Lecture #16 - Muscular Pathologies of the Hip
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Questions and Answers

What are the 7 most common muscle pathologies in athletes?

Muscle strain Teninopathy Muscle contusion Delayed onset muscle soreness Muscle cramps Myofascial pain syndrome Compartment syndrome

What are the two acute mechanisms of injury (MOI) that can cause muscular pathology of the hip?

Sudden, unexpected movements and compressive forces or direct blows.

How does a chronic mechanism of injury (MOI) contribute to muscular pathology of the hip?

Chronic MOI results from habitual postural positions that are not aligned correctly.

Describe the consequences of sudden, excessive movement on hip muscle health.

<p>Sudden, excessive movements can lead to strains or tears in the hip muscles.</p> Signup and view all the answers

Explain how compressive forces might affect the hip musculature.

<p>Compressive forces can cause direct damage to hip muscles, leading to inflammation and pain.</p> Signup and view all the answers

What role do chronic postural issues play in developing hip muscular pathologies?

<p>Chronic postural issues can lead to muscle imbalances and overuse injuries in the hip.</p> Signup and view all the answers

What are the five key steps to perform AROM on an individual effectively?

<ol> <li>Observe 2. Cue/correct 3. Palpate 4. Ask about pain 5. Verbalize ROM</li> </ol> Signup and view all the answers

Which assessment step is often overlooked when evaluating hip AROM and why?

<p>Observing for compensation or asymmetry is often overlooked, particularly at the hip.</p> Signup and view all the answers

In assessing a hip muscular pathology, should you evaluate strength or length first?

<p>You should test length first.</p> Signup and view all the answers

When considering strength of the hip/pelvic musculature with an injury, list one possible strength condition.

<p>Strong and painful, weak and painful, or weak and pain-free.</p> Signup and view all the answers

What three tests are most relevant for assessing adverse neurodynamic issues?

<ol> <li>Slump 2. SLR (Straight Leg Raise) 3. Prone knee bend</li> </ol> Signup and view all the answers

Which four occupations or sports pose the highest risk for hip muscular pathology?

<p>Lifting, running, jumping, and sudden change of direction.</p> Signup and view all the answers

How does smoking relate to hip muscular pathology?

<p>Smoking increases the risk of hip muscular pathology by negatively impacting tissue health.</p> Signup and view all the answers

What are the four common symptoms associated with hip muscular pathology?

<p>Dullness, aching, stiffness, and tightness.</p> Signup and view all the answers

What two factors aggravate pain associated with hip muscular pathology?

<p>Movements that contract or stretch the affected tissue and sustained postures.</p> Signup and view all the answers

At what time of day is hip pathology typically stiffer?

<p>In the morning.</p> Signup and view all the answers

Which observation indicates a potential hip muscular pathology?

<p>SHARD, altered weight-bearing, and abnormal gait.</p> Signup and view all the answers

What is the impact of activity on chronic hip muscular pathology?

<p>Sustained postures are more likely to aggravate chronic hip muscular pathology.</p> Signup and view all the answers

What two factors determine the amount of SHARD present in hip muscular pathology?

<p>The severity of the injury and the location of the affected muscle.</p> Signup and view all the answers

Which factor is likely to be hypomobile in response to joint pathology?

<p>Muscle length</p> Signup and view all the answers

Adverse neurodynamic issues are irrelevant in assessing chronic muscular problems.

<p>False</p> Signup and view all the answers

In a hip muscular pathology assessment, what should you prioritize testing first?

<p>Length</p> Signup and view all the answers

The three tests most relevant for assessing adverse neurodynamic issues are Slump, SLR, and __________.

<p>Prone knee bend</p> Signup and view all the answers

Match the following strength conditions with their descriptions:

<p>Strong and painful = Experiencing pain despite strength Weak and painful = Reduced strength with associated pain Weak and pain-free = Decreased strength without pain</p> Signup and view all the answers

Which of the following are symptoms commonly associated with hip muscular pathology? (Select all that apply)

<p>Dull pain</p> Signup and view all the answers

Smoking is a causal factor for hip muscular pathology.

