Preface	6
	Chapter 1: Epidemiology of Hip and Pelvis Injury	14
	CLINICAL PEARLS	14
	CASE REPORT: PRESENTATION	14
	Chief Complaint and History	14
	Physical Examination	14
	INTRODUCTION	15
	AGE	15
	SPORT	17
	GENDER	18
	CASE REPORT: CONCLUSION	18
	Assessment and Plan	18
	SUMMARY	19
	References	19
	Chapter 2: Physical Examination of the Hip and Pelvis	21
	CLINICAL PEARLS	21
	CASE REPORT: PRESENTATION	21
	Chief Complaint and History	21
	Physical Examination Results	22
	INTRODUCTION	23
	ANATOMY	23
	HISTORY	24
	PHYSICAL EXAMINATION	26
	Range of Motion	26
	Palpation	29
	Neurologic Testing	31
	Special Tests	32
	CASE REPORT: CONCLUSION	46
	Assessment	46
	Plan	46
	Follow-up	46
	References	46
	Chapter 3: Functional and Kinetic Chain Evaluation of the Hip and Pelvis	49
	CLINICAL PEARLS	49
	CASE PRESENTATION	49
	Chief Complaint and History	49
	Physical Examination	50
	INTRODUCTION	51
	NATURAL HISTORY	52
	FUNCTIONAL ANATOMIC CONCEPTS AND NEUROMUSCULAR CONTROL	54
	CLINICAL BIOMECHANICS	55
	COMMON HIP AND PELVIS DYSFUNCTIONS	63
	EVALUATION	70
	Functional Diagnostic Imaging	72
	PRINCIPLES OF TREATMENT	72
	Principles of Sequencing the Exercise Prescription	73
	CASE REPORT, CONCLUSION	73
	SUMMARY	73
	References	74
	Chapter 4: Gait Assessment	82
	CLINICAL PEARLS	82
	CASE PRESENTATION	82
	Chief Complaint	82
	History of Present Illness	82
	Review of Systems	83
	Physical Examination	83
	Testing	85
	GAIT ASSESSMENT	85
	THE ELEMENTS OF GAIT	85
	THE DETERMINANTS OF GAIT	91
	AGE AND DIFFERENCES IN GAIT	92
	MALE AND FEMALE GAIT	93
	CASE ASSESSMENT AND TREATMENT	93
	SUMMARY	95
	References	95
	Chapter 5: Imaging of Hip and Pelvis Injuries	98
	CLINICAL PEARLS	98
	INTRODUCTION	98
	MODALITIES	99
	Radiography	99
	US	101
	CT	101
	Magnetic Resonance Imaging	101
	Magnetic Resonance Arthrography	102
	RADIOLOGIC DIAGNOSIS OF HIP PAIN IN ATHLETES	103
	Osseous	103
	Stress Fracture	103
	Acute Fracture	107
	Articular Pathology	109
	Osteoarthritis	110
	Developmental Dysplasia	111
	Femoroacetabular Impingement	112
	Labral Tears	115
	Hip Ligaments	117
	Tendon	118
	Snapping Tendons	119
	Sportsman’s Hernia	119
	Muscle	120
	References	123
	Chapter 6: Adult Hip and Pelvis Disorders	125
	CLINICAL PEARLS	125
	CASE REPORT: PRESENTATION	125
	Physical Examination	126
	INTRODUCTION	126
	ANTERIOR HIP AND PELVIS PAIN	128
	Adductor Strain (Groin Pull)	128
	Rectus Femoris Strain/Quadriceps Strain	129
	Quadriceps Contusion	130
	Iliopsoas Strain/Hip Flexor Strain	131
	Rectus Abdominis Strain	132
	Pubic Symphysis Dysfunction	132
	Osteitis Pubis	133
	Pubic Ramus Stress Fracture	134
	Femoral Neck Stress Fracture	135
	Hip Dislocation	137
	AVN of the Femoral Head	138
	Osteoarthritis	139
	Acetabular Labral Tear	139
	Femoroacetabular Impingement	140
	Iliopsoas/Iliopectineal Bursitis	140
	Athletic Pubalgia (Sports Hernia)	141
	Internal Snapping Hip	142
	LATERAL HIP AND PELVIS PAIN	144
	External Snapping Hip	144
	Hip Pointer (Iliac Crest Contusion)	145
	TFL Syndrome	145
	Greater Trochanteric Bursitis	146
	Meralgia Paresthetica (Lateral Femoral Cutaneous Nerve Entrapment)	147
	POSTERIOR HIP AND PELVIS PAIN	147
	Hamstring Strain	147
	Ischial Bursitis	149
	Gluteus Maximus Strain	149
	Gluteus Medius Strain	149
	SI Joint Dysfunction/SI Sprain	150
