[CN]CHAPTER 19



CHAPTER 19

The Hip and Pelvis

Preparation and Resources Needed

Materials: None.

Equipment: One or more models of the hip joint and pelvis, showing ligament and tendon attachments.

Personnel: An orthopedic surgeon to talk about hip joint problems; a recipient of an artificial hip, talking about what led to the need for the surgery and how he or she is coping.

Recommended Time to Complete: Seven days (based on two class periods per day, 170 school days per year). More activities are available through the textbook, workbook, and instructor’s manual than can be fit into the recommended time. The instructor should select activities that best suit his or her own teaching situation and training program duration.

Key Terms

adductor muscles A muscle group that aids in adduction of the hip; consists of the adductor longus, adductor brevis, and adductor magnus muscles.

coccyx The tailbone.

greater sciatic notch A space in the pelvis through which the sciatic nerve travels to the legs.

hamstring muscles A muscle group that aids in hip movement; consists of the biceps femoris, semitendinosus, and semimembranosus muscles.

hip flexors A muscle group that aids in flexion of the hip; consists of the iliopsoas, sartorius, pectineus, and rectus femoris muscles.

iliac crest contusion A painful injury caused by a direct blow to the hip, resulting in ecchymosis, tenderness, and swelling; also known as a hip pointer.

iliac crest The upper ridge of the ilium.

iliac fossa The broad, slightly concave inner surface of the ilium.

ilium A broad, flared bone that makes up the upper and lateral sections of the pelvis.

ischium The portion of the pelvis attached to the pubis in front and the ilium laterally in the back; bears the weight of the body when sitting.

obturator foramina The large openings in the ischium through which blood vessels and nerves pass to the legs.

pubis The bone in the pelvis to the front and below the bladder.

sacrum The portion of the vertebral column between the lumbar vertebrae and the coccyx; composed of five fused vertebrae.

symphysis The center of the pubis where the two sides of the pubis are fused together.

Lecture Outline

I. The Hip and Pelvis

a. The hip is one of the most stable joints in the body

i. Well protected and surrounded by muscle

ii. Freely movable, ball-and-socket joint

Key Concept

The hip is the strongest joint in the human body. It allows a great deal of motion. The pelvis, a support structure for the body, transmits the weight of the axial skeleton to the lower limbs. The pelvis also provides points of attachment for many muscles, as well as providing protection for the organs of the digestive, urinary, and reproductive systems.

b. The pelvis:

i. Provides attachments for various muscles that connect to and control the lower limbs

ii. Houses parts of the digestive and urinary tracts

iii. Houses reproductive systems

c. Skeletal structure of the pelvis:

i. Ilium

ii. Sacrum

iii. Ischium

iv. Pubis

v. Coccyx

d. Primary muscles of the pelvis, hip, and thigh

Key Concept

The hip joint is where the spherical head of the femur fits into the deep socket of the pelvis. The ilium, sacrum, ischium, pubis, and coccyx are the structures that constitute the pelvis.

Key Concept

Muscles from the lower back, pelvis, and thigh contribute to strength and stability. The largest muscle group of the hip and pelvic region is the gluteals. The adductor muscles assist in hip adduction. The quadriceps and hamstring muscles also assist in hip movement.

II. Common Injuries and Conditions of the Hip and Thigh

a. Bursitis

i. Commonly seen in athletes who do not sufficiently stretch and warm up the outside of the hip

. Symptoms: tenderness

. Treatment: limiting activity, stretching exercises, ice massage, and nonsteroidal anti-inflammatory medicines

e. Hip fracture

i. Break of the top part of the femur where it connects to the pelvis

. Symptoms: severe hip pain

. Treatment: highly individualized

f. Quadriceps and hip flexor strains

i. Common in sports requiring jumping, kicking, or repetitive sprinting

. Treatment: icing, compression with an elastic wrap, and anti-inflammatory medications

. Rehabilitation: progressive and sport specific

g. Hamstring strains

i. Mild or moderate damage in the muscle tissue

ii. Completely tearing the muscles or separating them from connective tendons is a hamstring tear

. Symptoms: sharp pain in the back of the thigh, bruising, swelling, loss of strength, and hearing a “pop”

. Treatment: RICE, medication, and physical therapy and rehabilitation

h. Adductor (groin) strains

i. Common in sports requiring sudden sideways changes in direction

. Treatment: rest, ice, and anti-inflammatory medications, adductor stretching and strengthening exercises

i. Iliotibial band syndrome

i. Inflammation of iliotibial band

. Symptoms: irritation over the outside of the knee joint

. Treatment: rule out mechanical problems or training errors; proper footwear, icing the area of pain, and stretching

j. Quadriceps contusions

i. Usually caused by a direct blow to the thigh

. Treatment: compression, ice (applied during the first 24 to 48 hours), and crutches

k. Myositis ossificans

i. Usually the result of recurrent trauma to a quadriceps muscle that was not properly protected after an initial injury

. Symptoms: hard, painful mass in the soft tissue of the thigh and progressive loss of bending motion of the injured knee

. Treatment: heat, limitation of joint motion, rehabilitative exercises within the limits of pain; surgery may be necessary

l. Iliac crest contusion

i. Painful injury caused by a direct blow to the hip

. Symptoms: extreme tenderness, swelling, and ecchymosis over the iliac crest

. Treatment: ice and compression

m. Overuse injuries

i. Cumulative effect of very low levels of stress

ii. Include chronic muscle strains, stress fractures, tendonitis, snapping hip, and bursitis

. Treatment: rest and exercise different body parts

n. Stress fractures

i. Pelvis stress fractures occur most often in runners and dancers

ii. Femur stress fractures usually occur in runners

. Symptoms: chronic, ill-defined pain over the groin and thigh

. Treatment: rest and nonweight-bearing endurance exercises

Key Concept

In athletics, there are several common injuries to the hip and pelvic region:

• Bursitis is inflammation of bursae toward the outside of the hip. Treatment is to rest and ice the affected area. Anti-inflammatory medication is also helpful.

