Chapter 4: The Hip And Thigh

The list of superlatives attributable to the pelvis, hips and thighs could be the script for a truck TV commercial:  ranked number one in every category—largest and longest bones, heaviest bone, largest joint, largest and strongest muscles, the foundation for the entire upper body and the guardian of the pelvic organs. And that’s not all. At no extra charge, this all comes with style—symmetrical arches, portals and curves. It is clearly the most aesthetic community of bones in the body.

Maybe it could be the body’s equivalent of the truck. Certainly for many athletes it does truck work. It carries the load.

Table of Contents:   Hip  and  Thigh   77    What’s  Normal?  79    Hip  Joint  79         Muscles  80    Injuries  85    Groin  Injury  85   Muscle  Contusion  86   Muscle  Strain  90    Hip  Pointer  96    Avulsion Fractures  99    Stress Fractures  101    Bursitis  104   Labrum  Injury  108    Hip  Dislocation  110    Avascular  Necrosis  111    Cartilage  112

The 2 Minute Drill

  • This is not a fragile structure, but there are several fragile parts.                                                                                 
  • Even though the pelvis, hip and thigh region covers a lot of territory, there are basically only two moving bony parts—the pelvis and the femur bone.
  • Injuries love motion; most injuries are near the junction of these two moving parts.
  • Identifying the cause of pain can be difficult because symptoms overlap; serious conditions can feel the same as minor conditions.
  • Injuries usually involve one of three elements:  joints, bones, and muscle—very common.
  • The serious injuries to the pelvis, hip and thigh are the joint injuries and they can be very serious.
  • Injury near the joint is either:                                                                                          a. outside of the joint—usually resolve with treatment, or                                           b. within the joint—some cause chronic problems.
  • Muscle injuries are most common to the thigh.

Preview another exerpt from Chapter 4: Hip and Thigh:

BURSITIS AND TENDINOSIS                                                                                                        A bursa is a clever device to reduce friction between two structures. It is a flattened sack containing a thin layer of lubricating fluid (see Chap. 1:Bursa, page 16, Fig. 1-3).  Strategically sandwiched between soft tissues (muscle, tendon and skin) and hard bone, it serves to prevent abrasion and friction damage to the more delicate tissue. When the bursa becomes irritated, it is called bursitis.

What irritation?                                                                                                                Bursitis can be caused by direct impact trauma that results in bleeding into the bursa sack, but more often it is due to excessive friction. In the region of the hip joint, there are two common sites of bursitis:

  • the bursa of the greater trochanter (femur)
  • the bursa of the iliopsoas muscle

Greater Trochanter Bursitis                                                                                               The greater trochanter (the GT) is the prominent bony knob on the upper, outer side of the femur. A bursa separates the GT from the overlying iliotibial band (see Fig. 4-13). GT bursitis can be a problem for distance runners, football and soccer athletes; sometimes this is related to an abrupt change in their training routine.  Because the GT is not well padded, the bursa is also vulnerable to injury by direct impact with another player or a fall onto a hard surface.

Another condition, which is often indistinguishable from bursitis, is tendinosis of the abductor tendons (the glutes tendon) that attach to the GT.

How does it feel?                                                                                                      1.  Pain develops at the greater trochanter (lateral hip pain) and may extend down the outer side of the thigh.                                                                                                                                                        2.  Activities which flex the hip such as climbing stairs, standing from a sitting position and running worsen the pain.                                                                                                                                                               3.  Direct pressure, such as lying on the affected hip during sleep, is painful.                        4.  The pain may be accompanied by a snapping sensation or sound with leg movement (extension to flexion).

Iliopsoas  Bursitis                                                                                                                   The iliopsoas muscle extends from the deep pelvis and the lower spinal column to the femur. The muscle and tendon drape and drag across the front of the hip joint (see Fig. 4-14). The bursa lies between the joint and the muscle. Both the cushioning bursa and the tendon can become irritated and painful during repetitive movement.

Because the iliopsoas muscle is the major hip flexor, it plays a critical role during walking, running and kicking (see Fig. 4-9). It advances the leg by swinging the thigh forward and upward.

How does it feel?                                                                             1.  Pain can limitambulation.                                                                2.  Pain often improves when the thigh is bent upward and held in flexion; straightening (extending) the thigh stretches the iliopsoas muscle and worsens the pain.

Treatment                                                                                                                                         The treatment of both types of bursitis is similar. Most symptoms respond to the initial therapy of rest, ice, and over-the-counter pain medication or anti-inflammatory medications. It is helpful to avoid painful activities and positions, such as sleeping on the affected side in the case of trochanter bursitis.  As the pain improves, gentle stretching and heat application are useful.  As recovery progresses, muscle strengthening exercises are begun as tolerated.  Sometimes injecting anti-inflammatory medication (corticosteroid) into the bursa is necessary.  Recovery is variable but can be four to six weeks.  Medical evaluation is important to rule out a joint injury.

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