What are the key components of hip anatomy. How do bones and muscles work together in the hip joint. What causes hip pain and discomfort. How can you maintain hip health and prevent issues.

The Fundamentals of Hip Joint Structure

The hip joint is a remarkable feat of biological engineering, serving as the largest ball-and-socket joint in the human body. This intricate structure allows for a wide range of motion, enabling activities like walking, running, and climbing. Let’s delve into the core components that make up this essential joint.

The Pelvic and Femur Connection

At its core, the hip joint consists of two primary bones: the pelvis and the femur (thighbone). The rounded end of the femur, known as the femoral head, fits snugly into a concave depression in the lower side of the pelvis called the acetabulum. This configuration forms the characteristic ball-and-socket structure of the hip joint.

The Role of Cartilage in Hip Function

Cartilage plays a crucial role in the smooth operation of the hip joint. It acts as a protective layer between the femoral head and the acetabulum, reducing friction during movement. However, when this cartilage begins to wear down or becomes damaged, it can lead to hip pain and discomfort.

Essential Muscles and Tendons of the Hip

The hip’s range of motion is controlled by a network of powerful muscles and tendons. These structures work in harmony to provide stability and facilitate movement. Understanding these key players can help in maintaining hip health and addressing potential issues.

The Gluteal Muscle Group

Perhaps the most well-known hip muscles are the gluteal muscles, commonly referred to as the “glutes.” These large, strong muscles attach to the back of the hip bones and form the buttocks. They play a vital role in maintaining posture and enabling walking by attaching to the greater trochanter, a bony prominence on the upper femur.

The Iliotibial Band

Overlaying the gluteal muscles is the iliotibial band, a long tendon that runs from the brim of the pelvis down the leg. This structure can contribute to hip pain if it becomes too tight or overused.

Other Important Hip Muscles

• Adductor muscles: Located on the inside of the thigh
• Iliopsoas muscle: A hip flexor muscle attaching to the upper thighbone
• Rectus femoris muscle: One of the quadriceps muscles on the front of the thigh

These muscles work in concert to provide a full range of motion while maintaining body stability and upright posture.

Common Sources of Hip Pain and Discomfort

Hip pain can stem from various sources, ranging from muscle strains to more serious conditions like arthritis. Identifying the root cause is crucial for effective treatment and management.

General Causes of Hip Pain

1. Muscle strain
2. Bone fractures (e.g., femoral neck fracture)
3. Tendinitis
4. Arthritis
5. Bone spurs or other hip malformations

Bursitis: A Common Culprit

Bursitis is a frequent cause of hip pain, particularly in the form of trochanteric bursitis. This condition occurs when the bursae, small fluid-filled sacs that act as cushions between bones, muscles, and tendons, become inflamed or damaged. Trochanteric bursitis specifically affects the outside of the hip, but bursae in other parts of the hip can also be affected.

Maintaining Hip Health and Preventing Issues

Preserving hip health is crucial for maintaining mobility and quality of life. By implementing certain practices and habits, you can reduce the risk of hip problems and manage existing conditions more effectively.

The Importance of Flexibility and Muscle Tone

Maintaining flexibility and muscle tone is fundamental to hip health. Regular stretching and strengthening exercises can help keep the hip joint and surrounding muscles in optimal condition. This approach can significantly reduce the risk of pain and injury.

Lifestyle Modifications for Hip Health

• Maintain a healthy weight to reduce stress on the hip joint
• Engage in low-impact exercises like swimming or cycling
• Practice good posture to distribute weight evenly
• Wear supportive footwear
• Avoid sitting for prolonged periods

Diagnosing Hip Problems: When to Seek Professional Help

While some hip discomfort may be manageable with home remedies, certain symptoms warrant professional medical attention. Recognizing these signs can lead to earlier intervention and more effective treatment.

Red Flags for Hip Issues

• Persistent pain lasting more than a few days
• Difficulty walking or bearing weight on the affected hip
• Swelling or deformity around the hip joint
• Pain that interferes with sleep or daily activities
• Sudden onset of severe pain following an injury

If you experience any of these symptoms, it’s advisable to consult with a healthcare professional for a proper diagnosis and treatment plan.

Treatment Options for Hip Conditions

The treatment of hip conditions varies depending on the underlying cause and severity of the problem. From conservative approaches to surgical interventions, there are numerous options available to address hip pain and dysfunction.

Conservative Treatment Approaches

• Rest and activity modification
• Physical therapy and targeted exercises
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Ice or heat therapy
• Corticosteroid injections

Surgical Interventions

In cases where conservative treatments are ineffective, surgical options may be considered. These can range from minimally invasive procedures to total hip replacement, depending on the specific condition and patient factors.

The Future of Hip Care: Emerging Treatments and Technologies

As medical science advances, new approaches to hip care are continually emerging. These innovative treatments and technologies hold promise for improved outcomes and faster recovery times.

Regenerative Medicine

Stem cell therapy and platelet-rich plasma (PRP) injections are gaining attention as potential treatments for various hip conditions. These approaches aim to harness the body’s natural healing processes to repair damaged tissues.

Advanced Imaging Techniques

High-resolution MRI and 3D imaging technologies are enhancing diagnostic accuracy and treatment planning. These tools allow for more precise identification of hip problems and tailored treatment strategies.

Robotic-Assisted Surgery

Robotic-assisted hip surgery is becoming increasingly common, offering potential benefits such as increased precision and shorter recovery times. This technology allows surgeons to perform procedures with enhanced accuracy and control.

Understanding hip anatomy is crucial for maintaining joint health and addressing potential issues. By familiarizing yourself with the bones, muscles, and common pain sources associated with the hip, you can take proactive steps to prevent problems and seek appropriate care when needed. Remember that maintaining flexibility, muscle tone, and a healthy lifestyle are key factors in preserving hip function and overall mobility. If you experience persistent hip pain or other concerning symptoms, don’t hesitate to consult with a healthcare professional for proper evaluation and treatment.

A Guide to Hip Anatomy: Bones, Muscles, Tendons & Pain Sources

If you are starting to feel hip pain or stiffness, you’ll want to know more about the bones and muscles that make up the hip’s anatomy.

Hip Anatomy: Bones

The hip joint is made up of two bones: the pelvis and the femur (the thighbone). It is the largest ball-and-socket joint in your body. The “ball” is the rounded end of the femur (also called the femoral head). The “socket” is a concave depression in the lower side of the pelvis (also called the acetabulum). The femoral head fits into the acetabulum to form the hip joint. This anatomy allows for a lot of motion within the joint — for instance, walking, running, and climbing.

The femoral head attaches by way of the femoral neck to the rest of the femur. At the top of the femur, next to the femoral neck, there is another bump on the outside of your hip called the greater trochante to which muscles attach. Cartilage helps prevent friction between the femoral head and the acetabulum, but hip pain can occur if your cartilage begins to wear down or is damaged.

“I see a lot of patients who have injuries to the joint, especially to cartilage,” says Brian Parsley, MD, assistant professor in the department of orthopedic surgery at the Baylor College of Medicine in Houston, Texas.

Hip Anatomy: Muscles and Tendons

The motion of the ball-and-socket is controlled by several very powerful muscles which attach to the bones. The muscles you probably know the best are your “glutes” (gluteal muscles), the large, strong muscles that attach to the back of your hip bones and comprise the buttocks.

“The glutes attach to your greater trochanter; those muscles help hold your pelvis and your body up so you don’t fall over and also help you walk,” says Dr. Parsley. “On top of that layer of muscle is the iliotibial band, which starts at the brim of your pelvis outside the hip joint and runs down your leg.”

If the iliotibial band (a long tendon that many muscles in your hip and leg attach to) becomes too tight or overused, this can contribute to hip pain.

Some of the other muscles in the hip are:

• Adductor muscles on the inside of your thigh.
• Iliopsoas muscle, a hip flexor muscle that attaches to the upper thigh bone.
• Rectus femoris muscle, one of the quadriceps muscles on the front of your thigh.

Muscles play an important role in the health and well-being of your hip. All these muscles work together to provide you with range of motion in your hip while keeping your body stable and upright. “The underlying recommendation for preventing hip pain would be to try and maintain flexibility and muscle tone,” Parsley says.

Hip Anatomy: Pain Sources

General causes of hip pain include:

• Muscle strain
• Bone fracture (such as a fracture of the femoral neck)
• Tendinitis
• Arthritis
• Bone spurs or other malformations of your hip

Parsley also sees a lot of patients with bursitis of the hips. This condition is caused when bursae, small fluid-filled sacks that act as cushions in parts of your body where there is friction between muscles, bones, and tendons, become inflamed or damaged from injury or infection.

One of the most common forms of bursitis is trochanteric bursitis (pain on the outside of your hip), but there are bursae in other parts of your hip as well. For example, there is one under the iliopsoas muscle in the front of your hip.

The hip is a complicated mechanism and therefore hip pain can originate in many different parts of the joint. Learning the anatomy of your hip will better enable you to pinpoint your pain and work with your doctor to keep it from limiting your life.

Surgery for Trochanteric Bursitis of the Hip

Introduction

In many areas of the body, muscles and tendons must slide over and against one another during movement. At each of these places, a small sac of lubricating fluid helps the muscles and tendons move properly. One of these places is the hip. Usually these sacs of fluid, called bursae, function to reduce friction, but if they become swollen and irritated, they can cause pain.

One common area where this occurs is the bursa on the outside of the hip (trochanteric bursa) creating a condition known as trochanteric bursitis. This condition is common in older individuals, but may occur in younger patients who are extremely active.

Anatomy

The hip socket is called the acetabulum and forms a deep cup surrounding the ball of the upper thighbone (femur), or femoral head. The hip is surrounded by the thick muscles of the buttock at the back and the thick muscles of the thigh in the front.

On the outside of the upper end of the femur is a large bump (greater trochanter). This bump is the point where the large buttock muscles that move the hip connect to the femur. These muscles help rotate and move the hip outward. Another layer of muscle, the gluteus maximus, slides over this bump and is attached further down on the thigh bone (femur).

Where friction must occur between muscles, tendons, and bones there is usually a structure called a bursa. A bursa is a thin sac of tissue that contains a bit of fluid to lubricate the area where the friction occurs. The bursa is a normal structure, and the body will even produce a bursa in response to friction.

