1.

Hip Pointer Structure: Blow to the iliac crest (iliac crest contusion), can be disabling because of soft tissue damage and secondary muscle spasm. The abdominal muscles attached to the iliac crest are crushed between the iliac crest and the object causing the injury. can lead to periostitis. Can be debilitating S/S: Swelling, Rapid formation of ecchymosis- escape of blood into tissue because of ruptured blood vessels, Muscle spasm in the abdominal and hip muscles, hip and trunk ROM painful and reduced, point tenderness, inability to rotate trunk and flex thigh Tx: RICE, NSAIDS, Stretching, protective padding, refer, cortisol injection, 1-3 weeks recovery 2. Femur Fx Structure: Can be acute or a stress fx that is chronic. Usually occurs at middle 1/3 of bone. . Immature skeleton- increase risk, Mature skeleton- suspect osteoporosis or bone tumor, Elderly- increased risk -Stress fx occur more frequently in athletes. Women experience the injury 4 to 10 times more frequently than men. Female endurance runners who are often amenorrheic, are more susceptible to stress fx, possible b/c of lower bone mineral densities. Stress fx usually precipitated by sudden significant increase in frequency, intensity, or duration of exercise. S/S: Patient may complain of a pulling sensation in the anterior thigh, pain or tenderness over the rectus femoris muscle, pain increases with activity, deformity, mild swelling, leg is shortened (because of powerful quadriceps and hamstring) and rotated, shock can result from the internal blood loss - monitor vitals, stress fx's usually develop around the femoral neck area (tension-side = superior aspect, compression-side= inferior aspect, displaced-require surgical fixation and are visible on plain radiographs) and typically produces consistent pain most of the time , bone scan is helpful to diagnose stress fx; also can use the fulcrum test, fist, or one-legged hop. Diffuse anterior hip pain, Full but painful ROM, Limping/limited activity b/c of pain, Tension-side (a), compression-side (b), displaced (c) Tx: Immobilize and refer, conservative care 3. Hip Dislocation- Avascular Necrosis Structure: Head of femur displaced from socket on pelvic girdle, rare, requires significant force or trauma, foot is usually planted and trunk/torso gets rotated in another direction, Femur is usually dislocated posteriorly. S/S: Severe pain, spasms, affected leg will be shortened and adducted with internal rotation Tx: Immbolize and Call EMS Complication: Avascular Necrosis -Death of bone tissue due to a lack of blood supply, which can led to tiny breaks in the bone and the bone eventually collapses. Hip most commonly affected

Mech: Certain traumas (such as hip dislocation), associated with long-term use of high dose steroid medications and excessive alcohol intake. The blood flow to a section of bone can be interrupted if the bone is fractured or the joint becomes dislocated. S/S: early: little/no indications, pain with wt. bearing, loss of ROM Tx: referral, eventual surgery and joint replacement 4. Hip Labral Tear Structure: A hip labral tear involves the ring of soft elastic tissue, called the labrum that follows the outside rim of the socket of your hip joint. The labrum acts like a socket to hold the ball at the top of your thighbone (femur) in place. Labrum in the acetabulum (acetabular labral tear) S/S: A locking, clicking or catching sensation in your hip joint, pain in your hip or groin, stiffness or limited range of motion in your hip joint, asymptomatic- showing no evidence of disease, but carries disease or infection Tx: Rest, NSAIDS, Physical Therapy, refer (arthroscopy) 5. Trochanteric Bursitis Structure: Caused by friction between the bursa and trochanter or result from direct trauma, such as landing on the lateral hip or a direct blow, affecting bursa over greater trochanter. Proximal ITB syndrome is a possible cause of snapping hip and often occurs concurrently with trochanteric bursitis. The snapping results as the ITB moves over the greater trochanter or in other cases the gluteus maximus snaps over the greater trochanter. Gluteus medius tendon rubs over greater trochanter. S/S: Lateral Hip pain aggravated by hip external rotation and abduction, if acute ecchymosis and swelling may be present, person may rotate the femur to clear the ITB from the greater trochanter, end ranges of motion may be uncomfortable, patient may lean away from the involved leg, placing most of the weight on the uninvolved extremity- antalgic gait, pain as ITB passes over the greater trochanter, inflammation, pain, untreated cond. Can lead to calcific bursitis, Pain on the outside of the hip and thigh or in the buttock. Pain when lying on the affected side. Pain when you press in on the outside of the hip. Pain that gets worse during activities such as getting up from a deep chair or getting out of a car. Pain with walking up stair

