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Injuries to the hip and gluteus muscles
By Othon Molina, Ph.d.c, LMT

Most injuries to the hips are due to misalignment of the pelvis. The torque can aggravate several areas. Most commonly the hip at the trochanter, where the femur meets this hip joint is a stressful area. You can get trochanter bursitis, there is a bursa at the head of the femur, and it can be a painful situation. For this condition only an injection can help, as massage will irritate it further.

The muscles involved there is the insertion of the gluteus group, and the fascia lata. One of the muscles involved is often the periformis, this deep gluteal muscle can have a lot of stress put on it if the pelvis is out of alignment. In fact, most runners have tension and some tightness in the gluteal muscles as these are the main hip extensors and are used in running, jumping and most sports.

They seldom are injured as far as a tear, because they are very strong muscles, they can get stressed because of over use syndrome. Mostly runners get stressed, there from long distance training. You can also get injured in contact sports, or from falling on the hip.

Other injuries can happen to the ligaments holding the hip to the sacrum, these can be a be a problem (see back). Weight lifters doing heavy squats can hurt this area, or moving in the wrong direction, or a fall on the buttocks, are all ways to injure these ligaments.

Test

For injuries to the gluteus group test the gluteus maximus, have the patient prone, have them lift the knee off the table. Stabilize the opposite hip and press down on the back of the hamstring. If this hurts it will be noticeable in the tissue that s injured. If it s more at the front of the hip, have them sitting and lift the knee towards the ceiling while you push down on the thigh and resist the movement (Hip flexors test).

If the muscle pain is more on the side, then have them lay with the painful side up, on their side and have them abduct the leg (raise the leg off the table) have them hold and you push down at the knee. If that hurts it could be the fascia lata muscle. If you still can find it do the periformis test. Patient supine, bend the knee 90% and have them move the leg medially while you push laterally at the ankle. (external rotation of the hip)
For the ligaments, have the patient supine. Then move the leg on the suspected side over to the opposite pelvis, and put a stretch on the ligaments. Palpation is next, press on the lateral edge of the sacrum, and feel for pain. It can be very painful to the touch.

Treatment

RICE of course is the treatment of choice, unless it s in the deeper gluteus muscles. The next approach is DTF, massage, on the lesion. You can also use compression massage for the gluteus group. Further down the road, working on balancing the pelvis, as well as deep cross friction massage to prevent further injuries.

The ligaments will respond well to DTF, and would improve in three to four weeks. Careful not to stretch this area during the acute phase. Later they may respond well to manipulations of the sacroiliac joint (SI Joint).

For the ligaments if all else fails an injection of corticosteroid can increase the healing. For stubborn and consistent pain in the sacral ligaments a proliferant injection will create stability and scar tissue to aid in the healing.

The Quadriceps Muscle and upper leg

The muscle usually injured in the thigh is called the Rectus Femoris. Runners, football players and dancers can injure this muscle. This muscle is the main hip flexor, in other words it helps you lift the knee. The rest of the quads (see knee) only extend the leg at the knee (straighten the leg) The higher it hurts the more likely you injured the tendon. If is down on the middle of the leg, you may have some micro tears in the muscle tissue. This tissue can be injured in contact sports (football, rugby or soccer). It can also be inured in a slip or fall.
Of course overuse in running can injure this muscle, it can also be oversteatched by novice runners pulling too hard on their ankles, stretching it cold.

Test

As above, two tests can be done for the quads, first if the injury is high. Have the patient sitting and have them try and lift their knee towards the ceiling as you resist holding down their thigh (hip flexors). Next have them lay supine, bend the knee at the hip holding the leg in a 90% and then stabilize the knee while the other hand pushes down on the ankle. This will set off the pain in the tissue that is injured.

Treatment

This injury responds well to MICE. Movement with the ice bag would consist of slight extensions and contractions of the leg, while sitting. This could last four to six weeks if the injury is severe. Of course DTF is great for this muscle especially the muscle itself. If the tendon is injured DTF is very painful be careful. You may need to hang the leg off the table to get a good stretch on it as it is a deep tendon. Deep tissue massage should never be done directly on the lesion, as you will separate the tear further, however all around the area is great as it increases circulation and aids in reducing the edema.

For a serious tear you may need to see a doctor. A corticosteroid injection to the ligament can work wonders and can reduce unwanted scar tissue. Remember you need to bench the athlete after these injections.

Inner thigh or groin pull

These groin pulls can be very serious, and take a long time to heal. Most athletes at sometime or another have injured these adductor muscles. They pull your legs together and if you have spread them too far as in reaching for the bag at first base, or just ran too hard before you warmed up correctly. Racquetball or tennis comes to mind, as many people rarely stretch enough when playing these sports. It can be a mild injury and only hurt when you push the body, or if you stretch too far. It can also be serious enough to hurt for years, especially with re-injury. Other injuries to this area can be horse back ridding too much when you are not use to it.

Test

Have the patient supine and have them hold their legs together tight. You stabilize one leg with one hand and pull at the ankle with the other. If this hurts you can find the area and know what it is. If it s not conclusive you may have them sit, cross legged with the knees up high, have them resist as you push both knees down with your hand.

RICE will help if you start right away, never stretch a groin pull. DTF will help accelerate the healing as well, you need to be very precise with the location of the lesion or it will not help much. Deep massage later will help increase circulation as well as deep cross fiber work.
Of course if that doesn't help and injection will increase the healing, as well as for chronic problems. Because of the location prevention of further injuries it s good to squeeze a ball with the knees to strengthen this group.

Hamstrings

These muscles at the back of the leg are very often injured in track and field, football, in fact any all out running sport can injure a hamstring. The actual muscles we are talking about are the Biceps Femoris, the Vastus Laterals, Semmembranosis, and the Semitendinosus. I have hear this injury pop very loud. Often it s because of improper warm-up. It can also be caused because the Quads are so much stronger that the balance becomes out of proper control. Often the quads are twice as strong as the hamstrings, and it should be closer ratio of 60 to 40%. It can hurt in the buttocks all over the back of the thigh or at the knee.

Test

Have the patient lay prone, have them bend the knee, till the foot is straight up in the air. Support the hamstrings as you pull down at the ankle. This will set off the pain and give you a clue to where the injury is. These muscles heal quick, but you have to make sure you get them treated right, NO STRETCHING.

Treatment

MICE is great for healing this injury the sooner the better, you may have seen football games where there is a guy with an ice bag, and an ace bandage standing on the sidelines. You can reduce the healing time by days if you ice it right away. Keep it moving too, this will create a subtle scar tissue, and keep it flexible.
DTF is the best on these tissues as they are easy to get to and will respond well to the therapy. Later you can do deep tissue massage, to increase circulation and separate the muscles from each other. The key is to not let a improper scar tissue form there or you can have a chronic injury. Many runners hurt it over and over again, because they don t get the proper treatment. You will see a big hematoma on it in a day or two, you can still work on it just be careful, if left alone it will heal in three to four weeks, if not severe. However it can plage an athlete for years if it heals improperly. Prevention is to strengthen them with weight training, do twice the workout on the hamstrings than you do on the quadriceps. Lunges are also a good way to strengthen as well as lengthen the hamstring group.

Othon Molina, Ph.d.c, LMT,
P.O. Box 1231 Kamuela, HI 96743
Cell: (808) 895-2688



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