Causes

Sometimes a bursa can become inflamed because of too much friction or because of an injury to the bursa which can result in pain.

Friction can occur in the bursa during walking if the long tendon on the side of the thigh is tight. It is unclear what causes this tightening of the tendon. The gluteus maximus attaches to this long tendon. As you walk the gluteus maximus pulls this tendon over the greater trochanter with each step. When the tendon is tight, it rubs closely against the bursa with each step. The rubbing causes friction to occur in the bursa, leading to irritation and inflammation. Friction can also start if the outer hip muscle (gluteus medius) is weak, if one leg is longer than the other, or if you run on banked surfaces.

Most cases of trochanteric bursitis appear gradually with no obvious underlying injury or cause. Trochanteric bursitis can occur after artificial replacement of the hip joint or other types of hip surgery. This may be a combination of changes in the way the hip works, the way it is aligned, or the way scar tissue has formed from the healing incision. Trochanteric bursitis can also occur as a result of repetitive motion injuries from activities such as running.

A fall on the hip can injure the bursa. This may cause bleeding into the bursa. The bleeding is not serious, but the bursa may react to the blood by becoming inflamed. The inflammation causes the bursa to become thickened over time. This thickening, constant irritation, and inflammation may result in the condition becoming chronic, or long lasting.

Symptoms

The first symptom of trochanteric bursitis is usually pain. The pain can be felt in the area of the hip right over the bump that forms the greater trochanter. Eventually the pain may radiate down the outside of the thigh. As the problem progresses, the symptoms include development of a limp when walking and stiffness in the hip joint. Eventually, the pain will also be present at rest and may even cause a problem with sleeping.

Diagnosis

The diagnosis of trochanteric bursitis begins with a history and physical examination. In fact, this is usually all that is necessary to make the diagnosis. Your doctor will want to know when the pain began and which motions cause the pain. A physical examination will be done to determine how much stiffness you have in the hip and if you have a limp. Once this is done, X-rays will most likely be ordered to make sure that there are no other abnormalities in the hip.

Diagnostic Injection

One simple way that the diagnosis of trochanteric bursitis can be made is with an injection of local anesthetic directly into the bursa. This is a procedure that can easily be performed in the office. To perform this procedure, you will probably be asked to lay on the examining table on your side with the sore hip up. Once the skin is cleansed with antiseptic, a long needle is used to inject ten to twenty milliliters of a medication such as novocaine directly into the trochanteric bursa. If the injection removes the pain immediately, then the diagnosis is probably trochanteric bursitis. Most physicians will also add a bit of cortisone medication into the novocaine to help treat the condition at the same time.

Treatment

Conservative Treatment

Conservative treatment can be very successful for trochanteric bursitis. Younger patients who suffer from trochanteric bursitis because of repetitive motion can usually be treated by reducing their activity or changing the way they do their activity. Combining this with an exercise program of stretching and strengthening and a brief course of anti-inflammatory medications will usually resolve the problem.

Your doctor may also prescribe sessions with a physical therapist. Treatments are used to calm inflammation and may include heat or ice applications. Therapists use hands on treatment and stretching to help restore full hip range of motion. Improving strength and coordination in the buttock and hip muscles also enables the femur to move in the socket smoothly and can help reduce friction on the bursa. You may need therapy treatments for four to six weeks before full motion and function return.

If rehabilitation fails to reduce your symptoms, an injection of cortisone into the trochanteric bursa may ease your symptoms and give temporary relief of the condition. Cortisone is an anti-inflammatory medication which when injected directly into the bursa can reduce the inflammation and pain. Injections will probably not cure the problem but may control the symptoms for months.

Surgery

Surgery is rarely needed to treat trochanteric bursitis. When all else fails and the pain is disabling, your doctor may recommend surgery. Several types of surgical procedures are available to treat trochanteric bursitis.

The primary goal of all procedures designed to treat this condition is to remove the thickened bursa, to remove any bone spurs that may have formed on the greater trochanter, and to relax the large tendon of the gluteus maximus. Some surgeons prefer to lengthen the tendon slightly, and some prefer to remove a section of the tendon that rubs directly on the greater trochanter.

Rehabilitation

Even if surgery is not needed, you may need to follow a program of rehabilitation exercises. Your doctor may recommend that you work with a physical therapist. Your therapist can create a program of stretching and strengthening for your hip. It is very important to maintain a balance of flexibility and strength of the hip. You will probably progress to a home program within four to six weeks.

If surgery is required, physical therapy sessions may be needed for up to two months after surgery. The first few treatment sessions will focus on controlling the pain and swelling after surgery. You will then begin exercises that gradually stretch and strengthen the muscles around the hip joint. Your therapist will help retrain these muscles to keep the ball of the femur moving smoothly in the socket. Your therapist will give you tips on ways to do your activities without straining the hip joint.

Surgery for Trochanteric Bursitis of the Hip

Introduction

The bump of bone on the outside of the hipbone is called the greater trochanter. When the tissue or bursa in this area becomes thickened and inflamed causing pain, surgery may be needed to remove the bursa and to reduce tension on the tendon that glides over it.

Where friction must occur between muscles, tendons, and bones there is usually a structure called a bursa. A bursa is a thin sac of tissue that contains a bit of fluid to lubricate the area where the friction occurs. The bursa is a normal structure, and the body will even produce a bursa in response to friction.

The trochanteric bursa lies over the greater trochanter of the hip, the bump on the outer part of the femur. The gluteus maximus is the largest of three gluteal muscles of the buttock. This muscle spans over the side of the hip and joins the iliotibial band. This long tendon passes over the bursa on the outside of the greater trochanter, runs along the side of the thigh, and attaches just below the outside edge of the knee.

Walking causes the gluteus maximus to pull on the tendon. If the tendon is tight, it will start to press and rub against the greater trochanteric bursa. It is unclear why the tendon becomes tight. The rubbing causes friction to build in the bursa, leading to irritation and inflammation in the bursa.

Friction can also start if the outer hip muscle (gluteus medius) is weak, if one leg is longer than the other, or if you run on banked surfaces.

Rationale

Surgery is indicated for this condition only after conservative treatments have failed including anti-inflammatory medications, cortisone injections and physical therapy. The primary goal of surgery is removing the thickened bursa, removing any bone spurs (knobby outgrowths) that may have formed on the greater trochanter, and relaxing the large tendon of the gluteus maximus. Some surgeons prefer to simply lengthen the tendon a bit, and some prefer to remove a section of the tendon that rubs directly on the greater trochanter. Both procedures result in taking pressure off the bursa.

Surgical Procedure

Before surgery begins, you will be given anesthesia. There are two basic options: a general anesthetic (one that puts you to sleep) or a regional block (one that numbs the area to be worked on). For hip surgery the most common type of regional anesthetic available is either a spinal block or an epidural block. Both of these regional blocks numb the body from the waist down.

An incision is made in the side of the thigh over the area of the greater trochanter. The surgeon continues the incision through the tissues that lie over the bursa.

The tendon is split so the trochanteric bursa and the bone of the greater trochanter can be seen. The tendon is split lengthwise.

The surgeon then removes the bursa sac.

The bone of the greater trochanter is smoothed, and any bone spurs are removed.

At this point the tendon may be lengthened or released and not repaired. If the surgeon chooses not to repair the tendon, scar tissue will eventually heal the loose edges of the tendon. As it heals, it will be looser than before surgery, so it won’t rub on the greater trochanter quite so much. The skin is closed with stitches.

As with any major surgery, complications are possible during the operation and after. Some of the most common complications following surgery for trochanteric bursitis are infection, nerve or blood vessel injury, and failure of the operation.

After Surgery

After surgery, your hip will be covered over with a padded dressing. You will probably be advised to avoid a great deal of activity within the first week after surgery. Support your outer hip with a pillow when you sit or recline. During this time, you may also be instructed to use crutches to keep from placing weight on your hip while standing or walking. Your stitches will be removed ten to fourteen days after surgery. If your surgeon chooses to use dissolvable stitches, these will not need to be removed.

Rehabilitation

Rehabilitation after surgery can be a slow process. You will probably need to attend therapy sessions for several weeks, and you should expect full recovery to take several months. Getting the hip moving as soon as possible is important. However, this must be balanced with the need to protect the healing muscles and tissues.

Ice and electrical stimulation treatments may be used during your first few physical therapy sessions to help control pain and swelling from the surgery. Your therapist may also use massage and other hands-on treatments to ease muscle spasm and pain.

Treatments include range-of-motion exercises and gradually work into active stretching and strengthening. Active therapy starts two to three weeks after surgery. You may begin with light isometric strengthening exercises. These exercises work the muscles without straining the healing tissues.

At about four weeks you may start doing more active strengthening. Exercises focus on improving the strength and control of the buttock and hip muscles. Your therapist will help you retrain these muscles to keep the ball of the femur moving smoothly in the socket.

Some of the exercises you’ll do are designed get your hip working in ways that are similar to your work tasks and sport activities. Your therapist will help you find ways to do your tasks that don’t put too much stress on your hip. Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems.

Causes, Pain Relief & Prevention

Types of hip joint injuries

The hip joint is designed to allow for smooth movement of the leg. It is a large joint that can withstand a fair amount of wear and tear. When you run, various structures (cartilage, bursas) help the joint move without friction. The hip joint is not immune to injury. Runners are especially prone to different types of damage. The muscles and tendons can be overused. The cartilage can get worn down or damaged. Bones can break due to a fall or injury². Any of these injuries can cause hip pain in runners.

The Injurymap app has a range of exercises for the hip that strengthen the muscles around the joint and help avoid such injuries.

If you are a runner and have hip pain, it’s important to understand what could be causing the discomfort and how to get relief. You don’t have to live with discomfort or stop running due to hip pain. Here are five of the most common causes of hip pain in runners along with their treatment and prevention.

1. Trochanteric bursitis

Causes

A bursa is a fluid-filled lubricating sac that reduces friction between bones, tendons, and muscles. There are about 150 bursae located near the various joints in the body. The trochanteric bursa, located at the tip of the thigh bone, allows the hip joint to move smoothly. Frequent repetitive motions, such as running, can cause this bursa to become irritated and inflamed.³ Bursitis is a common cause of hip pain.

Trochanteric bursitist

Symptoms: What does Trochanteric bursitis feel like?