Tx: NSAIDS, corticolsteroid injection, possible surgery 6. Illiopsoas Bursitis Structure: Largest Bursa in body (6x3 cm), because of its proximity to the iliopsoas tendon, tendinities or bursitis can develop secondary to the other. Causes: rheumatoid arthritis, acute trauma, and overuse injury.

S/S: Gradual onset of progressive groin or anterior hip pain, pain especially during hip extension may be only symptom, shortened stride, and pain over illiopsoas bursitis, hip may be held in flexion, adduction, and external rotation to relieve pressure over bursa. Tx: Conservative care, strengthen, stretch, Bursectomy 7. Athletic Pubalgia Structure: Chronic Pubic or Inguinal region pain. Sports Hernia. A dilated superficial ring of the inguinal canal. Repetitive stress due to kicking, twisting, turning, cutting at high speeds causing constant stress leading to a strain or tear of any soft tissue (muscle, tendon, ligament) in the lower abdomen or groin area. S/S: Symptom onset may be acute or insidious. Pain is usually in the medial inguinal and pubic regions. Pain upon activity, usually around lower abdominals and into testicles; pain is increased with contraction of the abdominals, hip flexion and/or internal rotation; also pain on hip adduction with no adductor tenderness is a common sign. Tx: RICE, NSAIDS, refer, treatment consists of deep massage for about a week followed by stretching of torso/hip musculature for another week and then starting abdominal, hip adductor and flexor strengthening; at 3 to 4 weeks, running can begin, if conservative treatment is not successful, steroid shots or surgery is indicated 8. Osteitis Pubis Structure: Inflammation of the pubic symphisis, can occur from quadriceps strain. Chronic inflammatory condition S/S: Lower abdominal and pelvic pain, pain in groin area, especially upon running, doint sit-ups or doing squats Tx: Rest, Ice, NSAIDs 9. Quad/ Hamstring Strain Structure: Hamstring Strain- Sudden change from concentric to eccentric motion during activities makes hamstring susceptible to injury. A hamstring injury can be a pull, a partial tear, or a complete tear. Muscle strains are graded according to their severity. A grade 1 strain is mild and usually heals readily; a grade 3 strain is a complete tear of the muscle that may take months to heal. Most hamstring injuries occur in the thick part of the muscle or where the muscle fibers join tendon fibers. In the most severe hamstring injuries, the tendon tears completely away from the bone. It may even pull a piece of bone away with it. This is called an avulsion injury. They start at the bottom of the pelvis at a place called the ischial tuberosity. They cross the knee joint and end at the lower leg. Hamstring muscle fibers join with the tough, connective tissue of the hamstring tendons near the points where the tendons attach to bones. Flex Knee, Extend hip, tends to occur between musculotendinous junction, either proximally near the tendon insertion onto the ischial tuberosity or more toward the midbelly of the muscle, where tendon slips extend. Quad- Sudden contraction of the quadriceps muscle group. Most Common is Rectus femoris. This is because it is the only one of the four muscles which crosses both the hip and knee joints (one end performing concentric and the other performing eccentric). This makes it more susceptible to injury. The

most common site of injury is around the musculotendinous junction (where the muscle becomes tendon), just above the knee. Patellar tendon rupture- rupture between patella and distal insertion. Quadriceps tendon rupture- is a rupture that occurs between the origin of the individual muscles of the quadriceps group and the patella. S/S: Ham- Quick secondary spasm, ecchymosis within 2 days, defect in muscle contour, limited knee flexion, hip extension, antalgic gait, burning pain, may hear a pop or snap where tear takes place, painful lump or swollen area over back of thigh. Quad- Grade 1-2- decreased strength in affected to leg, antalgic gait, Grade 3- patient is likely unable to stand or bear weight on the extremity, inability to lift leg, stiff-legged gait is possible, in which the knee is locked by the hamstring. Pain and tenderness in the front of the thigh, Stiffness in the quadriceps, Weakness of the quadriceps, Bruising on the front of the thigh (if blood vessels are broken) Popping or snapping sensation as the muscle tears (rare) Grade 1