<p>False</p> Signup and view all the answers

What activity is more likely to exacerbate chronic hip muscular pathology?

<p>Sustained postures</p> Signup and view all the answers

The presence of ______ is often associated with hip muscular pathology, indicating a reduction in available motion.

<p>decreased ROM</p> Signup and view all the answers

Match the following symptoms to their descriptions:

<p>Dull = A persistent low-level discomfort Aching = A deep and often generalized feeling of pain Stiff = Reduced flexibility and movement Tight = A sensation of muscle contraction or tension</p> Signup and view all the answers

What is a primary risk factor for individuals experiencing hip muscular pathology?

<p>Running</p> Signup and view all the answers

What is SHARD in the context of hip muscular pathology?

<p>Severity, Health, Asymmetry, ROM, and Dysfunction</p> Signup and view all the answers

Leg length discrepancy can be an observation associated with hip muscular pathology.

<p>True</p> Signup and view all the answers

Name three special tests associated with rectus femoris pathology.

<p>Kendall, Thomas, Ely’s</p> Signup and view all the answers

What observation sign indicates a strain in the rectus femoris and iliopsoas muscles?

<p>Lordosis in standing vs kneeling</p> Signup and view all the answers

What are two special tests used to assess hamstring pathology?

<p>SLR and 90-90 SLR</p> Signup and view all the answers

What two actions should be taken before palpating sensitive areas around the hip?

<p>Explain what you’re doing and seek permission</p> Signup and view all the answers

List three differential diagnoses for hip muscular pathology.

<p>Tendinopathy, Bursitis, Sprain</p> Signup and view all the answers

The Kendall test is associated with both rectus femoris and iliopsoas pathology.

<p>True</p> Signup and view all the answers

Name one special test that is used to assess IT band pathology.

<p>Ober’s test</p> Signup and view all the answers

To palpate more sensitive areas around the hip, one could use a ______.

<p>towel</p> Signup and view all the answers

Match the following special tests with their associated pathologies:

<p>Ely’s = Rectus femoris Faber/Patrick’s = Iliopsoas SLR = Hamstring Piriformis length test = Piriformis</p> Signup and view all the answers

Which of the following is NOT a differential diagnosis for hip muscular pathology?

<p>Anemia</p> Signup and view all the answers

Kneeling is an appropriate position for palpating the hip area.

<p>True</p> Signup and view all the answers

What should be explained to the patient prior to palpating sensitive areas around the hip?

<p>The purpose of the palpation.</p> Signup and view all the answers

The position a patient cannot be in when palpating for hip area issues is ______.

<p>supine</p> Signup and view all the answers

List two special tests associated with hamstring pathology.

<p>SLR and 90-90 SLR</p> Signup and view all the answers

Which special test is specifically associated with piriformis pathology?

<p>Piriformis Length Test</p> Signup and view all the answers

The Lordosis observation sign is associated with iliopsoas and rectus femoris strains.

<p>True</p> Signup and view all the answers

What two materials could be used for palpating more sensitive areas around the hip?

<p>Towel and hand</p> Signup and view all the answers

The three special tests associated with iliopsoas pathology are the Kendall, Thomas, and ______.

<p>Faber/Patrick's</p> Signup and view all the answers

Match the special tests with their associated pathologies.

<p>Kendall = Rectus Femoris SLR = Hamstring Ober's = IT Band Adduction Contracture = Adductor</p> Signup and view all the answers

The supine position is preferred for palpating the hip area in all cases.

<p>False</p> Signup and view all the answers

What are two things that should be done prior to palpating around the hip?

<p>Explain what you're doing and seek permission</p> Signup and view all the answers

A common observation indicating a hip muscular pathology is ______ discrepancy.

<p>leg length</p> Signup and view all the answers

When testing hip AROM, what common observation method is often missed?

<p>Observing for any compensation or asymmetry at the hip.</p> Signup and view all the answers

What are the three possible strength conditions in the case of hip muscular pathology?

