Hip Injuries
mvpboxing  |   May 04, 2017, 12:05PM

Labral Tear
  1. Definition and Occurrence
    1. Similar to the shoulder, the hip joint has a structure called a labrum that helps deepen the hip socket and situate the head of the femur. The labrum is made of a certain type of cartilage and thus can be stretched and ultimately torn if there is a traumatic hip injury.
    2. Most commonly occurs with a hip dislocation
    3. With sports that require repetitive and explosive hip movement, especially cutting and rotating, the labrum can become weakened, ultimately leading to a tear
    4. Osteoarthritis and hip impingement can lead to tearing of the labrum by weakening the cartilage.
  2. Signs and Symptoms
    1. Catching, popping, or locking in the hip joint when the leg is moved
    2. Pain and inflammation of the hip joint
  3. Treatment and Pre-hab
    1. Stretching
      1. Adductors, IT band, Quadriceps, Hamstrings, Piriformis, hip flexor muscles
      2. Important to maximize available hip range of motion so that there is enough room for the femur to move in the hip socket and to prevent any uneven loading within the joint
    2. Strengthening
      1. Hip flexors, abductors, adductors, gluteal muscles, hip rotators
      2. Balance exercises with one leg focusing on centering body weight over weight bearing leg
      3. Agility exercises to strengthen hips and legs in sport specific movements.
Calcification of Greater Trochanter
  1. Definition and Occurrence
    1. The greater trochanter is a bony prominence on the outside part of the upper femur that provides an attachment for many large hip and leg muscles. The muscles that attach here control rotation of the leg and help stabilize the hips during walking and running.
    2. Running overuse injury from the large stabilizing and rotator muscles pulling on the bone. It is rare, but sometimes the muscle tendon can become calcified due to overuse and inflammation.
  2. Signs and Symptoms
    1. Pain with resisted leg abduction and external rotation
    2. Sometimes there is pain with bending and flexing the lumbar spine
    3. Pain with passive leg internal rotation because you are stretching the large muscles that attach to the greater trochanter
    4. Full passive movement of the hip
  3. Treatment
    1. Ice and rest
    2. In the initial stages, cross training to maintain fitness but avoid continued stress on the greater trochanter
    3. Soft tissue massage of the muscles at their insertion to the greater trochanter
    4. Hip strengthening
      1. Hip abductors
      2. Hip extensors
    5. Stretching
      1. Piriformis, IT band, hip external rotator
    6. Proper footwear for running
  4. Pre-hab (prevention)
    1. Hip strengthening
    2. Hip stretching
    3. Balance training
    4. Core strengthening
Hip Pointer
  1. Definition and Occurrence
    1. This injury occurs when there is direct hit or blow to one of the bony prominences of the hip which causes a bruise. It primarily occurs in the areas of the iliac crest and greater trochanter.
    2. Common in contact sports, but also known to occur with falls onto the hip. Bone becomes bruised and inflammation and pain can spread to surrounding muscles and ligaments.
    3. Common in contact sports, but also known to occur with falls onto the hip.
    4. Bone becomes bruised and inflammation and pain can spread to surrounding muscles and ligaments.
  2. Signs and Symptoms
    1. Extreme, localized pain and inflammation where injury occurred
    2. Pain with active hip movements depending on muscles involved with injury and limits normal motion at the hip and trunk
    3. Because of close proximity of internal organs, follow-up with a family physician is advised to rule out potential fracture or internal injury
    4. Pain with contracting abdominal muscles since they attach at iliac crest
  3. Treatment
    1. Ice and rest
      1. This injury needs time to heal. Training through it could likely lead to compensations that could lead to other injuries
    2. The doctor may recommend anti-inflammatory injections to reduce pain and inflammation and speed recovery.
    3. Once pain has diminished, a gradual return to sport specific strengthening can be attempted.
      1. Important to stretch and strengthen muscles that may have become tight/ weak during period of inactivity, otherwise muscle imbalances leading to injury could result.
  4. Pre-hab (prevention)
    1. Proper padding and protection during contact sports
    2. Proper tackling form with football and other sports
Hip Bursitis
  1. Definition and Occurrence
    1. The bursa is a fluid filled adhered to the bone that helps promote smooth movement of muscles against the hip bones.
    2. If the muscles overlying the bursa are tight or are overused to compensate for a muscle imbalance, the bursa can become inflamed and crowd the space available for the muscle to function.
    3. Common overuse injury with sports
  2. Signs and Symptoms
    1. Pain with walking/running
    2. Pain with active hip abduction (moving leg away from body)
    3. Pain with passive hip adduction (moving leg towards midline of body)
    4. Pain on outside of upper leg and with lying on affected hip
  3. Treatment
    1. Rest, ICE, NSAIDs
    2. Stretching
      1. IT band
      2. Piriformis
    3. Strengthening
      1. Gluteus Medius
      2. Gluteus Maximus
      3. Core Strengthening
    4. Anesthetic injection
  4. Pre-hab
    1. Hip strengthening
    2. Hip stretching
    3. Gradual training buildup
    4. Alternating running surfaces
Piriformis syndrome
  1. Definition and Occurrence
    1. The piriformis muscle functions to rotate the leg outwards and to stabilize the hips during running and cutting maneuvers. The sciatic nerve sometimes pierces this muscle as it courses down the back of the leg. If the piriformis muscle should become tight, it can entrap the sciatic nerve and send pain signals down the leg.
    2. Can sometimes be misdiagnosed as lumbar disc herniation
  2. Signs and Symptoms
    1. Pain in the buttocks and down the back of the leg that is aggravated by prolonged sitting
    2. Pain with direct pressure on piriformis muscle
    3. The physician/physical therapist will perform several tests to distinguish this injury from lumbar disc herniation
  3. Treatment
    1. Stretching of piriformis muscle and Gluteal muscles
      1. It is important to strive for equal ranges of motion in both hips so that muscle imbalances don’t result leading to injury
    2. Postural Correction and biomechanics correction
      1. Over-pronation on one side can lead to increased rotation of the femur with each step, this could lead to the piriformis becoming overworked and inflamed from trying to prevent the femur from rotating too far inward.
    3. Soft tissue massage of piriformis muscle to help lengthen muscle and make room for sciatic nerve to glide
    4. Sciatic nerve gliding under direction of physical therapist
    5. Lifestyle changes
      1. Taking more frequent breaks with jobs that require sustained sitting posture
  4. Pre-hab (prevention)
    1. Stretching as mentioned above
    2. Hip and core muscle strengthening
    3. Remove wallet from back pocket
      1. Males who keep their wallet in the back pocket are placing prolonged direct pressure on the sciatic nerve as it passes under or through the piriformis muscle.

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