By Scott Butcher (B.Sc.PT)
Injuries to the pelvis, hip and thigh are common in sports, especially high energy or contact sports. There are several general categories in which these may be placed. There may be sprains, strains, contusions, avulsions, traumatic fractures, stress fractures, or other various injuries. Many of these are potentially serious or life threatening and others may be sporting career threatening. Injuries of the hip and thigh tend to be soft tissue injuries and those of the pelvis tend to be bone or joint injuries.
Sprains to ligaments and joints are relatively uncommon in this region due to the fact that the ligaments of the hip and pelvis are very thick and strong. If these do occur, the most common joints are the sacroiliac joint and the pubic symphysis. The hip is very seldom sprained. Treatment is most often non surgical and depends upon the location and severity.
Strains are relatively common leg injuries and most often occur in the thigh. Strains are muscle injuries that result from rapid and/or excessive stretch or contraction of that muscle. This will cause a tearing of a number of muscle fibers or the connective tissue surrounding the muscle fibers. The severity of strain is determined by the amount of tearing that occurs. A complete muscle tear usually requires surgery Common areas of susceptibility include the hamstrings, groin (adductor and hip flexor muscles) and quadriceps. Strains are usually managed conservatively by employing the RICE principle (Rest, Ice, Compression, Elevation) initially, then progressing to stretching and active exercise, then eventually to a gradual return to sport.
Tendon ruptures are uncommon among the adolescent athlete but may be much more prevalent in middle aged men. These usually result from a contraction of the muscle that attaches to the tendon when that muscle is in a stretched position. Many researchers believe that tendon ruptures are the result of long term degeneration in the tendon and often only a relatively small force of contraction is needed to rupture the tendon. Severity depends upon the amount of tearing that occurs and moderate to severe tears and complete ruptures will usually require surgery. The quadriceps and patellar tendons are often involved.
Avulsions are the fracturing of a bone at it’s attachment to a tendon as a result of a strong pull of that tendon. This usually occurs with a violent contraction of the muscle or a sudden passive stretch. Adolescents are more commonly affected because the fracture from an avulsion tends to occur at the growth plate. Common areas include the Anterior Superior Iliac Spine with a pull of the Sartorious tendon, the Anterior Inferior Iliac spine with a Rectus Femoris pull, the Ischial tuberosity with a Hamstrings pull and the Tibial tuberosity with a Quadriceps pull. Treatment will tend to be non surgical with rest for up to three months.
Contusions, or deep bruises, are common in contact sports. Contusions are usually caused by a direct blow from hard or fast moving object, implement or piece of equipment. These can occur in both soft tissue structures (muscles) or bony structures. The quadriceps and gluteal muscles and the iliac crest, coccyx, and greater trochanter are often involved. Contusions to bone can be very painful as the layer of tissue that covers the bone (the periosteum) can be very sensitive. Contusions to muscle can be very serious. There are two possible serious consequences. The first is a compartment syndrome. The contusion will cause a bleed in the muscle that may be contained by the muscle’s connective tissue in a ‘compartment’. If this bleed is severe, the compartment will fill up and stretch. This will cause increased pressure on the other structures within the compartment (i.e. the artery, vein and nerve) and may cause a blockage of blood which is a life threatening situation. The second possible consequence is myositis ossificans. This is the formation of a bony callous in the muscle tissue. If the direct blow is deep enough to go through the muscle and damage the bone, the cells that regenerate the bone will escape into the muscle tissue and begin to lay down bone. This can be very serious and career ending. Treatment is non surgical initially with complete rest for up to one year. If a bony callous is still present at that time, surgery may be considered to remove it.
Acute or traumatic fractures can occur in the pelvis or femur. High speed forces or direct blows are often the culprit. Pelvic fractures can occur at the iliac crest and coccyx and femur fracture most often occur close to the hip (at the femoral neck). Treatment, depending on the site and the severity, may be surgical or non surgical with traction and/or casting. Return to sport may be delayed 6 months to a year or longer.
Stress fractures can occur at the pelvis or femur. Stress fractures are the gradual breakdown of bone from repetitive stresses. These occur due to long term abnormal stresses and are common in runners. Pain with these stress fractures may be felt in the groin and may be mistaken for a groin strain. Treatment is usually non surgical and involves rest and a gradual return to activity.
Snapping hip syndrome is a click or a snap with certain hip movements. It is usually due to the rubbing of a tendon over a bony prominence. The iliotibial band rubbing over the greater trochanter or the iliopsoas (hip flexor) rubbing over the lesser trochanter may be the cause. Snapping hip syndrome may cause or be caused by a bursitis, an inflammation or a tight muscle. Treatment usually involves rest, stretching and ice to reduce the inflammation.
These are just a few of the hip, pelvis and thigh injuries that may be encountered by coaches, parents or trainers at sporting events. Treat every injury with caution and if in doubt, assume a serious injury and seek help.