<p>Strong and painful, weak and painful, weak and pain-free.</p> Signup and view all the answers

Which assessment should be performed first when evaluating a hip muscular pathology?

<p>Length should be tested before strength.</p> Signup and view all the answers

What position assists in identifying the specific affected hip muscle during assessment?

<p>Palpation of the affected area.</p> Signup and view all the answers

In relation to a muscular pathology, what is the degree difference observed in contralateral pelvis landmarks?

<p>The difference is typically 20-30 degrees.</p> Signup and view all the answers

What does 'adverse neurodynamic' refer to in the context of chronic muscular issues?

<p>It refers to how nerve function might be impaired due to the muscular issue.</p> Signup and view all the answers

How likely is it to clear a hip clearing exam with a muscular pathology present?

<p>The likelihood is quite low.</p> Signup and view all the answers

What are the three tests most relevant for assessing adverse neurodynamic issues?

<p>Slump, SLR, and prone knee bend.</p> Signup and view all the answers

Why is it unlikely to experience pain when stretching a muscle actively with a muscle pathology?

<p>It's not very likely for stretching to cause pain if the muscle is not severely affected.</p> Signup and view all the answers

What should you prioritize when evaluating an individual's hip muscular pathology?

<p>You should prioritize length testing before any other assessments.</p> Signup and view all the answers

List four associated symptoms of a hip muscular pathology.

<p>Dull, aching, stiff, and tight.</p> Signup and view all the answers

How does the relationship between smoking and hip muscular pathology manifest?

<p>Smoking increases the risk of hip muscular pathology but is not necessarily causal, as it negatively impacts tissue health.</p> Signup and view all the answers

Why might pregnancy or menstruation contribute to an increased risk of hip muscular pathology?

<p>They can decrease stability, which increases the risk of hip muscular injury.</p> Signup and view all the answers

What activities are likely to aggravate pain due to hip muscular pathology?

<p>Movements that actively contract or stretch the affected tissue and sustained postures.</p> Signup and view all the answers

What measures can alleviate pain associated with hip muscular pathology?

<p>Ice, heat, medications for pain, and managing spasm and inflammation.</p> Signup and view all the answers

What time of day is a hip muscular pathology often stiffer, and why is this significant?

<p>In the morning; it highlights the need for gentle movement or stretching upon waking.</p> Signup and view all the answers

What does joint play generally depend on in the context of hip muscular pathology?

<p>It depends on the severity of the injury and the specific location of the affected muscle.</p> Signup and view all the answers

What observation findings suggest a potential hip muscular pathology?

<p>Altered weight bearing, abnormal gait, muscle spasm, and pelvic tilt.</p> Signup and view all the answers

Explain the significance of decreased range of motion (ROM) in hip muscular pathologies.

<p>Decreased ROM indicates the presence of tightness or injury in the hip musculature.</p> Signup and view all the answers

How does the presence of abnormal standing pelvic levels relate to hip muscular pathology?

<p>It suggests pelvic instability or muscular imbalance, indicating potential injuries.</p> Signup and view all the answers

What are the two hip ROM movements affected when the sciatic nerve pierces through the piriformis?

<p>Internal rotation and external rotation.</p> Signup and view all the answers

What is the primary method to determine if someone has their sciatic nerve mispositioned in relation to the piriformis?

<p>Diagnostics/imaging.</p> Signup and view all the answers

In what position should a patient lie down to locate the sciatic nerve between the ischial tuberosity and the greater trochanter?

<p>Side lying position.</p> Signup and view all the answers

What anatomical anomaly can occur in relation to the position of the sciatic nerve and the piriformis muscle?

<p>The sciatic nerve can pierce through the piriformis.</p> Signup and view all the answers

Describe the anatomical relationship of the sciatic nerve to the piriformis muscle in a normal scenario.

<p>The sciatic nerve should pass anterior and deep to the piriformis.</p> Signup and view all the answers

When the sciatic nerve pierces through the piriformis, which two hip movements are affected?