The pain from Trochanteric bursitis is usually located outside the hip or thigh and worsens with activities like running, walking, going up stairs, and getting out of a car or deep chair. Trochanteric bursitis pain may be worse at night from lying on that side, which puts pressure on the area.³ A hallmark sign of Trochanteric bursitis is tenderness to touch on the side of the hip.^4,5

Is it ok to run with Trochanteric bursitis?

Trochanteric bursitis is often an overuse injury (it can also sometimes occur due to trauma, such as a fall on the hip). If you suspect your hip pain is due to bursitis, it’s a good idea to reduce mileage or stop running for a short period of time. If you do decide to continue running, proceed with caution and run only if it does not worsen the pain.⁶

Treatment / relief

The mainstay of Trochanteric bursitis treatment is rehab exercises to strengthen and stretch the hip muscles. It’s recommended to start with gentle stretching exercises and doing strengthening exercises when the sharp pain reduces.

Other treatments include icing and pain medications to manage symptoms. In some cases, an injection of steroid and local anesthetic may be recommended for pain relief. Surgery is the last option for recalcitrant Trochanteric bursitis, during which the surgeon takes the pressure off the bursa or removes the bursa itself.⁵

Recovery time and prevention

While you are recovering from Trochanteric bursitis, you may need to change your activity to one that does not worsen symptoms, for example, swimming. A mildly inflamed bursa can improve in a few weeks. A significantly inflamed bursa can take a few months to get better.⁷

To prevent recurrence, always remember to warm up and stretch before a run. Physical therapy exercises can effectively heal Trochanteric bursitis and strengthen the joint to prevent future injuries.⁵

2. Hip flexor strain

Causes

Hip flexors are muscles that allow us to bend and lift the leg, kick high, and bend at the waist. A strain in the hip flexors is a stretch or tear in these muscles due to overuse.⁸ It is a common injury in athletes, especially those who jump, run, or participate in activities that involve forceful kicking, such as soccer.

Symptoms: What does strain of hip flexors feel like?

The most common symptom of strain in the hip flexor muscles is pain in the area where the thigh meets the trunk.

Hip strain

Is it ok to run with hip flexor strain?

It is recommended to stop doing activities that cause pain to give the muscles a chance to heal. If you want to keep up with your training, you may need to go swimming, or cycling instead of running.⁸

Treatment / relief

Physical therapy stretching and strengthening exercises can help strained hip flexor muscles to heal.⁸ Regular stretching keeps the muscles loose and can help prevent injuries.

There are several effective stretches for hip flexors that can be performed standing, kneeling, and lying down. Icing and pain medication may also help if the hip flexors are strained.

Recovery time and prevention

Mild strains usually heal within a few weeks. More severe strains can take 6 weeks or longer to improve. ⁸ The key to preventing strains in the hip flexor muscles is to do warm-up exercises before running. It’s also important to perform strengthening exercises to keep the muscles from getting injured.

3. IT band syndrome

Causes

The IT (iliotibial) band is a thick band of fibrous tissue that runs along the outer thigh from the pelvis to the calf, crossing both the hip and knee joints. IT band syndrome is a condition that is closely linked to hip bursitis and occurs when the IT band is too tight, leading to friction near the hip and causing inflammation and pain.

IT band syndrome is a common overuse injury among runners and can affect both new and seasoned runners. A sudden increase in the level of activity, such as an increase in mileage, increases the risk of IT band syndrome in runners⁹. Wearing worn-out shoes and running downhill are other risk factors.¹⁰10

Symptoms: What does IT band syndrome feel like?

Symptoms of IT band syndrome are similar to hip bursitis and include pain and discomfort on the outer side of the leg. The pain typically increases with activity. Some people experience a clicking or rubbing sensation.

Is it ok to run with IT band pain?

The best way to treat IT band pain is to rest the hip by running shorter distances or completely stop running. Without rest, IT band syndrome can become chronic (longstanding). While taking a break from running, you can continue training with other activities like swimming, cycling, and rowing.¹⁰

Treatment / relief

IT band syndrome is treated with rest,, stretches, icing, anti-inflammatory medications like ibuprofen, and a temporary reduction in training. Steroid injections may be prescribed in more severe cases. Exercises and stretches can help prevent IT band syndrome and keep it from getting worse.

Recovery time and prevention

Preventive measures for IT band syndrome include proper conditioning, warming up and stretching before and after running, and gradually increasing mileage. You should always wear proper shoes. Talk to your trainer about possibly shortening your running stride if the problem is recurrent.⁹ Complete healing from IT band syndrome usually occurs in about 6 weeks.

4. Iliopsoas tendinitis

Causes

The Iliopsoas is a muscle located deep within the hip. The Iliopsoas tendon is a band of tissue that attaches the muscle to bone. Overuse can lead to a pull on the tendon and cause it to become inflamed and painful. Iliopsoas tendinitis is common in runners who increase their mileage or do speed work¹ Other activities that predispose to Iliopsoas tendinitis include dancing, ballet, cycling, rowing, soccer, and gymnastics.¹¹11

Iliopsoas tendinitist

Symptoms: What does Iliopsoas tendinitis feel like?

The pain from Iliopsoas tendinitis is present on the front of the hip or groin and may radiate down toward the knee. It typically occurs with lifting up the leg, getting out of a car, and walking up stairs.¹² The pain is usually gradual in onset. It may occur after a specific aggravating activity and resolve when the activity is stopped. As the condition progresses, the pain may be present during both activity and rest.

Is it ok to run with Iliopsoas tendinitis?

As with most soft tissue injuries, the return-to-running program for Iliopsoas tendinitis is pain-mediated, i.e., you should gradually return to running as pain allows. The tendon needs time to heal. This can take from a few days to a few weeks, depending on the severity of the injury.13 When you start running again, you should gradually build up speed and mileage.

Treatment / relief

The goal of the treatment for Iliopsoas tendinitis is to reduce inflammation and pain. This can be accomplished with rest, ice application, and physical therapy consisting of stretches and range of motion exercises. Pain medications and steroid injections may also work to decrease pain and inflammation. In rare cases, a minimally invasive (keyhole) surgery may be needed if other treatments have not been effective. ¹²

Recovery time and prevention

Recovery from Iliopsoas tendinitis can take a few weeks. A progressive hip strengthening program with rehab exercises can help reduce stress on the Iliopsoas muscle and prevent future problems.¹³

5. Hip labral cartilage tears

Causes

The hip labrum is a strong, flexible cartilage that lines the socket of the hip joint. A tear in this cartilage can occur due to repetitive high-impact sports like running.¹⁴ Like many running injuries, labral tears can occur due to running too much without enough strength training exercises to make the legs strong.¹⁵

Labral tear

Symptoms: What does a hip labral tear feel like?

In runners, symptoms usually appear gradually over many months and consist of pain in front of the hip, around the side of the hip, or in the groin area. The pain is typically a deep, dull ache at rest and a sharp, stinging pain during running.¹⁴ There may also be a clicking, catching, or locking sensation. Some runners also experience hip instability (a feeling that the leg is about to give way) when running.¹⁴

Is it ok to run with a hip labral tear?

Running puts a lot of stress on the hip. Before you return to running or any high-impact activity, you should make sure your muscles and tendons are strong. This will ensure they can absorb the impact of running and prevent the joint from getting injured. If you have a tear in the hip labrum, it’s a good idea to focus on strengthening exercises for some time and let running take a back seat.¹⁵

Treatment / relief

Nonsurgical treatments for a hip labral tear include rest, pain medicines, steroid injections directly into the hip joint, and physical therapy. Exercises to strengthen the buttocks, thigh, and back muscles and improve hip stability are a safe and effective treatment for labral tears. If conservative measures do not relieve symptoms or the labral tear is severe, a doctor may recommend surgery. ¹⁴

Recovery time and prevention

Symptoms of hip labral tear typically improve in 10 to 12 weeks with rehabilitation exercises. One of the best ways to prevent this injury from occurring is proper stretching, warm-up, and strengthening. When runners have strength and endurance in the legs, hips, and core, they reduce the risk of injuring the labrum and the rest of the hip joint.

How to Fix a Clicking Hip

Snapping hips can be a scary sound for any athlete. However, there is no need to be alarmed if you notice your hips making a snapping, clicking or popping noise. Clicking hips are actually a fairly common condition among active people, and there are plenty of remedies to reduce hip pain.

In this article, we’ll look at what causes clicking hips, what dancer’s hip is, who is most at risk of developing these conditions, and how to prevent and treat snapping hips. If you’ve experienced clicking hips recently, keep reading to find out how to relieve your hip pain.

What Causes Hips to Click?

Whenever a hip starts to click, it is usually due to snapping hip syndrome (SHS), a hip disorder medically referred to as coxa saltans. SHS occurs when the muscle tendons around the hip joint become inflamed and begin to click as they rub over the hip socket bone. Because stretching the tendons creates extra tension, someone with SHS can typically hear a snapping sound or feel a snapping sensation when moving their hip joint.

There are three different types of SHS, and the root cause of a clicking hip depends on the type. Below are the three variations of SHS and what causes them:

1. External SHS

External SHS is the most common type. The condition occurs when the iliotibial band slides over the top of the femur along the outside of the hip. Also known as the IT band, the iliotibial band runs along the outside of the thigh and consists of connective tissue called fascia. When this connective tissue gets too tight, it has trouble sliding over the femur and may make a snapping noise during hip movement.

Pain and tenderness due to external SHS are typically felt along the outside of the hip. Because the IT band plays such a large role in hip mobility, those with external SHS may experience snapping when running or climbing stairs. External SHS symptoms may worsen over time to the point where it hurts to even lie on the affected hip at night.

2. Internal SHS

Another form of SHS that involves the hip muscle and tendons is internal SHS. Internal SHS is typically caused when the iliopsoas tendon — which connects the inner hip muscle to the thigh bone — moves over the pelvic bone, resulting in the hip muscle or tendons sliding over the front of the hip joint. Alternatively, internal SHS may be caused by the quadriceps muscle moving over the ball portion of the hip’s ball-and-socket joint.

Unlike external SHS, internal SHS is felt in the front part of the hip and may include pain near the groin area. Those with internal SHS usually experience gradually worsening symptoms and may even hear popping when they run.

3. Intra-Articular SHS

As opposed to external and internal SHS, intra-articular SHS is not caused by a muscle or tendon issue. Instead, a preexisting hip joint problem or injury can lead to intra-articular SHS. Because it stems from a prior injury or trauma, this condition can occur suddenly.