Some stretching with microtearing of muscle fibers. Recovery can be complete in 10-21 days.

Grade 2

Partial tearing of muscle fibers. Recovery can take up to 1-2 months.

Grade 3

Complete tearing (rupture) of muscle fibers. Recovery can take more than 3 months. Surgery may be needed to repair the torn muscle fibers.

Tx: RICE, NSAIDS, stretching, strengthen, 10. Myositis Ossificans Structure: Occurs as a result of muscle contusion. Most often found in the quad and brachialis muscles. Ectopic bone forms within the muscle as an outgrowth of the hematoma after a contusion. Myositis ossificans is an unusual condition that often occurs in athletes who sustain a blunt injury that causes

deep tissue bleeding. A typical story is a soccer player who is kicked forcefully in the mid-thigh, and develops pain and significant bruising. The soft-tissues that were injured in the traumatic event initially develops a hematoma, and subsequently develop the myositis ossificans. The word myositis ossificans means that bone forms within the muscle, and this occurs at the site of the hematoma. No one knows exactly why this occurs in some people. S/S: Point tenderness, swelling, discoloration, decrease ROM, include: stiffness, loss of ROM, severe pain, limping, ecchymosis, moderated swelling Tx: RICE, stretching, NSAIDS. 11. Groin Strain Structure: Occur in sports that require strong eccentric muscle action of the adductors. Adductor longus most frequently injured, tends to be injured at musculotendinous junction. MOI- usually a sudden, passive lengthening with a simultaneous active muscle contraction. Risk of strain increases if the strength ratio between adductors and abductors is less than 80% S/S: Pain and tenderness in the groin and the inside of the thigh, Pain when you bring your legs together. Pain when you raise your knee. A popping or snapping feeling during the injury, followed by severe pain. Symptoms of a groin strain Grade 1

Discomfort in the groin or inner thigh. This may not be noticed until after exercise stops. The groin muscles will usually feel tight. There may be an area which is tender to touch Walking is normal, discomfort may only be when running or even just on changes in direction.

Grade 2

A sudden sharp pain in the groin area or adductor muscles during exercise. Tightening of the groin muscles that may not be present until the following day. There may be minor bruising or swelling (this might not occur until a couple of days after the initial injury). Weakness and possibly pain on contracting the adductor muscles (squeeze your legs together). Discomfort or pain on stretching the muscle. Walking may be affected. Running is painful.

Grade 3

Severe pain during exercise, often on changing direction suddenly when sprinting. Inability to contract the groin muscles (squeeze your legs together). Substantial swelling and bruising on the inner thigh within 24 hours.

Pain on attempting to stretch the groin muscles. It may be possible to feel a lump or gap in the muscles.

Tx: RICE, stretch, refer if grade 3 Tests- Adductor Squeeze 12. Hip Flexor Strain Structure: Hip Flexor Strain is a muscle (illiopsoas) strain felt in the front part of the hip. It is often associated with speed training or compensating for another injury, especially Achilles tendonitis or plantar fasciitis. S/S: Pain, swelling, pain with flexion, pain with walking, muscle spasm, Hip flexor strains range from grade 1 to grade 3 and are classified as follows:

Grade 1 Tear: a small number of fibres are torn resulting in some pain, but allowing full function. Grade 2 Tear: a significant number of fibres are torn with moderate loss of function. Grade 3 Tear: all muscle fibres are ruptured resulting in major loss of function.

Tx: RICE, stretch, refer