Damage to the ligaments of the hip joint: symptoms and treatment

The hip joint (HJ) takes on significant load when walking and running. It is rarely injured, because this is due to the anatomical features of the joint. But there is also a weak point - the ligaments, and any excessive physical activity can lead to their damage.

Anatomy of the thigh muscles and the specifics of their stretching

The thigh muscles are divided into 3 large groups. Let's look at each of them.

1. Posterior group – flexors (biceps, semitendinosus, semimembranosus, popliteal). Contraction of the first with a bent knee rotates the tibia outward. The rest of the listed muscles contribute to the inward movement of the lower part of the leg, the last of which acts only on the knee joint, bending it. With a fixed pelvis, the lower leg is flexed at the knee joint and the thigh is extended; with the lower leg fixed, the torso is extended. If during these actions the muscle has not been pre-warmed, it can stretch painfully - the victim feels severe pain.
2. The anterior muscles include:

• tailoring;
• quadriceps;
• straight;
• medial wide;
• lateral wide;
• intermediate wide.

Damage to the anterior group of muscles in the area in question, incl. strain of the quadriceps femoris muscle is provoked mainly by sudden movements during outdoor games.

1. The medial group is the adductor muscles (pectineus, brevis, longus and adductor magnus, slender), located on the inner surface of the thigh. They help to adduct the thigh and slightly turn it outward, flex the hip joint, bend the lower leg at the knee joint and turn it inward.

Stretching of the adductor muscle of the thigh is observed in athletes with an unsuccessful landing after a jump, as well as a direct strong blow, or a split on unheated muscle tissue.

Anatomy of the biceps brachii tendon

The biceps, or biceps muscle, is a flexor muscle. It consists of muscle fibers and tendon parts. When it contracts, the upper limb moves in the elbow joint.

The long head of the biceps is attached to the tubercle of the scapula, and the short head is attached to its coracoid process. Both heads fuse to form a single tendon and attach to the tuberosity at the proximal end of the radius of the forearm. The biceps can not only bend the arm at the elbow joint, but also participate in rotational movements.

Fig. 1 a, b Structure of the shoulder joint (schematic representation)

The long head tendon of the biceps brachii runs through the shoulder joint and is longer than the short head tendon, so it is more susceptible to injury.

Causes of sprains

Injury to the thigh muscles occurs through a fairly simple mechanism. A smooth load on the hip joint allows you to minimize the load and distribute it to all muscle groups of the leg. A sharp and sudden jerk disables the muscles, increasing the likelihood of a thigh muscle strain. Causes of injury:

• sudden change of posture;
• high load with insufficient stretching;
• loss of elasticity of muscles and tendons as a result of prolonged lack of movement;
• physical exercise and work, lifting weights;
• external influence: directed blows, unsuccessful falls, unexpected collisions.

Signs of distortion

Symptoms of thigh muscle strain are manifested by characteristic signs for this pathology.

• A feeling of a characteristic click at the time of injury, which indicates a violation of the integrity of the fibers of the muscle structure - the formation of tears or complete rupture.
• The immediate appearance of intense pain after an injury, especially in the area of ​​the hip joints on the affected side - in the area of ​​​​concentration of nerve bundles. The development of painful traumatic shock cannot be ruled out. Further movements are impossible.
• Palpation of the affected area is painful, which immediately allows you to identify the location of the affected muscles.
• Manifestation of tissue and subcutaneous hemorrhages (bleeding) with the formation of hematomas in the area of ​​injury, as a result of increased pressure on the vessels.
• Muscle distortion is indicated by the formation of swelling in the affected area.
• Muscle stiffness syndrome develops, limiting limb movements.

Even the presence of characteristic symptoms after injuries is not a basis for self-diagnosis.

Only a doctor, based on a physical and instrumental examination, can diagnose thigh muscle strains and establish their severity based on the clinical picture, or refute this fact.

Clinical picture of sprain

Symptoms that a person has pulled a hip muscle include:

• Click. The patient feels it at the time of injury - muscle fibers are torn.
• Pain. Very intense, usually occurs immediately. The patient is forced to stop moving, and sometimes painful shock develops. Injuries in the area of ​​the hip joints are especially painful, since this is where bundles of nerve fibers are concentrated.
• Pain on palpation. It is impossible to touch the affected area. This immediately allows you to clarify the location of the injury.
• Hematoma. It is formed if blood vessels are damaged and hemorrhage occurs in the tissue and under the skin.
• Edema. This is a sign of a hamstring strain.
• Stiffness of movements.