The three most common intra-articular SHS causes include:

1. An articular cartilage injury — any injury that affects the cartilage around the ball or socket of the hip joint.
2. An acetabular labral tear — a rip in the cartilage that lines the hip socket.
3. Broken bone fragments of loose tissue getting trapped between the hip’s ball-and-socket joint.

What Is Dancer’s Hip?

Because of the technical maneuvers required for certain moves, snapping hip syndrome is especially common in ballet dancers and SHS is often referred to as dancer’s hip. Just like SHS, dancer’s hip involves popping or snapping hips when moving the legs in certain ways. Although the snapping noises that accompany dancer’s hip are often painless and harmless, they may sometimes involve pain and weakness in the hips.

Dancer’s hip typically refers to internal SHS when the iliopsoas tendon rolls over the hip bone during flexion and external rotation. Excessively tight quads can also lead to dancer’s hip symptoms. Considering dancers must repeatedly rotate and lift their legs to execute certain moves, dancer’s hip can make performing uncomfortable or painful, which can derail training.

More severe cases of dancer’s hip may include pain, inflammation, muscle weakness, swelling and the feeling that the hip is coming out of place. In its worst form, dancer’s hip can result in hip bursitis, which is the painful swelling of the fluid-filled sacs surrounding the hip joint.

Who Typically Develops Clicking Hips?

Although clicking hips can happen to anyone, SHS is most common in females. Of course, dancers are especially prone to developing dancer’s hip. However, snapping hips can be a problem for any athlete involved in a sport or activity that requires repetitive bending at the hip. Specifically, high-mobility sports such as soccer, running and gymnastics put participants at a greater risk of SHS.

Because SHS is typically caused by tightness in the muscles and tendons around the hip area, those who neglect to stretch and build up their flexibility are especially at risk of developing snapping hip syndrome. Young athletes, in particular, are more likely to have clicking hips because tightness in the hip’s muscle structures is a common side effect of adolescent growth spurts.

How to Prevent and Treat Clicking Hips

Although clicking hips is usually not a serious condition, leaving SHS untreated could lead to worse symptoms and even early onset joint degeneration. Fortunately, there are many conservative treatment options to alleviate snapping hips and mitigate hip pain.

Building up the hip’s strength and flexibility can help reduce an athlete’s chances of developing SHS. Along with strengthening the hips, strengthening the core can also decrease the likelihood of hip pain from clicking hips. Simple exercise moves to work the hip muscles include clamshells and glute bridges.

Along with strengthening the muscles surrounding your hips, try these five tips for relieving snapping hips:

1. Rest

Allowing your hip to rest from any rigorous activity may help lessen SHS symptoms. Taking a break from a certain sport will give your muscles and tendons time to repair themselves and heal. While resting, try placing a cold compress on the affected area to reduce inflammation and pain.

2. Warm Up

Once you return to your regular activities, be sure to warm up thoroughly before jumping into your workout. Warming up will help loosen up your muscles and prepare your body for the movements it is about to perform. Taking the time to warm up before exercising will reduce the risk of developing SHS by promoting blood flow to keep the muscles flexible and pliable.

3. Wear the Right Shoes

You can avoid suffering from tight or weak hips by wearing shoes that provide proper arch support when you exercise. The shoes you wear to work out should be comfortable while giving your feet the stability they need. Because most dance shoes, such as ballet slippers, offer little to no arch support, it is essential for ballerinas and other dancers to wear supportive footwear off stage.

4. Stay Hydrated

Drinking enough water each day will help keep your joints lubricated, which aids the range of motion in the hips. Because water also moves essential nutrients throughout your body, staying well-hydrated will improve your muscle performance and enable you to build more hip strength and stability.

5. Stretch

Stretching out your hips and legs after working out can help relieve hip tightness and pain. Lengthening and stretching your IT band and iliopsoas tendon can help reduce the tension in these areas and decrease hip snapping. Be sure to take time to stretch your IT band, hip flexors and hamstrings back out after every exercise session.

Contact Dr. Gombera for Hip-Related Pain and Injuries

Even after taking measures to strengthen and stretch your hips, you can still experience snapping hips and hip pain. If you’re suffering from a hip injury or hip-related pain, contact Dr. Gombera today to get expert care. Dr. Gombera is a trained orthopedic surgeon who specializes in knee, hip and shoulder injuries, which means he knows how to help patients recover as quickly as possible so they can get back to their usual activities.

Dr. Gombera and his team offer minimally invasive, specialized treatment plans at their practice conveniently located at Fondren Orthopedic Group and Texas Orthopedic Hospital in the heart of Houston. They also service patients within the Beaumont and Cypress areas. To begin your road to recovery, book an appointment with Dr. Gombera online or call 713-794-3457 today.

Posterior Hip Pain in an Athletic Population

Sports Health. 2010 May; 2(3): 237–246.

Differential Diagnosis and Treatment Options

Rachel M. Frank, BS, Mark A. Slabaugh, MD, Robert C. Grumet, MD, Walter W. Virkus, MD, Charles A. Bush-Joseph, MD, and Shane J. Nho, MD, MS^*

Rush University Medical Center, Chicago, Illinois

^*Address correspondence to Shane J. Nho, MD, MS, Healthy Hip Clinic, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Suite 300, Chicago, IL 60612 (e-mail: moc.ohtrohsur@ohnyajs).This article has been cited by other articles in PMC.

Abstract

Context:

Posterior hip pain is a relatively uncommon but increasingly recognized complaint in the orthopaedic community. Patient complaints and presentations are often vague or nonspecific, making diagnosis and subsequent treatment decisions difficult. The purposes of this article are to review the anatomy and pathophysiology related to posterior hip pain in the athletic patient population.

Evidence Acquisition:

Data were collected through a thorough review of the literature via a MEDLINE search of all relevant articles between 1980 and 2010.

Results:

Many patients who complain of posterior hip pain actually have pain referred from another part of the body—notably, the lumbar spine or sacroiliac joint. Treatment options for posterior hip pain are typically nonoperative; however, surgery is warranted in some cases.

Conclusions:

Recent advancements in the understanding of hip anatomy, pathophysiology, and treatment options have enabled physicians to better diagnosis athletic hip injuries and select patients for appropriate treatment.

Keywords: posterior hip pain, piriformis syndrome, sciatica, referred pain, gluteal region

Injury to the hip joint is a relatively uncommon but important clinical problem in the athletic population. Any athlete—especially one participating in golf, soccer, or dancing—is at risk of hip injury; thus, it is important to recognize and treat injuries associated with the hip joint. In the past, patients with athletic hip injuries were typically treated conservatively, regardless of their diagnosis.³⁴ Recently, however, the literature regarding hip pathology has grown, and advances in arthroscopic treatment^† techniques and implants have increased the ability of athletes to return to sport following hip injury. Furthermore, improvements in various imaging modalities^{3,11,18,32,42,54} have increased the ability of physicians to understand the cause of hip disorders and to more accurately diagnosis the various pathologies.¹ In actuality, the incidence of posterior hip injury may be climbing yet it is still underreported because of misdiagnosis.⁶

Hip pain can be classified in a variety of ways,^34,50 including overall location (anterior, posterior, lateral, medial/groin), location about joint (intra-articular, extra-articular), and onset (acute/traumatic, insidious). In addition, some patients presenting with hip pain have problems that mimic hip pathology, or they have pain referred from other joints. In particular, posterior hip pain—the least common type of hip pain (compared to lateral and anterior hip pain)—is often due to factors outside the hip joint, as discussed below.

Recent advancements in the understanding of hip anatomy, pathophysiology, and treatment options have enabled physicians to better diagnosis athletic hip injuries and select patients for appropriate treatment. Although much is known about the posterior hip in terms of anatomy and physiology, there are, to our knowledge, no complete reviews in the literature thoroughly describing the pathophysiology, presentation, diagnostic tools, and treatment modalities for the management of posterior hip pain.

Anatomy

The hip joint receives loads up to 6 and 8 times the body weight during normal walking and jogging, respectively.⁵¹ When high-impact sports-related activities are factored in, the hip joint bears substantial load and is prone to injury. It is imperative that treating health care providers understand the anatomy of the hip joint and surrounding structures to fully appreciate the sometimes confusing clinical presentations and make accurate diagnosis and appropriate treatment plans.

The hip joint is composed of a complex interaction of bones, muscles, and connective tissue.⁴³ The bony anatomy includes the acetabulum—which contains components of the ischium, ilium, and pubis bones—and the head of the femur. The acetabulum and femoral head articulate to form a spheroidal multiaxial ball-and-socket joint. A fibrous capsulolabral structure composed of the labrum⁴⁸ and several ligaments¹⁷ supports the articulation between the acetabulum and the femoral head. The iliofemoral and pubofemoral ligaments cover the anterior aspect of the joint, whereas the ischiofemoral ligament is posterior; each helps to stabilize the joint by preventing excessive translation of the joint during normal ranges of motion.

The bony geometry and ligamentous support surrounding the hip determine which movements are permitted: flexion, extension, adduction, abduction, external rotation, and internal rotation (). Muscles are responsible for providing the actual movement, including the iliopsoas,⁴² which is responsible for hip flexion, and the gluteal muscles,^2,44 which are responsible for extension (maximus), abduction (minimus and medius), internal rotation (minimus), and external rotation (maximus). Muscles of the anterior compartment of the thigh include the sartorius, tensor fascia lata, quadriceps femoris, pectineus, and iliopsoas. The medial compartment is composed of the pectineus as well as the adductor muscles (adductor longus, brevis, magnus, and gracilis). Finally, the posterior compartment contains the hamstrings (biceps femoris, semimembranosus, and semitendinosus). Another important muscle assisting in external rotation of the hip is the piriformis,¹⁵ which can often cause posterior hip pain when inflamed, owing to its proximity to the sciatic nerve.

Table 1.

Function of the major hip muscles.

