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March 13 - Ch17 thigh, hip,groin, pelvis.doc

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University of Alberta
Physical Education and Sport
Brad Kern

March 13 – Ch 17: Thigh, Hip, groin, and pelvis Prevention of Thigh Injuries • Thigh must have maximum strength, endurance, and extensibility to withstand strain. Poor flexibility will cause a strain in the thigh and groin areas. • Dynamic stretching programs may aid in muscle preparation for activity. Dynamic warm ups are the gold standard for pre-activity warm ups. • Strengthen programs can also help in preventing injuries (squats, lunges, leg press and core strengthening). The more musculature you have in your thigh, the more safer you are from injury. Recognition and Management of Thigh Injuries Quadriceps Contusions Cause of Injury • Constantly exposed to traumatic blows Signs of a Quadricep Contusion • Pain, transitory loss of function, immediate bleeding of affected muscles • Early detection and avoidance of internal bleeding are vital – increases recovery rate and prevents muscle scarring There are different grades of quad contusions. Grade 1 are superficial and have mild point tenderness and you can return to play Grade 2 contusions have more moderate intensity and are slightly deeper than grade 1. They are deeper and affect the ROM. There will be less than 90 degrees of knee flexion Grade 3 quad contusions are severe and can cause major disability and could split the fascia. It will bruise the deep muscle and cause deep muscle hematoma. ROM will be around 45-90 degrees of knee flexion. A small impact surface will cause a severe contusion rather than if you were hit with a large impact surface. A relaxed muscle will cause a more severe contusion. Pain may cause a limp Care for a Quadricep Contusion • RICE and NSAID’s. Put the knee on stretch and ice with the knee on stretch. • Crutches for more severe cases • Isometric quadriceps contractions should begin as soon as tolerated • Heat, massage and ultrasound to prevent myositis ossificans • Padding may be worn for additional protection upon return to play • We want to distribute the force on our thigh Myositis Ossificans Cause of Myositis Ossificans • Formation of ectopic bone repeated blunt trauma. If we don't try to protect the area getting hit, we will see myositis ossificans. Signs of Myositis Ossificans • X-ray shows calcium deposit 2-6 weeks following injury • Pain, weakness, swelling, decreased ROM • Tissue tension and point tenderness • There will irritation of an already injured area Care • Treatment must be conservative • May require surgical removal if too painful and restricts motion (after one year is when you should remove it – if removed too early, it may come back) • If condition is recurrent it may indicate problem with blood clotting Quadriceps Muscle Strain Cause of a Quadricep Muscle Strain • Sudden stretch when athlete falls on bent knee or experiences sudden contraction • Associated with weakened or over constricted muscle Signs of a Quadricep Muscle Strain • Peripheral tear causes fewer symptoms than deeper tear. Deeper tears cause severe pain, point tenderness, spasm and discoloration. • Pain, point tenderness, spasm, loss of function and little discoloration • Complete tear may leave athlete with little disability and discomfort but with some deformity. This mainly applies to the rectus femoris. There will only be little disability because there are 3 other muscles that do the same movement as the rectus femoris. People can have one muscle of the hamstring torn and will just do rehab on that muscle since there are other muscles to pick up the slack. Caring for a Quadricep Muscle Strain • Rest, ice and compression to control internal bleeding • Determine extent of injury early. We can do a muscle test (the -5 to +5 scale) • Neoprene sleeve may provide some added support Hamstring Muscle Strains This is the highest incidence of strain in all thigh muscles Cause of a Hamstring Muscle Strain There are multiple theories of injury • Hamstring and quad contract together • Change in role from hip extender to knee flexor • Fatigue, posture, leg length discrepancy, lack of flexibility, strength imbalances Signs of a Hamstring Muscle Strain • Muscle belly or point of attachment pain • Capillary hemorrhage, pain, loss of function, spasming and possible discoloration • Grade 1 – soreness during movement and point tenderness • Grade 2 – partial tear, identified by sharp snap or tear, severe pain, and loss of function. We may also be able to palpate a defect • Grade 3 – rupturing of tendinous or muscular tissue, involving major hemorrhage and disability, edema, loss of function, ecchymosis, palpable mass or gap • When you con
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