Common hip, thigh, and groin injuries Muscles of the hip and thigh are responsible for hip movements. Strains and contusions are the most common athletic injuries to the hip, thigh, and groin. Injuries of the hip, thigh, and groin are common in athletes and dancers. Twisting, falling, trauma, and overuse are the chief culprits. Most of these maladies are soft tissue injuries that, with proper treatment, heal without problems. But injuries that are neglected or treated incorrectly may lead to serious problems. Strains Strains are common injuries in sports that require repetitive sprinting or sudden changes in direction. A muscle strain is an indirect injury to muscles caused by stretching or tearing of the tissues. The injury may be acute (caused by a single action, such as twisting or falling) or chronic (caused by repetitive stress). Its severity is graded from I (mild) to III (severe). Careful sport-specific rehabilitation is needed to help prevent a strain from becoming a chronic problem. Properly treated, a Grade I strain usually will heal within seven to 10 days. More severe strains may take six weeks or longer to heal and should always be evaluated by a sports medicine specialist. Signs and symptoms of Grade II and III strains include severe pain and/or swelling, ecchymosis (black and blue discoloration), limited or abnormal function, and a palpable defect in the muscle or tendon. A Grade III strain involving complete avulsion (separation) of the muscle-tendon unit may require surgery. The best way to prevent a strain is to begin practice sessions and competitions with a proper warm-up and stretching exercises. Quadriceps and hip flexor strains: Strains of the quadriceps and hip flexors are common in sports requiring jumping, kicking, or repetitive sprinting. Most quadriceps strains involve the rectus femoris, which is the only two-joint muscle (hip and knee) in this group; hip flexor strains may involve the rectus femoris and/or iliopsoas muscle. With Grade I and II injuries the major concern is preventing re-injury and complete disruption (Grade III strain). Initial treatment involves ice, compression with an elastic wrap, and anti-inflammatory medications. (Certain drugs need physician approval.) Rehabilitation should be progressive and sport-specific. For example, for quadriceps strains caused by running, range-of-motion exercises and stretching should be started early and should progress to strengthening exercises, walking, pool-running, jobbing, 3é4-speed running, and full-speed sprints as soon as the athlete is free of pain. Hamstring strains: Like the rectus femoris, the hamstring muscles also span two joints and are prone to strain during sprinting and kicking. Hamstring strains are common in track and field events (particularly sprinting), and in other sports requiring high-speed running. Any of the three hamstrings may be injured, but the long head of the biceps femoris is most frequently affected. Healing of the hamstrings can be slow, and the treatment program is a delicate balance between measures designed to allow quick return and those necessary to avoid re-injury. The athletic trainer or sports medicine therapist should closely supervise rehabilitation. Initial treatment involves ice, compression, and anti-inflammatory medications with weight bearing as tolerated. Immobilization is usually avoided. Early functional exercises include light jogging, pool-running, and stationary cycling. Initial strengthening may include prone leg curls, progressing to backward running. Adductor (groin) strains: Adductor strains are common in sports requiring sudden sideways changes in direction, such as skating, soccer, track and field, and tennis. Most involve the adductor longus. Typically, an adductor strain is a Grade I or II strain (mild or moderate) and is characterized by groin pain when running or kicking. A variety of other conditions that cause groin pain should be ruled out before assuming the problem is a muscular strain. These include inflammation of the pubic bone, spine pathology, hernia, prostatitis, and hip pathology. Adductor strains are difficult to treat, and the risk of re-injury is high. As with hamstring strains, the athlete should be carefully monitored during rehabilitation. Treatment involves rest, ice, and anti-inflammatory medications, followed by adductor stretching and strengthening exercises. Contusions Contusions are common injuries in all contact sports but can occur in any sport. A contusion is a direct injury caused by blunt trauma, such as a blow from a knee or a football helmet. Local swelling, pain, and tenderness are typical symptoms. The injury involves compression of the deep muscles near the bone and causes considerable pain, discoloration (caused by bleeding) and, in some cases, temporary disability (swelling, loss of motion). Acute treatment is directed toward controlling bleeding and minimizing secondary insult. With proper treatment, minor contusions usually heal within two to three days. More severe contusions may take several weeks or months to heal and should always be evaluated by a sports medicine specialist. The best way to prevent contusions is to supervise play carefully and to use protective equipment-correctly fitted-whenever appropriate. Quadriceps contusions: Quadriceps contusions are common football, rugby, soccer, and basketball injuries usually caused by a direct blow to the thigh from a helmet or knee. The injury may limit motion and affect gait. The severity of the contusion is usually graded by the range of motion in the hip at the time of evaluation. Treatment consists of immediate compression, ice, and protection from weight bearing with crutches. Ice should be applied during the first 24 to 48 hours. Oral anti-inflammatory agents may be useful in the acute phase; analgesics may be necessary. Massage is contraindicated and may in fact cause further damage (bleeding and increased pain). Complete recovery can be expected, but painless full range of motion should be achieved before the athlete returns to his or her sport. Recovery time may last from two days to six months, depending on the severity of the injury and the development of complications, such as myositis ossificans. Myositis ossificans is a very painful condition in which an ossifying mass (calcium deposit) may form within the muscle. In many cases, myositis ossificans is the result of recurrent trauma to a quadriceps muscle that was not properly protected after an initial injury. A history of injury should always be confirmed to rule out other causes. A hard, painful mass in the soft tissue of the thigh and progressive loss of bending motion of the injured knee are indications of myositis ossificans. The definitive diagnosis of this condition is made by x-ray, but usually not until at least four weeks after the injury. In the early stages, treatment consists of heat, limitation of joint motion, and rehabilitative exercises within the limits of pain. Passive stretching and vigorous exercise during the first six months after injury are discouraged. The calcium mass usually will be re-absorbed by the body; however, resorption may take three to six months. Surgical excision may be necessary if pain and limited motion persist beyond one year. Iliac crest contusions: The iliac crest contusion, or "hip pointer," is a very painful injury caused by a direct blow to the hip. Hip pointers are common in football players who wear improperly fitting hip pads. Extreme tenderness, swelling, and ecchymosis over the iliac crest are diagnostic in cases with a history of a direct blow to the iliac crest. Treatment involves application of ice and compression followed by oral non-steroidal anti- inflammatory medications. Return to sport should be dictated by the athlete¼s pain level; the injured area should be padded to protect it from further injury. Overuse injuries Overuse injuries are common in athletes who have focused their efforts on one sport. These injuries are caused by the cumulative effects of very low levels of stress, such as the repetitive action of running. Chronic muscle strains, stress fractures, tendinitis (overuse/overload fatigue within the tendon), snapping hip (iliopsoas tendon snapping over the head of the femur), and bursitis (inflammation and thickening of the bursa wall) are examples of overuse injuries. An athlete with an overuse injury should rest from the sport aggravating the injury and use cross-training techniques or should take up exercises that use different parts of the body to maintain cardiovascular conditioning. An athlete with a chronic injury should be evaluated by a sports medicine specialist. The specialist may identify biomechanical problems-such as muscle imbalances or legs of different length-that predispose the athlete to injury. Strengthening and flexibility exercises or orthotics (custom-fitted shoe inserts) often can correct the problem. Stress fractures: Stress fractures of the pelvis occur most often in runners and dancers. Stress fractures of the femur usually occur in runners. The injured athlete may complain of chronic, ill-defined pain over the groin and thigh. Initially, many such athletes are diagnosed with a muscle strain; but if there is no history of acute injury, the correct diagnosis probably is a stress fracture. If the symptoms do not resolve with rest and rehabilitative exercise, the athlete should be examined by a sports medicine specialist. Diagnosis is performed by using x-rays and/or bone scans. Treatment of stress fractures consists of rest and non-weight bearing endurance exercises, such as running in water or swimming.