Because the majority of the articular hip is innervated by the femoral or obturator nerves, most intra-articular pathologies radiate to the anterior or medial hip, whereas the majority of posterior hip pain is typically caused by extra-articular conditions. Some conditions may cause a more global distribution or radiate to areas outside their typical clinical presentation. Furthermore, based on Hilton’s law of joint innervation⁴—which describes how the nerve supplying a joint also innervates the muscles moving the joint and the skin covering the joint—it is possible and even likely that hip joint pain is often referred pain from muscles. Specifically, the hip receives innervation from branches of lumbosacral plexus (L2-S1) and predominantly from the L3 nerve root. Thus, given the distribution of the L3 dermatome, hip joint pathology usually causes anterior or medial thigh pain, whereas posterior thigh pain is rarely a sign of actual hip intra-articular pathology.³⁴

Another important feature of hip anatomy and a common cause of hip pain are the various bursae around the hip joint—namely, the trochanteric bursa,⁵³ the iliopsoas bursa, and the ischial tuberosity bursa. Bursae of the hip, as in any part of the body, prevent excessive friction of soft tissue over bony prominences during normal ranges of motion but can cause severe pain when inflamed. With regard to posterior hip pain, ischial bursitis should always be on the differential diagnosis when a patient complains of severe pain upon direct palpation.

History, Physical Examination, and Imaging Studies

History and Physical Examination

A thorough history and complete physical examination are crucial for accurate diagnosis and treatment of any patient complaining of posterior hip pain. Because the hip joint is close to several important structures, including organs of the reproductive and gastrointestinal tracts, any patient presenting with systemic symptoms in addition to hip pain should be immediately worked up for potential infection or cancer, as well as for inflammatory arthritis.²¹ Alarming symptoms include fever, malaise, night sweats, weight loss, history of drug abuse, past or present diagnosis of cancer, or being immunocompromised. In addition, if the patient reports a history of trauma, a hip fracture must be ruled out.

After determining that the patient has no systemic symptoms and no history of trauma, the physician must learn as much as possible about the injury—specifically, the location of the pain (anterior, posterior, lateral, or medial/groin) as well as the characteristics of the pain. With the onset of pain, provocative activities, age, activity level, and other medical conditions should always be considered.

After eliciting as much information as possible from the patient, the physician should complete a thorough physical examination of both hips, which should follow a typical stepwise approach, including observation, palpation, and testing for range of motion, stability, and strength in all planes. A gait assessment should be included with each examination. Specifically, the physician should note if the patient has an antalgic or Trendelenburg gait or sign, and he or she should ask the patient to transfer from standing to sitting to lying down and, finally, back to standing. The height symmetry of the iliac crests, as well as leg length, should be assessed, given that differences in leg length can often cause or contribute to lower back pain, hip pain, and sacroiliac (SI) joint pain. When palpating each muscle group, the physician should pay particular attention to the various hip bursae, which are common sources of pain when inflamed—especially the ischial bursa in the patient presenting with posterior hip pain.

Range of motion testing should be performed on both the symptomatic hip and the contralateral hip. It is helpful to begin with the contralateral hip to avoid eliciting painful symptoms at the beginning of the examination, which may lead to guarding throughout the remainder of the exam. Passive and active internal rotation, external rotation, flexion, extension, abduction, and adduction should be measured with a goniometer: Normal values for these movements are 35°, 45°, 120°, 30°, 45°, and 20°, respectively.³⁴ The Thomas test is performed to evaluate for the presence of a hip flexion contracture. In the supine position, the patient grabs one knee with both hands and flexes it to the chest as the hip of the examined leg is allowed to completely extend. The test result is positive for a hip flexion contracture if the examined leg is unable to completely extend. To better stabilize the pelvis, this test may be performed with the hip flexed only to 90° instead of full flexion. Strength in each plane should also be tested: internal and external rotation, adduction seated or prone, abduction lying lateral with the leg abducted against the examiner’s resistance, extension while standing, and flexion in the seated and supine positions. Logrolling and impingement testing are not necessarily specific to posterior hip pathology but may be performed to rule out other potential etiologies of hip pain, including femoreacetabular impingement.

Examination should include Trendelenburg, Ober, FABER (Patrick), and Thomas tests. The Trendelenburg test assesses the gluteus medius and is performed by having the patient stand on one leg. The test is positive for gluteus medius weakness on the standing/supported leg if the pelvis on the opposite, or unsupported, leg drops or tilts. The gluteus medius on the standing leg should contract and elevate the pelvis on the opposite side.

The FABER (flexion, abduction, and external rotation) test can differentiate lumbar spine pathology from primary hip pathology. This test is performed supine with the painful leg flexed and externally rotated and with the ankle resting on the opposite knee, followed by manual pressure on the abducted knee. If the patient experiences posterior hip pain, the SI joint may be responsible. If groin pain occurs without loss of motion, the problem is most likely native to the hip (88% sensitivity in the athletic population for intra-articular pathology).³⁶ Patients with intra-articular hip pain may report that their “hip pain” is located in the distribution known as the C-sign, in which the patient grasps the lateral aspect of the hip with his or her thumb and pointer finger to indicate that the pain is located in between.⁶ The posterior impingement test of the hip is performed with the buttock at the end of the examination table with both legs suspended. With the hip extended, the examiner externally rotates the hip, and the test is positive if this maneuver reproduces pain.³³ A thorough lumbosacral examination—including inspection, palpation, range of motion, neurosensory assessment, and straight leg raises—should also be performed to rule out other causes or contributing factors related patient’s hip pain.

Imaging Studies

Imaging studies—including radiographs, computed tomography (CT) scanning, fluoroscopically and ultrasound guided injection, and magnetic resonance imaging (MRI) or magnetic resonance arthrography—can sometimes be helpful in evaluating posterior hip pain. The radiographic series should always include standard anterior-posterior films of the pelvis, with the coccyx 1 to 3 cm above the pubic symphysis with concentric obturator foramen. A number of lateral views of the hip have been used, including the cross-table lateral, frog-leg lateral, Dunn lateral, and false profile.⁵² It is important to obtain radiographs if the patient is at risk for bony pathology owing to trauma, osteoporosis, cancer, steroid, or alcohol use. Careful assessment of the posterior inferior portion of the hip joint is important because early arthritis can often be seen there, even when the superior joint space is normal. CT scan, especially with 3-dimensional reconstructions, can provide important information on the femoral version and osseous abnormalities. MRI is the study of choice in athletes; namely, it is helpful in providing information about the soft tissue structures surrounding the hip.¹⁸ Fluoroscopically guided hip injections of anesthetic medication can be useful in differentiating intra-articular from extra-articular pathology; ultrasound-guided injections to the iliopsoas and trochanteric bursae are also helpful.⁵² Of note, hip arthroscopy has been shown to be the final and definitive diagnostic procedure for assessing intra-articular pathology.³⁶

Differential Diagnosis and Treatment Options

As mentioned above, posterior hip pain is the least common when compared with anterior, lateral, and medial pain.³⁴ The structures around the hip—especially the lower back as well as the nerves coursing through the pelvis—are important when considering a patient presenting with posterior hip pain. Thus, a thorough understanding of hip anatomy is vital to appropriate diagnosis and potential treatment. In addition, fractures must be considered, especially in high-risk patients such as long-distance runners, those with osteoporosis, and those with a history of trauma or a falling episode. describes common causes and classifications of general hip pain.

Table 2.

Differential diagnosis of hip pain.

The most common causes of posterior hip pain include referred pain from the lumbar spine, SI joint dysfunction, hip extensor or rotator muscle pain, proximal hamstring rupture, early arthritis, and piriformis syndrome (). describes effective therapeutic exercises for these conditions, which can typically be performed at home.

Table 3.

Differential diagnosis of posterior hip pain.

Table 4.

Examples of home exercises.

Referred Pain From Lumbar Spine

The most common cause of posterior hip pain is referred pain from the lumbar spine area, the most common causes of which include herniated disks and sciatic radiculopathy. The pain is attributed to the innervation of the hip by the lumbar plexus, most notably via the L3 nerve root, as described above. Such patients typically complain of a history of low back pain that has worsened, with new onset of posterior hip and/or buttock pain. Symptoms can usually be reproduced during flexion or extension of the lumbar spine, and the patient may describe radicular symptoms traveling down the leg. Treatment for referred pain depends on the cause of the lumbar pathology, and it can range from conservative care, including therapy and activity modification, to steroid injections to surgical intervention.

SI Joint Dysfunction

SI joint dysfunction has a variety of causes—including hypermobility, hypomobility, trauma, degenerative arthritis, inflammatory arthropathy (sacroiliitis), infection, ligament strain, and/or stress fractures.⁵⁰ Patients with any of these conditions can experience pain near the posterior superior iliac spine and may have buttock pain that radiates down the leg. Pathology of the SI joint can be difficult to diagnosis; thus, a thorough neurological examination is warranted to rule out other pathology, including tumors. Images—including radiographs, CT scans, and MRI scans ()—are helpful, but fluoroscopic-guided injection into the SI joint is considered diagnostic if the patient experiences relief of pain.¹⁰ Treatment depends on the cause of the SI dysfunction, and it ranges from physical therapy (for patients with strength/flexibility deficits) to antirheumatic agents and nonsteroidal anti-inflammatory drugs for patients with inflammatory arthropathies. Surgical correction, manipulation, and radiofrequency neurotomy are controversial treatments and are considered on a case-by-case basis when more conservative therapies have failed.⁴³

Sagittal magnetic resonance imaging of the lumbosacral spine demonstrating large herniated nucleus pulposus at L5-S1 (left, T2; right, proton density fat-saturated image).

Extensor or Rotator Muscle Pain

The muscular support of the hip joint is complicated by the presence of several muscle attachments in a small, confined space, many of which have overlapping functions. Thus, when one muscle or muscle group is strained or overworked, it is common for the patient to complain of generalized hip pain, thereby making diagnosis difficult. The extensor muscles of the hip—including the biceps femoris, semimembranosus, and semitendinosus—all insert into various components of the posterior pelvis; strain or tear of any of these tendons can lead to posterior hip pain. The biceps femoris has 2 proximal attachments: the long head attaches to the ischial tuberosity and sacrotuberous ligament; the short head attaches to the lateral lip of the linea aspera and the lateral intermuscular septum. The semimembranous and semitendinosus also arise from the ischial tuberosity, and so injury to any of the hamstring tendons can lead to posterior hip pain. The rotator muscles, including internal and external rotators, have attachments on the posterior aspect of the hip; thus, strain or overuse of these muscles can lead to posterior hip pain as well. It is important to recognize gluteal tendinopathy, given that the gluteal muscles lie near the posterior hip but more often cause lateral hip pain in association with greater trochanteric pain syndrome,^{23,25,28,31,41} as opposed to posterior hip pain. Treatment for overuse of these muscles is typically conservative and includes activity modification, physical therapy, and nonsteroidal anti-inflammatory drugs.

