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INTRODUCTION

OBJECTIVES

After completion of this chapter, the physical therapist should be able to do the following:

  • Discuss the functional anatomy and biomechanics of the groin, hip, and thigh.

  • Discuss injuries to the groin, hip, and thigh and describe the biomechanical changes that occur during and after injury.

  • Discuss and describe the functional injury evaluation of the groin, thigh, and hip.

  • Articulate the role previous injury may play in subsequent injuries in the athlete.

  • Describe the at-risk populations and the mechanism of injury for muscle strains, muscle contusions, and acetabular labral injuries.

  • Demonstrate application of various intervention strategies for a wide variety of hip pathologies including muscle strains and contusions and acetabular labral injuries.

  • Apply principles of prevention and wellness using screening for imbalances and preseason-strengthening programs for susceptible populations.

  • Apply principles of stretching, strengthening, open- and closed-kinetic-chain exercises, plyometrics, isokinetics, and proprioceptive neuromuscular facilitation exercises to the hip complex as a part of comprehensive rehabilitation.

The occurrences of injuries to the hip, pelvis, and thigh are relatively small when compared to the other lower-extremity regions.1–5 Although statistically less prevalent, a hip pathology can cause immediate gait abnormalities, lead to chronic pain, and give rise to premature degeneration in the hip joint itself. These injuries can vary significantly depending on the specific sporting activity involved.6 Contact sports will have a high incidence of traumatic injuries, such as fractures, contusions, and dislocations, whereas endurance sports, like running, swimming, and biking, can lead to stress and overuse injuries. Flexibility-based sports such as dance and gymnastics predispose athletes to “impingement-induced instability” with activities that require extreme abduction and flexion causing anteroinferior and posteroinferior subluxation.7 No matter what the injury, proper diagnosis and intervention are key to returning the athlete back to the athlete’s sport(s) of choice. This chapter identifies common hip pathologies and directs an appropriate and concise rehabilitation program to optimize a patient’s recovery time.

ANATOMY AND BIOMECHANICS

The primary function of the hip joint is to support the weight of the head, arm, and trunk, while also serving as the connection between the lower extremities and the pelvic girdle. The anatomical design of the hip is well suited to handle this task as well as the increased loads that can be transmitted during athletic competition.8 Joint impact forces such as running produces loads up to three to five times body weight.

The joint itself is the articulation between the acetabulum of the pelvis and the head of the femur. These two segments form a diarthrodial ball-and-socket joint with 3 degrees of freedom: flexion/extension in the sagittal plane, abduction/adduction in the frontal plane, and medial/lateral rotation in the transverse plane.

The cuplike concavity of the acetabulum is formed by the fusion of three bones: ilium, ischium, and pubis. These bones typically unite by the late teenage years.9 The resulting socket is located ...

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