscles
• Biceps femoris,
semitendinosus,
semimembranosus
• Gluteus maximus
• These are muscles
located on the
posterior thigh
• Most of these
muscles originate in
or around the ischial
tuberosity
• Extension (0 – 20°)
Abduction
• Gluteus maximus,
gluteus minimus,
gluteus medius, tensor
fascia latae
• The 3 gluteus muscles
make up the muscle
group known as the
gluteals
• These muscles can be
located both posteriorly
and laterally
• Abduction (0 – 50°)
Adduction
• Adductors
• Adductor magnus,
adductor longus,
adductor brevis,
gracilis
• These muscles are
located on the
medial thigh
• Adduction (0 –
25°)
External Rotators
• Piriformis,
gemellus superior,
gemellus inferior,
obturator
externus,
obturator internus,
quadratus femoris
• These muscles
are located deep
• External rotation (0 –
50°)
Internal Rotation
• Gluteus medius, gluteus minimus, tensor
fascia latae
• These are muscles located on the lateral
thigh
• Internal rotation (0 – 40°)
Common Sports Injuries
• Sports-related injuries to the skeletal
structures (fractures and dislocations) of the
hip and pelvis are not common.
• Injuries to the soft tissues in the region are
more common and can be quite debilitating to
the athlete.
• Sports-related injuries to this area commonly
involve collision sports or forceful movements.
• However, overuse injuries are common especially
in endurance athletes.
Fractures of the Pelvis
• Pelvic fractures are not common in sports,
because it typically takes a great deal of force
to fracture the pelvis.
• Pelvic fractures are devastating injuries.
• Pelvic fractures in the adolescent can be
serious because of open growth plate.
• This injury may occur in sports such as
hockey, pole-vault, or football.
• No athlete should return to play after a
suspected pelvic fracture until being cleared
by a physician.
Fractures of the Pelvis
Signs and symptoms
• Abnormal pain, swelling, usually accompanied with
visual or palpable deformity in pelvic region.
• Pain elicited when iliac crests are pressed together.
• Injury to internal organ(s) may be associated with
this injury.
First Aid
• Treat for shock and internal bleeding, monitor vital
signs.
• Arrange for transportation to a medical facility on a
spine board, elevated at the feet.
Other Fractures
Femoral Neck Stress Fracture
• Commonly occurs in amenorrheic athletes
involved in endurance sports.
• Athlete complains of severe anterior thigh or
groin pain and experiences pain when
walking.
• This problem can also be a partial result of
poor footwear, hard running surface, too
much training, or hip deformities.
• Referral to physician and 6-8 weeks rest is
recommended.
Hip Dislocation
• This serious injury is rare in athletics, but it
may occur in contact/collision sports.
• Injury can occur from a violent collision such
as seen in tackle football or ice hockey.
• Typical mechanism of injury is falling on a
flexed knee and hip causing force through
femur and posterior dislocation.
Hip Dislocation
Signs and symptoms
• Pain and loss of movement in affected leg.
• Hip is flexed and knee of the involved leg is
angled toward the opposite leg.
• Swelling and deformity that is palpable.
First Aid
• Treat for shock.
• Immobilize the athlete and contact EMS.
• Monitor blood flow to the lower leg at all
times.
Avulsion Factures of the Hip
• In an avulsion fracture, a bone fragment is
torn away with tendon attached.
• Avulsion fractures of the hip are
uncommon but can occur—the ischial
tuberosity, AIIS, and pubis are likely sites
of this injury.
• Injury likely to occur while sprinting,
landing, or jumping.
Avulsion Fractures of the Hip
Signs and symptoms
• Snapping or popping sensation upon injury.
• Pain and swelling at site of injury.
• Point tenderness and bruising over injury.
• Inability or pain using the muscle group involved
due to avulsion.
First Aid
• Immediately apply ice and limit athlete’s
movements. Crutches may be necessary.
• Refer to a physician for evaluation.
Labral Tears
• Results from trauma, repetitive
excessive hip motions (soccer, hockey,
dance), and/or femoroacetabular
impingement (FAI).
• Athletes generally complain of anterior
hip or groin pain, and some may
indicate buttock or leg pain.
Hip Pointer
• Hip Pointer is a common injury, involving a
contusion to the anterior/superior portion of the
iliac crest (ASIS).