	Piriformis Syndrome	151
	Coccygeal Injury	152
	Other	152
	Leg Length Discrepancy	152
	CONCLUSION OF THE CASE	153
	References	153
	Chapter 7: Hip and Pelvis Injuries in Childhood and Adolescence	158
	CLINICAL PEARLS	158
	CASE STUDY	158
	INTRODUCTION	159
	DEVELOPMENTAL Dysplasia of the Hip	159
	Diagnosis	160
	Treatment	161
	Legg-Calve-Perthes Disease	161
	Diagnosis	162
	Treatment	163
	TRANSIENT SYNOVITIS	165
	Diagnosis	165
	Treatment	167
	Slipped Capital Femoral Epiphysis	167
	Classification	168
	Diagnosis	168
	Treatment	169
	APOPHYSEAL INJURIES OF THE YOUNG ATHLETE	171
	DIAGNOSIS	175
	Treatment	175
	References	176
	Chapter 8: Specific Considerations in Geriatric Athletes	180
	KEY POINTS	180
	CASE VINGETTE	180
	AGE-RELATED PHYSIOLOGICAL CHANGES	181
	Bone	181
	OSTEOPOROSIS EVALUATION	184
	MUSCLE	186
	CARTILAGE, LIGAMENTS, AND TENDONS	187
	BALANCE	188
	EXERCISE TO PREVENT INJURY	188
	Weight-Bearing Exercise	188
	Flexibility Exercise	190
	Balance Exercise	190
	EXERCISE AFTER HIP SURGERY	190
	CASE FOLLOW-UP	193
	References	194
	Chapter 9: Hip and Pelvis Injuries in Special Populations	196
	CLINICAL PEARLS	196
	CASE STUDY	196
	INTRODUCTION	197
	HISTORY OF DISABLED ATHLETICS	202
	THE AMPUTEE ATHLETE	203
	Overview	203
	Running	204
	Skiing	206
	Water Sports	207
	Cycling	208
	THE ATHLETE WITH CEREBRAL PALSY	209
	THE WHEELCHAIR ATHLETE	210
	SUMMARY	212
	References	212
	Chapter 10: Functional Therapeutic and Core Strengthening	215
	CLINICAL PEARLS	215
	CLINICAL VIGNETTE	215
	INTRODUCTION	216
	ANATOMY	217
	MECHANISM OF THE CORE AND THE KINETIC CHAIN	222
	ASSESSING THE CORE MUSCULATURE	226
	EXERCISE PROGRAMS FOR CORE STRENGTHENING AND ENDURANCE	233
	ROLE OF CORE STRENGTHENING AND SPECIFIC MUSCLE GROUPS	237
	CONCLUSION	239
	References	239
	Chapter 11: Manual Medicine of the Hip and Pelvis	241
	CLINICAL PEARLS	241
	CASE	241
	INTRODUCTION	243
	FUNCTIONAL ANATOMY OF THE HIP AND PELVIS	244
	MANIPULATION BASICS	247
	METHODS OF MANIPULATION	247
	ACTIVATING FORCES	248
	GOALS OF TREATMENT	248
	MANUAL MEDICINE TECHNIQUES	249
	Counterstrain9,15,21	249
	Psoas	249
	Piriformis	250
	Muscle Energy Techniques15,20,22,23	250
	Anteriorly Rotated Inominate, or the Inferior Pubic Shear	250
	Posterior Rotated Inominate, or Superior Pubic Shear	251
	SI Joint Dysfunction/Pubic Shear	251
	Restricted Hip Abduction	251
	Restricted Hip Adduction	252
	Restricted Hip Extension	253
	Restricted Hip Flexion	253
	Restriction in Hip External Rotation	253
	Restricted in Internal Rotation	254
	Sacral Base Anterior	254
	Sacral Torsion About the Same Axis	256
	High Velocity Low Amplitude Techniques15,20,22,23	256
	Unilateral Sacral Shear, Superior Inominate Shear	256
	Right Posterior Innominate	258
	Sacral Base Posterior	259
	Table Assisted Technique	260
	Right Posterior Innominate	260
	Articulatory Technique for the Lumbar Spine and the SI Joint15	260
	Stretching Techniques	262
	Hamstrings (Semitendinosus, Biceps Femoris, Semimembranosus)	262
	Iliopsoas	262
	Quadriceps Femoris Stretch	263
	Iliotibial Band Stretch	263
	Gluteal Stretch (Figure 4 Stretch)	264
	Piriformis Stretch	265
	Doctor-Assisted Resisted Piriformis Stretch	267
	Groin Stretch	267
	SUMMARY	267
	References	269
	Chapter 12: Taping and Bracing for Pelvic and Hip Injuries	271