Piriformis Syndrome

Piriformis syndrome is another cause of posterior hip pain, and it may account for up to 5% of all cases of low back, buttock, and leg pain.⁴⁰ Patients generally complain of pain in a sciatic nerve distribution; that is, buttock pain referred down the leg. The classic features of piriformis syndrome include pain in the region of the SI joint, greater sciatic notch, and piriformis muscle and exacerbation of pain caused by stooping or lifting and, potentially, gluteal atrophy.⁴⁰ Patients may complain of pain with straight leg raise. Results of the Pace test are positive if the patient has pain with resisted hip abduction in a seated position.³⁹ The Freiberg test can be performed with forceful internal rotation of the extended hip, the result of which is positive if the pain is produced by stretching the piriformis muscle.¹⁴ Some recommend a pelvic or rectal examination, which may reveal a tender, palpable, spindle-shaped mass considered to be the intrapelvic portion of the piriformis muscle.⁴⁶ Because clinical presentations can be vague and there are few validated and/or standardized diagnostic tests, patients are often diagnosed via exclusion. Electrodiagnostic testing with electromyographic and nerve conduction studies should be performed if piriformis syndrome is suspected, which may provide findings consistent with sciatic nerve compression at the level of the piriformis muscle.¹⁹ Traditional treatment includes conservative therapy with a focus on physical therapy, stretching, and steroid or analgesic³⁷ injections. Recently, the use of botulinum toxin^22,26 and arthroscopic release⁸ have been used as a therapy with promising results.

Proximal Hamstring Rupture

Rupture of the proximal hamstring tendons is another common cause of posterior hip pain.^7,20,38 Injury can occur following a one-time traumatic rupture, or it can occur over time after several episodes of hamstring strain and tendonitis. Patients with rupture present with posterior hip pain and often have signs of muscle weakness and sciatica.^{23,25,28,31,41} In the past, treatment consisted of conservative therapies; however, recent research has shown that early operative intervention,^5,30 compared with conservative therapy or late surgical intervention,⁴⁷ yields substantially better results. In addition, some studies have shown that surgical repair with allograft tendons can be successful in acute and chronic cases (-).^13,27

Physical examination demonstrating ecchymosis after a torn hamstring.

Intraoperative images of proximal hamstring repair. A, proximal end of the hamstring tendon tagged with numerous sutures. B, repair of proximal hamstring with suture anchors to the ischium.

T2 magnetic resonance images of acutely torn hamstring tendons: A, axial cuts demonstrating torn hamstring tendon with fluid around the proximal end; B, coronal image with 3 hamstring tendons torn with retraction and hematoma formation.

Femoroacetabular Impingement

Although the typical presentation of femoroacetabular impingement (FAI) occurs in the groin area, there are cases that present globally or focally (ie, on the posterior aspect of the hip). FAI occurs as a result of structural abnormalities that cause chondral and labral injury with repetitive hip motion. A number of osseous abnormalities of the acetabulum and/or femoral head may lead to hip impingement, including CAM impingement, Pincer impingement from focal acetabular overcoverage (acetabular retroversion) or global acetabular overcoverage (coxa profunda or protrusion acetabuli) (). If an athlete has repetitive groin strains with loss of range of motion that is refractory to physical therapy and so results in loss of participation, the next step is referral to a hip specialist and radiographic evaluation. As previously mentioned, such patients typically have groin pain, worse with prolonged sitting or rotational maneuvers. The physical examination demonstrates limitations, with hip flexion, internal rotation, and external rotation being involved in some cases. Less than 20° of internal rotation is abnormal, and the clinician should be suspicious of FAI. An impingement sign is positive if the patient has groin pain with flexion, adduction, and internal rotation. The posterior impingement test is performed with the hip in extension and external rotation, and the result is considered positive if the test produces pain in the posterior aspect of the hip. Patients with global acetabular overcoverage may have a positive posterior impingement sign. Fluoroscopic injection of the hip joint with lidocaine is the next step. A positive response to the injection, with hip motion or activity that elicits the pain, is considered to be diagnostic for an intra-articular cause of hip pain. Advanced imaging studies with MRI or CT scans are appropriate to further delineate the hip morphology and injury to the articular cartilage and labrum. If the patients have symptoms that are refractory to nonsurgical management, hip surgery to correct bony deformities can be performed through an open approach or hip arthroscopy.

Bilateral global acetabular overcoverage secondary to acetabular protrusio. Radiographs demonstrate that the acetabular line (arrow) is medial to the ilioischial line. A crossover sign is also evident, with the anterior wall (dashed line) being more lateral than the posterior wall (solid line).

Clinical Workup

A systematic approach³⁴ to address posterior hip pain should be used in an attempt to diagnosis the cause of pain and select the appropriate treatment strategy. If the patient describes an acute onset of pain and has a history of low back pain or radiating symptoms, the physician should perform imaging studies of the lumbar spine. In these cases, the most likely cause of pain is herniated nucleus pulposus, lumbar degenerative disc disease, arthropathy, or spinal stenosis, and the appropriate treatment typically begins with conservative measures. If the patient describes a more gradual onset of injury, as in the case of overuse or sports-related pain, the physical exam can be helpful in narrowing the possible causes. Specifically, if the patient has a positive result for the FABER test or has pelvic asymmetry, SI joint dysfunction can be considered, with appropriate therapy including physical therapy, modification of activity, and selective injections. For patients who do not experience relief of symptoms, the physician should perform an MRI or bone scan of the pelvis to rule out a stress reaction within the pelvis. If the patient instead has pain with resisted extensor or rotator muscle testing and/or gluteal muscle tenderness to palpation, the likely diagnosis is muscle strain. The appropriate treatment in this case is activity modification, physical therapy, and nonsteroidal anti-inflammatory drugs. Athletes with persistent groin strain with limitations in range of motion may have FAI and so require evaluation by a hip specialist for possible radiographic evaluation and injections. Those who do not improve with activity modification and therapy may be indicated for either open or arthroscopic hip surgery. In addition, patients with proximal hamstring avulsion should immediately be referred to an orthopaedic surgeon for possible repair of hamstring tendon.

Conclusions

Posterior hip pain is the least common complaint among patients with hip pain. To make proper treatment decisions, physicians must use a logical and systemic approach to assess patients presenting with posterior hip pain. Common causes of posterior hip pain include referred pain from the lumbar spine, SI joint dysfunction, hip extensor or rotator muscle strain, proximal hamstring rupture, and piriformis syndrome.

One or more authors has indicated a potential conflict of interest: Shane J. Nho and Charles A Bush-Joseph have received research and institutional support from Arthrex, Smith & Nephew, Livatec, Miomed, Athletico, and DJ Ortho.

^†References 9, 12, 16, 23, 24, 29, 35, 45, 49, 52, 55.

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Problem: My Hip Hurts | Runner’s World

Q: Do you feel a dull ache on the outside of your hip? Does it hurt during or after a run? Do your leg muscles feel tight?

If the answer is yes, you could have bursitis, see [A] below. If not, read on.

Q: Is the pain more on the inside of your hip? Is most of your training on concrete or asphalt? Do you run all season and rarely take a break?

If the answer is yes, you could have a stress fracture, see [B] below. If not, read on.

Q: Do you have a “clicking” or “catching” feeling? Is the pain intermittent? Did you fall or twist your hip recently?

If the answer is yes, you could have a cartilage tear, see [C] below. If not, read on.

Q: Does the outside of your knee hurt? Is most of your running done on the roads or the track, and do you stick to the same route?

If the answer is yes, you could have iliotibial band syndrome, see [D] below. Otherwise, consult your physician.

[A] Bursitis is inflammation of the fluid-filled sacs that lubricate your joints. It’s caused by overuse or a tight hamstring or iliotibial band (the ligament that runs along the outside of the thigh). You may feel a dull ache, burning, rubbing, or popping sensation on the outside of your hip. Initially pain appears during or after a run. Reduce your mileage, stretch your hamstrings and ITB after a run, apply ice, and take anti-inflammatories. You should be better in about a week.

[B] Stress fractures occur when your bones are broken down faster than they can repair themselves. You’ll feel a throbbing pain in the groin area that gets worse the longer you run until you’re limping through your daily activities, says Sherwin Ho, M.D., associate professor at the University of Chicago. See a sports medicine specialist, who will prescribe imaging tests to rule out a complete fracture (which means surgery). Treatment is six to eight weeks of rest. You may be able to do some low-impact cross-training (walking, low-resistance stationary bike, swimming). When you’ve been cleared, ease into your running, and switch to softer training surfaces.

[C] Cartilage tears usually occur where the ball and socket joint insert. Most are caused by trauma (sudden twisting or a fall). You’ll probably notice a clicking feeling in the hip and an intermittent, sharp pain in the groin that will feel fine until you “catch” it in just the right position, says Dr. Ho. Stop running and see a sports medicine specialist if you notice a loss of range of motion.

[D] Iliotibial band syndrome is irritation of the ligament that runs down the outside of the thigh from the hip to the shin. You can get it by always running on the same side of the road or the same direction on the track, running too much too soon, having tight hamstrings, or wearing old shoes. Change your route or alternate directions on the track, stretch your hamstrings and ITB, and replace your shoes. Sometimes warmth brings relief, says Robert Bronstein, M.D., sports orthopedist at the University of Rochester. Apply a heating pad on a low setting for 10 to 15 minutes. If you catch it early, you can reverse it in a week or so.

Get a complete training plan – designed for runners – that will help you get stronger and faster, while reducing injuries. Buy Now

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Hip Injuries and Treatment | UC San Diego Health

Hip problems are common in older adults and athletes, and they’re treatable.

Look to UC San Diego Health orthopedists for comprehensive diagnosis and treatment of your hip condition. We are repeatedly ranked among the nation’s best in orthopedic care by U.S. News & World Report. 

UC San Diego Health is the Official Health Care Provider of the San Diego Padres. We are also a designated Center of Excellence for orthopedic care by Optum, which means you’ll receive expert, safe and cost-effective care.

