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Module 5: Hip and Thigh Injuries - Coggle Diagram
Module 5: Hip and Thigh Injuries
Hamstring Injuries
Intro
high recurrence rate among athletic injuries
as high as 33% in some sports
larger lesions are more likely to have recurring issues
most common injury in some sports
Most common is biceps femoris
76-87% of HS injuries are in the bicep femoris
Risk Factors
Instrinsic
history of HS strain
history of other lower body injury
age (older=more prone)
hamstring strength: Quad ratio
appropriate ratio = 50/50
Extrinsic
sport/position
fatigue
Injury Mechanism
eccentric contraction (Type 1)
muscle involved
long head of biceps femoris
site of injury
proximal MT junction
rehab
shorter recovery
pain
acute onset, immediate loss of function
Prolonged Stretch (Type 2)
rehab
longer recovery
muscle involved
proximal semimembranosis (often tendon) can also involve QF and AM
pain
may be less clear
site of injury
near ischial tuberosity
Diagnosis
Active & Passive ROM
comparing point of pain
Strength Testing
palpation
Imaging
if full rupture suspected - always MRI
MRI can also be done to establish prognosis
Sources of referred pain
lumbar spine
nerve root compression
spondylolisthesis, spondylolysis
muscular/ligamentous pain
sacroiliac joint
gluteal myofascial trigger points
glute med, glute min, piriformis
Injury Management
Acute HS
NSAIDS appear no more effective than analgesics
Once walking is pain-free, and an athlete can perform resisted knee flexion pain-free, jogging can begin
First 48 hrs
ice and compression seem to help
isometric or active prone knee flexion 3-4x/day
Subacute
Massage
Strengthening/neuromuscular control
Address any other contributors
lumbar issues, SIJ, pelvic tilt
gradual return to play
Controlled stretching program may be used
HS stretching + hip flexor and other surrounding musculature
Hip Injuries
Femoral Stress Fractures
Neck Stress Fracture
Intro
often felt as groin pain
groin pain worse with activity
usually vague location and insidious onset
pain at extremes of hip ROM on exam
Must distinguish b/w other common causes of groin pain
hernia
hip labral tear
hip flexor pathology
adductor strain
History and good clinical exam is important in distinguishing
Risk factors
poor footwear
hard training surfaces
leg length discrepancy
poor bone density
often seen in distance runners
female athlete triad
or in military trainees
Treatment
tension side fractures
surgical emergency
require urgent internal fixation due to high risk of fracture completion
compression side fractures
non WB
Femoroacetabular Impingement (FAI)
Intro
3 types
Pincer impingement
especially deep or retroverted acetabulum, resulting in a deep anterior acetabular wall
Mixed
both characteristics observed
Cam (ganz) lesion
a bony formation occurs at the femoral neck
either genetic or from over-activity at the epiphyseal plate during growth in adolescence
20% of ppl have FAI but not always symptomatic
often observed as groin pain with a concomitant loss of ROM
May lead to the development of
Chondropathy
Osteoarthritis
labral tears
Clinical assessment involves the FADIR test but xrays are likely for diagnosis
FADIR test (flexion, adduction, Internal Rotation)
Risk Factors
Extrinsic
Volume of training
Footwear
Type of sport
Playing surface
Intrinsic
Reduced hip internal rotation
reduced hip extension
Reduced hip flexion
increased femoral adduction/internal rotation
pelvic tilt/lumbar hyperextension
poor lumbopelvic control
overpronation
tight ITB
Poor ankle mobility
Treatment
Avoiding the aggravation position
depends on the resulting pathologies of FAI
Activity modulation
Labral Tears
Acetabular Labral tears
Intro
Anterior labral tears are most common
Classified as Type 1 or 2
Increased likelihood in individuals with FAI or hip dysplasia
Mechanism
Labrum is subjected to shear forces in the presence of hip dysplasia
In athletes, repeated twisting and pivoting of the hip
Labrum becomes impinged in cases of FAI
Imaging
MR Arthrogram
still may not be 100% reliable
May have to wait until surgery to diagnose
Treatment
Injection therapy
corticosteroid
Surgical treatment may be indicated
conservative treatment may be trialed
Hip strengthening (especially deep musculature)
Gait retraining
Avoiding aggravating positions, especially at end ranges
Attempting to unload the torn labrum
Pubic Bone Stress
Terminology
Non-specific exercise-related groin pain has been termed things like ‘osteitis pubis’ or ‘athletic pubalgia’
Osteitis pubis initially described groin pain that showed structural changes on imaging
Became an umbrella term to describe groin pain
this type of groin pain is rarely inflammatory
pubic bone stress may be more accurate
Factors leading to bone stress
Shortened Iiliopsoas muscle
High adductor tone
High rectus abdominus tone
Decreased lumbopelvic stability
Lumbar/SIJ dysfunction
Limited hip ROM
Cause and Effect
bone stress often presents as generalized, chronic groin pain
Uncertain whether bone stress causes pain/dysfunction
or if pain/dysfunction in surrounding stabilizers causes bone stress
Imaging
77% of soccer players with groin pain/PS tenderness had bone marrow edema on MRI
54% of asymptomatic players also showed MRI evidence of bone marrow edema
Groin pain was more closely associated with training load than extent of MRI changes
Treatment
Corticosteroids
No well-controlled studies, but oral and injected corticosteroids seem to provide acute relief
Dextrose prolotherapy
some evidence
Addressing the predisposing factors and adjusting training
Surgical debridement
in severe chronic stage cases, where imaging shows erosion