• Fractures of the hip usually result from a fall and cause severe hip pain. Treatment will depend on the fracture type.

• Quadriceps and hip flexor strains usually occur in athletes whose sports require repetitive sprinting, jumping, and kicking. Treatment consists of ice, compression, and anti-inflammatory medications.

• Hamstring strains result when these muscles are pulled too far, too fast. Treatment is usually a combination of RICE, medication, and physical therapy.

• Adductor strains usually result from sudden sideways changes in direction. Typically, they are difficult to treat; rest, ice, anti-inflammatory medications, and stretching are recommended.

• Iliotibial band syndrome is an inflammation of the iliotibial band. Treatment includes analysis of gait and modification of the athlete’s training regimen.

• Quadriceps contusions are the result of a direct blow to the thigh. Treatment consists of compression, ice, and protection from weight bearing.

• Myositis ossificans is a painful condition in which a calcium deposit forms within the muscle. Treatment involves heat, limitation of joint movement, and rehabilitative exercises.

• Iliac crest contusions are a result of a direct blow to the hip. Treatment involves ice and compression.

• Overuse injuries are the result of the cumulative effects of low-level stress on one particular area. Treatment may include developing a more well-rounded training routine.

• Stress fractures of the pelvis occur most often in runners and dancers. Treatment consists of rest and nonweight-bearing exercises.

III. Conclusion

a. The hip is a stable joint that is well protected and surrounded by muscle on all sides

o. The pelvis is made up of several flattened bones that function as a support structure

p. Injuries to the hip and thigh are very common in athletics

Lesson Plans and Teaching Strategies

Follow the lecture outline to present material to students, using a variety of teaching strategies described in the Instructional Strategies, such as modified lecture and cooperative/collaborative learning.

Use an orthopedic surgeon as a guest speaker, focusing on a discussion of hip problems.

Contact a person who is living with an artificial hip, preferably someone whose replacement was the result of a sports-related problem. Ask the speaker to describe the experience, and any restrictions because of the surgery.

Answers to Student Exercises

Textbook Review Questions

1. In women, the pelvic bones are a bit less dense, shorter, and wider than the male pelvis. Also, bony protrusions are not as sharply defined in women.

2. The adductors include the adductor longus, adductor brevis, and adductor magnus. The abductors include the gluteus medius, gluteus minimus, and abductor brevis.

3. Common injuries to the hip and pelvic region include bursitis, an inflammation of the bursae, located toward the outside of the hip; fractures of the hip, usually from a fall, which result in severe hip pain; quadriceps and hip flexor strains, usually seen in athletes involved in sports requiring repetitive sprinting, jumping, and kicking; hamstring strains, when these muscles are pulled too far, too fast; adductor strains, usually from sudden sideways changes in direction; illiotibial band syndrome, an inflammation of the iliotibial band; quadriceps contusions, the result of a direct blow to the thigh; myositis ossificans, a painful condition in which a calcium deposit forms within the muscle; iliac crest contusions, the result of a direct blow to the hip; overuse injuries, the result of cumulative effects of low-level stress on one particular area; and stress fractures of the pelvis, occurring most often in runners and dancers.

4. A hip flexor strain most often involves the rectus femoris and/or iliopsoas muscles. A groin strain involves the adductor muscles.

5. The muscles include the biceps femoris, semitendinosus, and semimembranosus.

6. Pulling the hamstrings too far or too fast stretches the muscle fibers, causing the strain.

7. This disorder occurs in people who suddenly increase their level of activity, such as runners increasing their mileage; who overpronate; have leg discrepancies; or are bowlegged.

8. An ossifying mass forms within the muscle; usually a result from recurrent trauma to the muscle.

9. This is an iliac crest contusion caused by a direct blow to the hip.

10. The use of cross-training techniques may reduce the risk of overuse injury. These injuries are caused by the cumulative effect of very low levels of stress such as that caused by the repetitive action of running. An athlete with an overuse injury should rest from the sport that aggravated the injury and use cross-training techniques. Exercises that work different parts of the body to maintain cardiovascular conditioning will help the athlete to return to the sport sooner.

Workbook Vocabulary Review

Matching

1. J

11. O

12. D

13. G

14. A

15. N

16. I

17. B

18. A

19. C

20. L

21. K

22. M

23. E

24. F

25. P

26. E

Workbook Quiz

1. D

2. A

3. C

4. B

5. C

6. A

7. D

8. B

9. A

10. B

Critical Thinking

1. Answer will vary. Initial treatment includes icing, compression with an elastic wrap, and anti-inflammatory medications. As with all medications, a physician should be consulted. Rehabilitation should be progressive and sport specific. For example, for quadriceps strains caused by running, range-of-motion exercises and stretching should commence early and progress to strengthening exercises, walking, pool-running, jogging, limited speed running, and full-speed sprints as soon as the athlete is free of pain.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download