When to See a Doctor

If you have hip pain that lasts more than a week, you should see a doctor. An early diagnosis and the right treatment can prevent more serious or permanent damage to your joint or surrounding soft tissue.

Do I Need a Referral for Orthopedic Care?

You can make an appointment with one of our orthopedic specialists directly without a referral. If you have an HMO, however, your insurance plan may require a referral from your primary care physician.

Hip Conditions Treated

UC San Diego Health treats all types of hip conditions, including these common ones:

• Arthritis
• Bursitis
• Cartilage injuries
• Hip impingement, also known as femoroacetabular impingement (FAI)
• Labral tears
• Stress fractures
• Tendonitis

Evaluation and Diagnosis

At UC San Diego Health, you receive a complete work up of your hip condition. This includes a careful review of your health history and current symptoms, a physical exam of your hip, and X-rays. To learn more about your condition, your doctor may also recommend an injection or MRI (or both) if there are inconsistencies in your diagnosis, symptoms or response to treatment. Once you have a diagnosis, you and your doctor will discuss your treatment options and goals.

Nonsurgical Care

Your UC San Diego Health care team may be able to treat your hip condition without surgery. 

Lifestyle Modifications

Because the hip is a weight-bearing joint, you may find relief with low-impact exercise such as swimming or biking, instead of running, as well as weight loss when appropriate.

See Weight Management Program for expert weight loss help.

Physical Therapy and Injections

Targeted exercises to strengthen the muscles that support your hip can also help. If physical therapy doesn’t improve your symptoms, your doctor may recommend a corticosteroid injection to reduce joint inflammation.

See
Physical Medicine and Rehabilitation for more information on our comprehensive non-surgical care for orthopedic injuries and conditions.

Hip Surgery

UC San Diego Health orthopedic surgeons offer advanced surgical techniques for treating hip conditions that have not responded to conservative treatment.

Hip Arthroscopy

Hip arthroscopy, also known as a “hip scope,” is a minimally invasive approach for repairing a torn labrum, fixing an impingement, and cleaning away torn cartilage or loose bodies. Our minimally invasive approach reduces trauma to your hip joint and speeds recovery. 

Catherine Robertson, MD, performs hip arthroscopy at UC San Diego Health and is one of the only orthopedic surgeons in Southern California with specialized training in this complex surgical technique. She is also the lead team physician for the San Diego Padres and was an associate team physician for the San Diego Chargers.

Hip Replacement and Resurfacing

If you have severe joint damage or degeneration, you may be a candidate for a hip replacement or resurfacing. UC San Diego Health surgeons offer a range of surgical approaches and are sought out for their expertise in complex revision surgeries as well.

See
Hip and Knee Replacement for more information on our surgical expertise in total and partial joint replacement.

If you have X-rays or an MRI and would like a second opinion about hip replacement, hip resurfacing or hip revision surgery, see: 

More About Hip Conditions and Care

For more general information about hip conditions and treatments, visit our Health Library:

detailed description, structure, functional features, location in the body

The muscles of the thigh are responsible for maintaining the human body in a strictly upright position, that is, they are involved in upright posture. They have their own impressive mass and length, and they are able to develop a rather big force that will affect the knee and hip joints. The thigh muscles are divided into groups – anterior, posterior and medial, or medial. The anterior muscle refers to the muscles that are responsible for extension, to the posterior – for flexion, and to the medial – the adductor muscles.

Experts attributed the tailor and quadriceps muscles of the thigh to the anterior muscle group. The quadriceps is the strongest muscle, which also has the largest mass in a person in the body. It includes four muscles that form its heads. These are the lateral, medial, rectus and vastus muscles of the thigh. They are in contact with the femur almost over the entire surface. The distal third of the thigh is composed of four heads that form one common tendon. Thanks to him, the muscle joins at the tuberosity of the tibia, as well as at the apex of the patella and lateral edges.Situated slightly further from the median plane, the superior point of the patella, the medial zone of the tendon extends to the patellar ligament.

The sartorius muscle is formed on the frontal iliac spine. It passes through the top, approaches downward and passes the frontal part of the thigh in the middle. The muscle is attached after it connects with the tendon stretch, to the connective tissue sheath of the lower leg and tibial tuberosity. The tailor muscle is recognized as one of the longest muscles in the human body.Its main functions are considered to be flexion of the lower leg and hip.

The biceps femoris, semimembranosus and semitendinosus are also equated to the posterior union of muscles. The biceps muscle is created on the outside of the back of the thigh. It includes two heads. One of them is longer than the other. The head of the greatest length originates from the ischial tuberosity, including the lateral muscular septum, and also on the lower zone of the rough part of the thigh. The biceps muscle extends from the transverse axis and then joins the head of the peroneal bone.This muscle affects the extension and, naturally, the flexion of the hip, and also the supination of the lower leg.

On the inner part of the back of the thigh lies the semitendinosus muscle. Interestingly, its beginning coincides with the beginning of the large head related to the biceps femoris, on the ischial tuberosity. Somewhat behind and inside the muscle reaches the knee joint, but at the same time it is fixed at the tuberosity of the bone. Due to it, a superficial goose foot is created. The semitendinosus muscle works for the benefit of extension and flexion of parts of the body such as the thigh and lower leg.

The semi-membranous muscle begins on the surface of the ischial tuberosity. Having reached the lower leg, the muscle joins at the sub-articular zone of the median condyle, which belongs to the tibia. The tendon of this muscle reaches the oblique popliteal ligament and the connective tissue sheath of the popliteal muscle. All tendon bundles, approaching the above formations, create a deep crow’s feet. The semi-membranous muscle takes responsibility for the extension of the thigh and flexion of the lower leg, and also participates in its pronation as the lower leg flexes.

The medial muscle group includes the gracilis, adductor, and comb muscles. Their main function is considered to be adduction of the hip. Due to our ability to walk upright, these muscles are very well developed. All of them begin at the outer part of two bones – pubic and sciatic, literally a few millimeters from the obturator end.

The thin muscle is usually classified as long and flat. It is located on the medial thigh surface of the thigh. Its beginning is represented by small, short tendons located on the lower zone of the pubic symphysis, at the bottom of the pubic bone.The lower third of the thigh and the abdomen of the muscle are located between the two muscles – the sartorius and the semi-membranous. The tendon itself joins the median zone of the tibia. The fine muscle, like many others, takes part in the creation of the superficial crow’s feet.

On the crest and upper branch of the pubic bone, a short, but almost flat muscle is formed, called the comb. It is attached to the platform located in the posterior zone of the lesser trochanter and by the line of the thigh, due to special flat and thin tendons.This muscle is capable of flexing, adducting and supinating the thigh.

The group of adductors includes three muscles – long, short and large. The long muscle has a triangular shape. It forms on the front of the pubic bone, namely the pubic tubercle. Then it goes downward, and over time it expands greatly. At this point, it is attached to the second third of the rough line. As the name of the group suggests, this muscle works on the adductor of the hip.

A short muscle is formed at the lower branch of the pubic bone, and then moves outward and downward.It is eventually attached to a rough line related to the thigh. The adductor muscle is used not only in adduction, but also for hip flexion.

The adductor muscle, as expected, is recognized as the largest in its group. This rather thick muscle appears to our gaze in a shape resembling a triangle. It originates in the area of ​​the ischial tuberosity, the upper zone of the ischial branch. The large muscle joins in two places: to the rough line and to the median epicondyle of the femur.

Improvement of the method of medical physical culture for sports injuries of the knee joint among basketball players

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Quadriceps femoris

Anatomy Muscles Muscles and fascia of the lower limb Muscles of the lower limb Muscles of the free lower limb Muscles of the thigh: anterior group

Rice. 396. Muscles of the pelvis and thigh, right; front view. (Surface layer.)
Rice. 395. Muscles and fascia of the thigh, right; front view. (The skin and subcutaneous layer have been removed.)

Quadriceps femoris , m. quadriceps femoris (see Fig. 395, 396, 397, 398, 399, 400, 401, 402, 403, 407, 411, 413).Each of the four heads has its own beginning, but, approaching the knee area, they all pass into a common tendon that covers the patella and attaches to the tibial tuberosity.

Rectus femoris , m. rectus femoris (see Fig. 396), the longest of the four heads. Occupies the front of the thigh. It begins with a thin tendon from the inferior anterior iliac spine, the supracostal sulcus. Heading down, the muscle passes into a narrow tendon, which is part of the common tendon of the quadriceps femoris muscle.Having reached the tibia, the muscle tendon attaches to the iliac tuberosity. Below the patella, this tendon is called the patellar ligament, lig. patellae.

Broad medial femoris , m. vastus medialis (see Fig. 397), occupies the anteromedial surface of the lower half of the thigh. The muscle bundles forming it are directed obliquely from top to bottom and from the inside to the front. In front, it is somewhat covered by a rectus muscle. The muscle originates from the medial lip of the rough line of the thigh and, going down, passes into the broad tendon, which is partly woven into the common tendon along with the rectus muscle, and partly attached to the medial edge of the patella, forming the medial patellar support ligament.

Lateral broad muscle of the thigh , m. vastus lateralis , occupies almost the entire anterolateral surface of the thigh. From above, it is somewhat covered by a muscle straining the fascia lata, and in front by a rectus femoris muscle. The muscle bundles are directed from top to bottom and from outside to front (see Fig. 396).

The muscle originates from the greater trochanter, the intertrochanteric line and the lateral lip of the broad line of the thigh. Heading down, the muscle passes into the broad tendon, which is part of the common tendon of the quadriceps muscle and participates in the formation of the lateral supportive ligament of the patella.

Intermediate broad muscle of the thigh , m. vastus intermedius (see Fig. 399), is located on the anterior surface of the thigh between the medial and lateral broad muscles, directly under the rectus femoris. This muscle is the weakest among the rest of the heads. It starts on the front surface of the femur – from the intertrochanteric line and, going down, passes (almost half of its length) into a wide tendon, which in the distal part joins the tendon of the rectus femoris muscle, passing into the common tendon of the quadriceps muscle.

Thus, all four muscle heads that form the quadriceps muscle of the thigh pass into the tendon, which includes the patella and attaches to the tuberosity of the tibia. The synovial bags are located in front and behind the tendon (see Fig. 268):

Rice. 268. Knee joint, articulatio genus, right. (Sagittal cut. The cavity of the knee joint was opened.)