• Although extremely painful and debilitating, it
does not require immediate medical attention.
• Signs and symptoms include swelling, pain,
and discoloration at injury site.
• Athlete may walk with slight limp (reduced
ROM/weakness).
• Coughing, sneezing, and laughing may also
produce pain at the site of injury.
Hip Pointer
First Aid
• Apply ice immediately.
• Athlete should rest and
avoid activities involving
lower extremities.
• In severe cases, crutches
may be necessary.
• Permit limited participation
within 1 to 2 weeks.
• Pad for protection upon
return to sport.
Muscle Strains
• Most often complain of hearing or feeling a pop,
pain at the site of muscle tear, possible palpable
deformity and ecchymosis, weakness and loss of
ROM compared bilaterally
• Most common in the adductor muscles and
hamstrings
• First aid
• Includes ice and compression
• Rehab to improve ROM and strength should
begin in 24 – 48 to prevent muscle atrophy
Trochanteric Bursitis
• “Snapping Hip Syndrome”
• A result of either acute trauma to the specific area
or repeated microtrauma to the tendon
attachments with secondary inflammation of the
bursae in the area.
• Iliotibial band, tensor fascia lata, and the gluteus
medius often cause.
• It is a problem seen most often in middleaged people, especially runners.
• Stretching, ice, anti-inflammatories, and rest
are first line of treatment.
Hernias
A protrusion of viscera through abdominal wall.
• Inguinal hernia is more common in males
• Femoral hernia is more common in females.
• Athlete should seek the advice of a physician
regarding surgical options.
• In a sports hernia, the posterior inguinal wall is
weakened without protrusion of abdominal
contents. No palpable hernia is detected, but
athlete complains of pain in groin and lower
abdominal areas.
Sport Hernias
• Common in kicking and explosive sports.
• Deep groin pain that does not have a specific
onset (or MOI) and gradually gets worse as
the days pass.
• Rarely heals without surgical intervention.
Chronic Hip Ailments
• Sacroiliac (SI) joint can become completely
immobile inflamed from an injury or other
problems.
• Requires specific movement techniques to reset.
• “Snapping Hip” that doesn’t resolve with
conservative treatment and/or pain deep in hip
joint should be examined by a physician.
• Rule out microfractures, hip deformities, and labral
tears to femoroacetabular joint (hip joint).
• These will be addresses conservatively but may need
surgical intervention.
Injuries to Male Genitalia
• These injuries are usually transient in nature.
• Scrotal trauma can cause testicular
contusion.
• Medical Emergency
• Severe trauma can rupture testicle.
• Severe trauma can cause testicular
torsion.
• Blood supply is compromised to or from the
area, causing swelling to occur in the scrotum.
• Wearing a protective cup is advised in
collision/contact sports.
Testicular or Scrotal
Contusions
Signs and symptoms
• Extreme pain & point tenderness.
• Assuming fetal position and grasping testicles.
• Athlete’s report of a blow to the testicles.
First Aid
• Apply ice, and allow athlete to rest lying down.
• Transport to medical care facility in cases of
excessive swelling or lasting pain.
Nerve Problems
• A common complaint is burning or tingling
sensation radiating from the hip to buttocks area
and going down the leg.
• This discomfort often results from sciatic nerve
irritation.
Treatment
• Continuing to participate in the activity aggravates the
irritation.
• Refer athlete to a physician.
• Rest, stretching, and strengthening exercises may be
helpful.
Piriformis Syndrome
• 2 major causes – Piriformis muscle becomes
inflamed or spasms and compresses the sciatic
nerve or an anatomical anomaly occurs and the
sciatic nerve splits the piriformis muscle
compressing the sciatic nerve.
• Signs and symptoms include: pain in back and leg,
numbness and/or tingling in the buttocks, pain
when climbing stairs, walking, or running
• Can be acute due to direct trauma or spontaneous
onset
• Can be difficult to diagnose; treatments can vary
from massage, to rest, to stretching and
strengthening
Prevention
• Many hip injuries can be prevented through
proper conditioning, stretching, and
strengthening of the associated musculature.
• Rest is also important for the body to repair
micro damages incurred by the stresses of
training.
• Protective equipment and proper footwear
may also help to prevent injuries from
occurring.