<p>Internal rotation and External rotation</p> Signup and view all the answers

The sciatic nerve normally passes anterior and deep to the piriformis.

<p>True</p> Signup and view all the answers

What anatomical structures is the sciatic nerve located between?

<p>Ischial tuberosity and greater trochanter</p> Signup and view all the answers

To locate the sciatic nerve, the patient should lie in a ______ position.

<p>side lying</p> Signup and view all the answers

Match the following anatomical features with their descriptions:

<p>Sciatic nerve = Passes anterior and deep to the piriformis Piriformis syndrome = Can affect hip range of motion Imaging diagnostics = Only way to identify sciatic nerve mispositioning Hip ROM = Affected by the nerve piercing the piriformis</p> Signup and view all the answers

Which of the following correctly describes true sciatica?

<p>Results from a lumbar disc pathology.</p> Signup and view all the answers

Pseudo sciatica can be caused by a hypertrophied piriformis.

<p>True</p> Signup and view all the answers

Name one other cause of sciatic nerve compression besides a hypertrophied piriformis.

<p>Spasm piriformis, excess bulk piriformis, lengthened piriformis, or trauma.</p> Signup and view all the answers

The primary cause of pseudo sciatica is a __________ piriformis.

<p>hypertrophied</p> Signup and view all the answers

Match the type of sciatica to its description.

<p>Pseudo sciatica = Symptoms not due to disc issues True sciatica = Results from lumbar disc pathology</p> Signup and view all the answers

What can cause pseudo sciatica due to a hypertrophied piriformis?

<p>Hypertrophied piriformis</p> Signup and view all the answers

True sciatica is always associated with a lumbar disc pathology.

<p>True</p> Signup and view all the answers

Name one way by which compression of the sciatic nerve can occur.

<p>Spasm of the piriformis</p> Signup and view all the answers

The two types of sciatica are ____ and ____.

<p>pseudo sciatica, true sciatica</p> Signup and view all the answers

Match the following conditions to their descriptions:

<p>Pseudo sciatica = Sciatic symptoms not due to lumbar spine issues True sciatica = Sciatic symptoms caused by lumbar disc pathology Hypertrophied piriformis = Enlarged piriformis muscle causing sciatica Spasm piriformis = Contraction of piriformis muscle leading to nerve compression</p> Signup and view all the answers

Which of the following is a primary cause of pseudo sciatica?

<p>Hypertrophied piriformis</p> Signup and view all the answers

True sciatica results from a compression caused by a lumbar disc pathology.

<p>True</p> Signup and view all the answers

List two types of sciatica.

<p>Pseudo sciatica and true sciatica</p> Signup and view all the answers

Sciatic nerve compression can occur due to ______, ______, and ______ of the piriformis muscle.

<p>spasm, excess bulk, lengthened</p> Signup and view all the answers

What is the function of the piriformis muscle below 60 degrees of hip flexion?

<p>External rotation</p> Signup and view all the answers

The piriformis muscle facilitates internal rotation of the hip when flexion exceeds 60 degrees.

<p>True</p> Signup and view all the answers

What happens to the function of the piriformis as hip flexion increases beyond 60 degrees?

<p>It facilitates internal rotation.</p> Signup and view all the answers

The function of the piriformis changes from __________ below 60 degrees of hip flexion to __________ above 60 degrees.

<p>external rotation; internal rotation</p> Signup and view all the answers

Match the degree of hip flexion with the corresponding function of the piriformis:

<p>Below 60 degrees = External rotation Above 60 degrees = Internal rotation</p> Signup and view all the answers

What is the role of the piriformis muscle in hip function when the hip is flexed beyond 60 degrees?

<p>The piriformis contributes to internal rotation of the hip above 60 degrees of flexion.</p> Signup and view all the answers

How does the piriformis muscle function when the hip is flexed below 60 degrees?

<p>It functions to externally rotate the hip below 60 degrees of flexion.</p> Signup and view all the answers

Discuss the implications of the piriformis's dual role in hip rotation for athletes.