The prevalence of edema and hematoma, the severity of pain are additional criteria for the severity of the injury.

What needs to be done to recover?

If a sprain occurs, urgent help is needed; without waiting for a doctor, the patient can already do some important steps:

• immediately stop muscle movements;
• apply a bandage to reduce swelling and prevent hematomas;
• place the hip in an elevated position;
• apply cold to the affected muscles;
• take a painkiller.

Maximum rest will be required for the first 1-2 weeks after the sprain. Bed rest is advisable, lameness should be eliminated or support devices should be used when walking. To avoid the development of inflammation, your doctor may recommend anti-inflammatory muscle therapy. For severe pain, anesthetic injections into the sprained area are possible.

Treatment consists of supporting the muscles and providing conditions for rapid natural restoration of function. What is it prescribed for:

• physiotherapy;
• relaxation programs;
• massage;
• special exercises (often with a load on the thigh placed in water).

To enhance the nutrition of muscle tissue, compresses and herbal medicine are often used. If the patient's initial response to stretching was delayed and the pain persists for a long time, therapy will take several months. In case of ruptures, invasion aimed at tissue suturing is often necessary.

Degrees of stretch

Injuries to the thigh muscles are classified depending on the degree of damage:

1. The first degree is characterized by the presence of pain in the absence of subcutaneous hemorrhages. The victim can continue to move, but experiences discomfort on the back of the thigh.
2. The second degree of thigh muscle strain is diagnosed when the integrity of the muscle fibers is partially disrupted (tear) and is characterized by the presence of hematomas and pronounced pain. The patient will experience difficulty walking and raising a straight leg.
3. The third degree of muscle strain is diagnosed with a complete rupture of the thigh muscles, accompanied by profuse subcutaneous hemorrhage and unbearable pain in the limbs. Movements of the leg are extremely painful, the patient cannot walk independently.

Consequences of injury

Stretching occurs either immediately or after some time. The main signal is pain in the thigh, spreading throughout the entire limb or concentrated in the affected muscles.

1. If the sprain is severe, to the point of tearing - partial or complete - a clicking/popping sound will be heard/felt in the muscle.
2. If the vessels are torn during stretching, then there will be a subcutaneous bruise, from red to purple.
3. Since stretching is most often observed in the part where the muscle passes into the tendon, the most sensitive area of ​​the thigh will be the periarticular area.

Diagnostics

To confirm the diagnosis, you need to contact a traumatologist. He conducts an examination and collects anamnesis. To determine the location of the injury, the doctor asks you to move the affected leg, bend and straighten it to check the function of the joints, examines the site of the bruise and assesses the pain of the injury. If there is any doubt whether the bone is damaged, an additional x-ray is prescribed. The doctor may also refer you for an MRI or ultrasound.

After examination and all diagnostic procedures, the doctor prescribes the necessary treatment. Treatment for a thigh muscle strain depends on the extent of the injury.

Verification of the injury zone

Since the pain syndrome when stretching the hips is very severe and significantly reduces the quality of life, it is recommended to seek help as soon as possible. An orthopedic surgeon, also known as a traumatologist, deals with issues of sprains. During the appointment, such a specialist will:

• Questioning about activities that led to the sprain;
• muscle examination;
• will ask you to bend/spread your legs/hips.

Often, diagnosis is limited to such manipulations of the hip. But in some cases, with severe swelling, redness and hemorrhages under the skin, ultrasound, MRI, CT and X-ray of the hip may be prescribed to eliminate the risk of severe muscle damage. The first three manipulations will help determine the degree of injury to the thigh fibers, the last will eliminate the likelihood of ruptures and damage to bone tissue.

First aid

In the event of an injury to the femoral muscle, it is first of all important to create rest for the injured limb so that unnecessary tension on the fibers does not occur. Place a cushion of soft material under your knee. The victim should remain in a supine position until pain and swelling decrease. Then cold is applied to the injured surface (ordinary ice from the refrigerator, wrapped in cellophane or a towel, will do). It is recommended to repeat the procedure for 20 minutes every 3 hours. Protect your skin from direct contact with the icy surface by covering it with napkins.

You can apply a special ointment with an analgesic effect to relieve inflammation. The use of warm and hot compresses is contraindicated: this leads to severe bruising. It is also necessary to apply an elastic tourniquet to the leg to protect the damaged area from swelling.