	CLINICAL PEARLS	271
	CASE STUDY	271
	INTRODUCTION	271
	INDICATIONS FOR TAPING	272
	EFFICACY OF TAPING	272
	DRAWBACKS	272
	TYPES OF TAPE	272
	TAPING TECHNIQUES	274
	BRACING	274
	Compression Shorts	274
	CASE CONCLUSION	276
	References	278
	Chapter 13: Nonsurgical Interventions	279
	CLINICAL PEARLS	279
	CASE PRESENTAION	279
	Physical Examination	280
	Differential Diagnosis	280
	Imaging	281
	INTRODUCTION	281
	RATIONALE FOR USE	281
	DIAGNOSTIC INJECTIONS	282
	THERAPEUTIC INJECTIONS	283
	PHARMACOLOGICAL AGENTS	283
	Corticosteroids	283
	Hyaluronic Acid	284
	Anesthetics	284
	Lidocaine	284
	Bupivacaine	285
	Proliferants	285
	SAFETY CONSIDERATIONS	285
	CONTRAINDICATIONS	286
	POTENTIAL COMPLICATIONS	286
	ANATOMY	287
	PROCEDURES	288
	Documentation	288
	Injection Technique Fundamentals	288
	Image Guidance	288
	Positioning	289
	Target Selection	289
	Sterile Preparation	289
	Drapes	289
	Universal Precautions	289
	Gloves	289
	Skin Wheel	289
	Negative Aspiration	289
	Injectate Volume	290
	Steroid Dosing	290
	Injection Resistance	290
	Microbicide Removal	290
	Dressing	290
	Sharps	290
	SOFT TISSUE INJECTIONS	290
	Greater Trochanteric Bursa (Fig. 13.3)	290
	Ischial Bursa (Fig. 13.4)	292
	Hamstring Origin (Fig. 13.5)	292
	Iliopsoas Bursa (Fig. 13.6)	293
	Hip Adductor Origin (Fig. 13.7)	294
	JOINT INJECTIONS	295
	Sacroiliac (Fig. 13.8)	295
	Hip (Fig. 13.9)	296
	Pubic Symphysis (Fig. 13.10)	297
	Sacrococcygeal (Fig. 13.11)	298
	NERVE BLOCKS	299
	Lateral Femoral Cutaneous Nerve (Fig. 13.12)	299
	CASE PRESENTION WRAP-UP	300
	References	301
	Chapter 14: Treatment Options for Osteoarthritis of the Hip	304
	CLINICAL PEARLS	304
	CASE VINETTE	304
	EPIDEMIOLOGY	305
	RISK FACTORS	306
	DIAGNOSIS	306
	NONOPERATIVE MANAGEMENT	309
	Nonpharmacologic Therapy	310
	Exercise: General Benefit	310
	Exercise: Type	310
	Hydrotherapy	311
	Exercise: Adherence and Risk	311
	Patient Education and Self-Management Programs	312
	Assistive Devices	312
	Weight Loss	312
	Pharmacologic Therapy	313
	Acetaminophen	313
	NSAIDs	313
	COX-2 Inhibitors	314
	Opioids	314
	Tramadol	315
	Intra-Articular Injectable Therapy	315
	Corticosteroids	315
	Viscosupplementation	316
	SUPPLEMENTS/ALTERNATIVE THERAPIES	317
	Glucosamine and Chondroitin	317
	Other Supplements	318
	Acupuncture	318
	Diacerein	319
	Future Directions	319
	INDICATIONS FOR SURGERY	319
	CASE CONCLUSION	319
	References	320
	Chapter 15: Surgical Interventions in Hip and Pelvis Injuries	323
	CLINICAL PEARLS	323
	CASE PRESENTATION	323
	Chief Compliant	323
	Patient History	323
	Physical Examination	324
	Imaging	324
	INTRODUCTION	324
	MUSCLE STRAIN/AVULSION	324
	HIP DISLOCATION	326
	HIP FRACTURES	327
	STRESS FRACTURES	327
	ACETABULAR LABRAL TEARS	329
	SPORTS/HOCKEY HERNIA	331
	GILMORE’S GROIN/GROIN DISRUPTION	331
	OSTEITIS PUBIS	332
	SNAPPING HIP SYNDROME	332
	NERVE COMPRESSION	333
	SCIATIC/PIRIFORMIS/HAMSTRING SYNDROMES	333
	ADOLESCENTS	336
	Slipped Capital Femoral Epiphysis	336
	Apophyseal Avulsions	337
	TUMOR	337
	CONCLUSION OF CASE PRESENTATION	338
	Intervention	338
	Follow up	338
	Decision-Making	338
	References	339
	Appendix 1	342
	EVIDENCE-BASED MEDICINE	342
	STRENGTH OF RECOMMENDATION TAXONOMY	342
	LEVEL OF EVIDENCE4,5	343
	References	345
	PHYSICAL THERAPY MODALITIES	346
	Summary	346