<p>Athletes may experience varied levels of muscle strain or tightness based on the angle of hip flexion during activities.</p> Signup and view all the answers

What biomechanical changes might occur in hip function if the piriformis is dysfunctional?

<p>If dysfunctional, the piriformis may lead to abnormal hip rotation, impacting stability and movement efficiency.</p> Signup and view all the answers

How might rehabilitation programs differ based on the piriformis's function at different angles of hip flexion?

<p>Rehabilitation may target specific strengthening or stretching exercises focusing on internal rotation above 60 degrees and external rotation below 60 degrees.</p> Signup and view all the answers

What is the primary function of the piriformis muscle when the hip is flexed beyond 60 degrees?

<p>Internal rotation.</p> Signup and view all the answers

How does the role of the piriformis change when the hip is flexed below 60 degrees?

<p>External rotation.</p> Signup and view all the answers

Describe how the piriformis contributes to hip dynamics in different flexion ranges.

<p>It assists in internal rotation beyond 60 degrees and external rotation below 60 degrees.</p> Signup and view all the answers

In what scenarios might an understanding of the piriformis's function at various degrees of hip flexion be clinically relevant?

<p>During rehabilitation and sports performance assessments.</p> Signup and view all the answers

Why is it important for practitioners to differentiate between the sacral and femoral attachment effects of the piriformis based on hip flexion?

<p>It influences treatment strategies for hip dysfunction and rehabilitation.</p> Signup and view all the answers

What is the function of the piriformis below 60 degrees of hip flexion?

<p>External rotation</p> Signup and view all the answers

The piriformis primarily contributes to internal rotation of the hip beyond 60 degrees of flexion.

<p>True</p> Signup and view all the answers

What movement does the piriformis assist with when the hip is flexed beyond 60 degrees?

<p>Internal rotation</p> Signup and view all the answers

The piriformis assists in ______ rotation of the hip when flexed below 60 degrees.

<p>external</p> Signup and view all the answers

Match the degree of hip flexion to the function of the piriformis:

<p>Below 60 degrees = External rotation Above 60 degrees = Internal rotation</p> Signup and view all the answers

Which two special tests are aggravated by piriformis syndrome that are typically not associated with it?

<p>SLR and slump</p> Signup and view all the answers

Piriformis syndrome primarily impacts the rectus femoris and iliopsoas muscles.

<p>False</p> Signup and view all the answers

What is one special test specifically associated with piriformis pathology?

<p>Piriformis test</p> Signup and view all the answers

The two tests that are aggravated by piriformis syndrome are _____ and slump.

<p>SLR</p> Signup and view all the answers

Match the following tests with their muscle associations:

<p>SLR = Nerve tension test Slump = Neurodynamic test Kendall = Rectus femoris pathology Ober = IT band pathology</p> Signup and view all the answers

What are the two special tests that would be aggravated by piriformis syndrome and are typically not associated with it?

<p>SLR and slump.</p> Signup and view all the answers

Explain how the SLR test can differ in patients with piriformis syndrome compared to other conditions.

<p>In piriformis syndrome, the SLR test may provoke pain due to sciatic nerve irritation, unlike in other conditions where pain might not be present.</p> Signup and view all the answers

Discuss the significance of the slump test in relation to piriformis syndrome.

<p>The slump test is significant as it can reveal altered neurodynamic function linked to sciatic nerve entrapment due to the piriformis muscle.</p> Signup and view all the answers

What is the relevance of identifying SLR and slump tests in the context of diagnosing piriformis syndrome?

<p>Identifying these tests helps differentiate piriformis syndrome from other conditions causing similar symptoms by focusing on neuromuscular function.</p> Signup and view all the answers

How can the results of SLR and slump tests guide treatment decisions for patients with piriformis syndrome?

<p>The results can inform practitioners about the need for targeted interventions, such as stretching or manual therapy to relieve nerve compression.</p> Signup and view all the answers

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