If, after providing first aid, hematomas appear and the pain does not decrease, immediately consult a specialist: delayed treatment can provoke future fractures, dislocations and displacements in the affected area.

Relieving pain and eliminating inflammation

In medicine, there are many different means to restore the motor activity of damaged muscles.

Priority is given to external gels and ointments with interference (cooling) and hyperemic (warming) properties, preventing:

• tissue hypoxia (lack of oxygen);
• stopping inflammation reactions;
• reducing swelling;
• preventing the formation of hematomas;
• stimulating tissue regeneration (recovery).

They are completely safe if you follow the instructions.

At the beginning of treatment, gels, creams or ointments are used with a cooling and analgesic effect, relieving swelling, preventing the development of hemorrhages and relieving pain, these are gels, creams or ointments - Reparil, Venoruton , Capilar , Gevkamen. They are not rubbed in, but lightly distributed over the painful area and allowed to be absorbed.

On the third day, you can use hyperemic gels or ointments. Among the most effective: gels Artrosilene, Valusal, Oruvel, Febrofid, Nise, Deep Relief, Dolgit, ointments - Ibuprofen, Fast Relief, Gevkamen, etc.

For persistent pain, it is possible to prescribe antispasmodics - drugs and analogues of mydocalm, drotaverine, no-shpa or potent painkillers - Diclofenac, Ketanov, Ibuprofen . In order not to provoke the development of an imbalance of intestinal microflora, their intake is limited to 3 days.

Rehabilitation treatment

Restoring mobility when stretching the thigh muscles in patients with mild and complicated distortion begins after pain symptoms are relieved and inflammation processes are completely eliminated. To prevent dense scar formations, a special set of therapeutic exercises is required, consisting of minimal stress on the muscles, and physiotherapy sessions. You can start physical therapy classes 2, 2.5 weeks after the injury.

If the muscles of the back of the thighs are damaged, recovery is quite long. Exercises are selected with minimal loads and performed smoothly.

Each muscle in the back of the thigh is worked individually. Since the distortion of these muscles is a consequence of inactivity, it is necessary to restore tone to the muscles, which will help protect them from damage.

A small example:

1. Leaning your hands on the support, your legs alternately perform amplitude swings.
2. Sitting position. Bend forward, chest pressed to your legs, try to grab your toes with your hands.
3. Standing position. In a squat, place your hands on the floor. Straighten your legs, do not lift your toes off the floor, make smooth rolls. Slowly straighten up and stretch, straightening your shoulders.

Rehabilitation of the first muscle group of the thighs is especially difficult. The following exercises can be used to regain control of mobility:

• In a sitting position, bend one leg and straighten the other. The toes of the foot are pulled towards you for 5 minutes.
• Lie on your stomach, grab your ankle with your hands and try to touch your buttocks with your heels.
• On your knees, sit down between your feet at a slow pace. Slowly lean back.

The duration of exercise depends on the severity of muscle damage. If exercise therapy is accompanied by pain, the exercises should be stopped and a gel with a warming effect should be massaged onto the limbs.

Physiotherapy

Physiotherapy techniques are selected according to the method of impact on tissue. Effective for muscle strains:

• dorsonvalization sessions, which allow using high-frequency current to dispel foci of inflammation and restore muscle tone;
• magnetic therapy, eliminating swelling, restoring muscle elasticity and accelerating tissue regeneration processes.
• Ultrasound is a kind of welding for damaged muscle structure. Has an analgesic and antispasmodic effect.

Sprain treatment

In the first and second degrees, the patient is prescribed rest. It is necessary to avoid any physical activity until muscle tissue and ligaments are completely restored. After pain relief, the patient is prescribed physiotherapy and physical therapy.

In the third degree of severity of damage, treatment may require more radical measures: in case of a rupture, surgery is performed on the damaged muscle tissue. Recovery can last up to six months, depending on the characteristics of the body.