• a) subcutaneous prepatellar bursa, bursa subcutanea prepatellaris ;
• b) suprapatellar bursa, bursa suprapatellaris , under the tendon of the quadriceps muscle, above the patella;
• c) deep subpatellar bursa, bursa infrapatellaris profunda , at the attachment of the patellar ligament to the tuberosity of the tibia;
• g) subcutaneous patellar bursa, bursa subcutanea infrapatellaris , anterior to the patellar ligament;
• e) subcutaneous bursa of the tibial tuberosity, bursa subcutanea tuberositatis tibiae , slightly lower than the previous one, lies on the anterior surface of the patellar ligament;
• f) subfascial prepatellar bursa, bursa subfascialis prepatellaris , between the apex of the anterior surface of the patella and the wide fascia of the thigh, unstable;
• g) pre-patellar tendon bursa, bursa subtendinea prepatellaris , in the thickness of the tendon of the quadriceps femoris muscle, on the anterior surface of the patellar base, unstable.

Some of these bags can communicate with the knee joint cavity.

Function: the quadriceps muscle, by contraction of all its heads, unbends the lower leg, due to m. recti femoris takes part in hip flexion.

Innervation: n. feraoralis (plexus lumbalis) (L _II -L _IV ).

Blood supply: aa. circumflexa femoris lateralis, profunda femoris, a. femoralis.

Rice.398. Muscles of the pelvis and thigh, right; front view. (The vastus lateralis is cut and retracted. The vastus intermediate is visible.)
Rice. 397. Muscles of the pelvis and thigh, right; front view. (The rectus femoris, sartorius and part of the iliopsoas muscle have been removed.)

Rice. 400. Places of origin and attachment of muscles and joint capsules on the thigh, right; front view (diagram).
Rice. 399. Muscles of the pelvis and thigh, right; front view. (The medial thigh muscle group is visible.)

Rice. 402. Muscles of the pelvis and thigh, right; side view.(Medial surface.)
Rice. 401. Muscles of the pelvis and thigh, right. (Internal pelvic muscles, anterior and medial thigh muscle groups.)

Rice. 407. Muscles of the pelvis and thigh, right; side view.
Rice. 403. Places of origin and attachment of muscles, ligaments and joint capsules on the femur, right; rear view (diagram).

Rice. 413. Places of origin and attachment of muscles, ligaments and joint capsules on the pelvic bone, right; outside view (diagram).
Rice. 411. Muscles and fascia of the thigh, right. (Cross cut at the mid-thighs.)

Applying kinesiological tapes to the quadriceps muscle of the thigh | Medical Taping

Anatomy

Quadriceps muscle. Each of the four heads has its own beginning, but, approaching the knee area, they all pass into a common tendon, which is attached to the tibial tuberosity (1).

The rectus femoris muscle (m. Rectus femoris) is the longest of the four heads. Occupies the front of the thigh. It begins with a thin tendon from the inferior anterior iliac spine, the supracostal sulcus.Heading down, the muscle passes into a narrow tendon, which is part of the common tendon of the quadriceps femoris muscle. Having reached the tibia, the muscle tendon attaches to the iliac tuberosity. Below the patella, this tendon is called the patellar ligament (1).

Broad medial thigh muscle (m. Vastus medialis) – occupies the anteromedial surface of the lower half of the thigh. The muscle bundles forming it are directed obliquely from top to bottom and from the inside to the front. In front, it is somewhat covered by a rectus muscle.The muscle originates from the medial lip of the rough line of the thigh and, going downward, passes into the broad tendon, which is partly woven into the common tendon along with the rectus muscle, and partly attached to the medial edge of the patella, forming the medial patellar support ligament (1).

Lateral broad muscle of the thigh (m. Vastus lateralis) – occupies almost the entire front lateral surface of the thigh. From above, it is somewhat covered by a muscle straining the fascia lata, and in front by a rectus femoris muscle.The muscle bundles are directed from top to bottom and from outside to front. The muscle originates from the greater trochanter, the intertrochanteric line and the lateral lip of the broad line of the thigh. Heading downward, the muscle passes into the broad tendon, which is part of the common tendon of the quadriceps muscle and participates in the formation of the lateral supportive ligament of the patella (1).

The vastus intermedius, located on the front of the thigh between the medial and lateral broad muscles, directly under the rectus femoris.This muscle is the weakest among the rest of the heads. It starts on the anterior surface of the femur – from the intertrochanteric line and, going down, passes (almost half of its length) into the broad tendon, which in the distal part joins the tendon of the rectus femoris muscle, passing into the common tendon of the quadriceps muscle (1).

Function: the quadriceps muscle, by contraction of all its heads, unbends the lower leg, at the expense of m. recti femoris takes part in hip flexion (1).

Indication for imposition:

• removal of muscle tension,

• hematoma,

• trigger points.

Step by step explanation:

1. Before applying the tape to thickly coated skin, the hair should be shaved off for maximum effect. In the case of this patient, the skin surface does not have a thick hair coverage, but for better fixation of the tape, the skin was treated with sterillium.

2. Measure and cut off three tapes of different lengths.In this case, the length of the first is about 20 cm, the second is 23-24 cm and the third is 25-27 cm. The length of the tapes directly depends on the anatomical features of the patient.

3. The patient from a standing position straightens the hip and bends the leg at the knee.

4. The first tape, the shortest in length, is glued on the inner side of the thigh. The base of the tape is applied without stretching to the upper part of the patella and then with 15% tension is applied along the lateral vastus muscle.

Attention! The photo shows the result of the overlay.During the very application of the tape, the leg should be straightened and bent at the knee.

5. Next, apply the longest tape to the rectus femoris muscle. The base of the tape is applied without stretching to the upper part of the kneecap and then with 15% tension is applied along the muscle.

Attention! The photo shows the result of the overlay. During the very application of the tape, the leg should be straightened and bent at the knee.

6. Tape 23-24 cm long, medium length, stick it on the vastus medialis muscle.The base of the tape is applied without stretching to the upper part of the kneecap and then with 15% tension is applied along the muscle.

Attention! The photo shows the result of the overlay. During the very application of the tape, the leg should be straightened and bent at the knee.

7. After application, carefully iron the tapes with your hand for a more firm hold on the skin.

Used literature:

1.R.D. Sinelkov, Ya.R. Sinelnikov. Atlas of human anatomy, volume 1.Moscow, 1996.Publishing House “Medicine” p. 291-295.

The instruction was prepared by: I. A. Siminaitis.

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Anatomy of the Hip Joint | News and promotions of the European Medical Center “UMMC-Health”

Due to the fact that man, as a result of evolution, stood on two legs, his hip joint is the main supporting joint and bears a significant load when walking, running, carrying weights.

The pelvic bones are involved in the formation of three joints: the pubic symphysis, the paired sacroiliac joint and the paired hip joint. The shape of the hip joint can be imagined as a ball located in a deep, rounded socket. The pubic symphysis and sacroiliac joint are inactive, and a large range of motion is possible in the spherical (or, more precisely, cup-shaped) hip joint, which provides both body stability and leg mobility.

The articular cavity of the hip joint is formed by the pelvic bone and is called the acetabular (acetabular) cavity.Along the edge of the cavity is the acetabular lip – a fibrocartilaginous formation. It increases the depth of the cavity by 30%, but its main function is to uniformly lubricate the articular cartilage of the femoral head with synovial fluid (articular). By creating a suction effect, it strengthens the hip joint.

Inside the acetabulum is the head of the femur, which is connected to the body of the femur by means of the neck. Often the neck of the femur is called the “neck of the femur,” but this is jargon.Somewhat below the femoral neck are bony eminences called the greater and lesser trochanters. Powerful muscles are attached to them.

Around the joint there is an articular capsule, which contains ligaments that strengthen the hip joint. On the one hand, these powerful ligaments are attached at one end to the pelvic bone and at the other end to the femur. Another powerful ligament (called the femoral head ligament, often also called the round ligament) connects the head of the femur to the bottom of the acetabulum.It is possible that this ligament also adds strength to the hip joint, limiting the external rotation of the hip. The same purpose is served by the capsule of the hip joint, which is stretched during external rotation and extension of the hip.

The hip joint is covered by the muscles of the gluteal region in the back and the muscles of the anterior group of the thigh in the front. The head of the femur, located in the acetabular cavity, is covered with articular cartilage. The articular cartilage in the hip joint, on average, reaches 4 mm in thickness, has a very smooth whitish surface and a densely elastic consistency.Due to the presence of articular cartilage, friction between the contacting articular surfaces is significantly reduced.

Clinical Hospital | Dislocation of the patella

The patella is the largest sesamoid bone in the human body and is, in addition to the femur and tibia, one of the bones that form the skeleton of the knee joint.

The functions of the patella are to stabilize the knee joint, increase the shoulder strength of the quadriceps femoris muscle, and painlessly slide the thigh tendon over the cartilage of the femur in the knee joint.Anatomically, the patella is a cancellous bone with a shape close to triangular and is located in the thickness of the tendon of the quadriceps muscle. The inner surface of the patella is lined with cartilage, which provides painless sliding along the cartilage of the femur.

Normally, the patella is stable and is kept from dislocation by sliding in the intercondylar groove of the thigh and fixed to the capsule of the knee joint with the inner and outer ligaments (patella retainers).

Patella in the intercondylar sulcus Fiber bundles left and right of the patella –

femur. MRI imaging. outer and inner retainers

Dislocations of the patella are rare. The most common external dislocation of the patella. The causes of dislocation are: underdevelopment of the lateral condyle of the thigh, which allows the patella to move outside; trauma; sharp contractions of the 4-head muscle.

Diagnosis of dislocation is usually simple and consists of severe pain in the knee. Palpation and X-ray is determined by a sharp displacement of the patella to the side of the thigh.

Left – X-ray of dislocation, right – computed tomogram. The arrow indicates the normal position of the patella.

In case of primary dislocation of the patella, treatment usually consists of immobilization. With three or more dislocations, it is considered habitual and therefore surgical treatment is indicated, which involves plastics of the internal retainer, and possibly the transplantation of a part of the patellar ligament at the point of attachment to the tibia (arthroscopic Yamamoto surgery, MPFL plasty, Blout plasty).The rehabilitation period varies depending on the choice of surgical technique, tissue condition and the patient’s constitution.