Conservative therapy

Treatment for hip muscle strain involves:

• Limiting physical activity is mandatory for effective healing of the thigh muscles: on the first day it is recommended to remain in bed, and in the next few days, use crutches to move around, which will reduce the load on the damaged muscles.
• Applying ice packs to treat a strained thigh muscle: Apply ice packs to the affected area two to three times a day for at least half an hour. An alternative is to use a heating pad filled with cold water.
• Wearing an elastic bandage or compression stockings.
• Fixing the limb in a position that facilitates the outflow of blood from the damaged area: to get rid of swelling, the leg must be positioned above the level of the heart. You can achieve the desired effect by placing a pillow or bolster under your foot.
• Oral intake of antispasmodics (No-spa, Mydocalm) and non-steroidal anti-inflammatory drugs (Diclofenac, Ketoprofen, Piroxicam).
• Topical medications should initially be applied with massage movements before bedtime. Subsequent treatment tactics are three times a day. The most effective pharmaceutical drugs: Lyoton-1000, Heparin ointment, Actovegin, Nicoflex, Voltaren Emulgel, Indomethacin.

Traditional methods

Treatment of thigh muscle strain at home using folk remedies is an addition to the main treatment prescribed by the doctor.

Below are the most popular recipes used in muscle fiber strain therapy:

1. Beer decoction. Heat the drink in a water bath without letting it boil. Soak a towel or gauze bandage in it, wring it out and sprinkle ground pepper on top. Apply the compress to the damaged area for 15 minutes.
2. Treatment with barberry. Pour a tablespoon of branches, roots and bark of the plant with a glass of water and cook over low heat. Let the liquid cool slightly, dip a piece of cloth into it, squeeze it out and apply it to the sore area.
3. Onion therapy. Finely chop the onion head. Mix with sugar to form a thick mixture. Wrap everything in gauze, place it on the damaged area and leave for an hour. Apply the compress once every 2 days.
4. Treatment with blue clay. Combine clay powder with water until you get a thick mixture. Put it in the refrigerator. Then apply the hardened clay to the affected area. Repeat the procedure every 4-5 hours.
5. Compresses with milk. Dampen a cloth with the liquid and apply it to the damaged area of ​​the thigh. Change the compresses every time after they have cooled completely.
6. Treatment with pine branches. Fill the enamel container halfway with pine branches. Fill to the top with water and cook for 30 minutes. Use the resulting decoction for a medicinal bath.

Alternative medicine methods are aimed at eliminating painful symptoms, but not at treating the underlying disease. Before using traditional recipes, you need to consult a specialist.

Treatment after confirmation of diagnosis

With the first and second severity of muscle and ligament injuries (when there is no complete rupture of muscle fibers and ligaments), the patient is treated independently at home. He must strictly follow the following recommendations:

• Complete rest of the affected area. Moving only on crutches. If these recommendations are not followed, the recovery period is significantly prolonged and complications may arise. For example, inflammation of the ligaments of the hip joint. A child may be given a plaster splint to prevent movement, since it is difficult to explain to young children the need for complete rest.
• The affected leg is placed above the level of the body, placing a pillow under it. This is done to prevent edema.
• It is advisable to fix the injury site with an elastic bandage without disrupting the blood supply to the tissue.
• For the first three to four days, cold is applied every 4 hours for 15 minutes, then you can lubricate the injured area with warming ointments. The criterion for the safety of their use is the disappearance of tissue edema. In addition to warming ones, there are other local drugs that alleviate the patient’s condition. We give a brief description of them in the table.

• If the injury site hurts even after the acute period, painkillers are prescribed. It is better to check the specific drug with your doctor, since, for example, in case of extensive hematoma and edema, aspirin and ibuprofen are contraindicated.

• During the recovery period, which depends on the severity of the injury, massage and physiotherapy are used. You can start doing massage already on the fifth day after a minor sprain of muscles and ligaments. Physiotherapy procedures are prescribed by a doctor on an individual basis.

In case of severe injury with complete rupture of muscles and tendons, surgical treatment is indicated. Such damage takes much longer to heal and can leave consequences - lameness, limited mobility in the joints.

Complications and prevention of sprains

Adverse consequences of ruptured ligaments and muscles of the hip area:

1. Degenerative changes in the joint - arthrosis. The factor leading to the disease is trauma to the cartilaginous covering of the bones.
2. If the round ligament of the femoral head is damaged, a complication may be its aseptic necrosis: due to impaired blood supply, tissue necrosis occurs in this area.
3. A muscle hernia can occur when the fascia (connective membrane) that covers the muscle is damaged. Pathology therapy is required if the victim is professionally involved in sports. Treatment is almost always surgical with the use of grafts.
4. Migeloses are compactions in the form of nodules that can be felt in the muscles. To prevent the development of such a disease, a foot massage should be performed after each exercise.