髋关节疼痛是许多运动员和中年女性非常常见的问题，我们就先从髋关节进行讲起哦

(´-ω-`)

首先呢，是关于治疗理念

治疗的重点不在于解剖结构而是损伤及改善的效果（we don't treat the path of anatomical diagnosis, we treat the impairments, within the context of diagnosis, so no matter what the path of anatomical diagnosis, we still treat what is tight what is weak. Collect all our range of motion and strength values and determine how they might relate to the diagnosis)

治疗时多关注Accetabula/labrum的问题，注意片子中出现的''offset''（如accetabula impingement AIF）而不是仅仅局限于关节囊松紧与关节炎

例如：芭蕾舞，运动员hip decrease 往往是过松的(laxity)lliofemoral ligament和过紧的Ischiofemoral ligament

第二，检查时要重视它的活动度问题

Hip ROM(偏大): Flexion 120/Extension 15/Abduction 50/Addiction 30/External rotation 60/Internal rotation 40(Interpret deficits in motion and end-feel to devise an appropriate treatment) 注：测量关节活动度时必须注意下腰椎是否一起活动(be careful not to incorporate lower spin motion into the measurement, patient with tight hips will compensate by moving the spin prematurely), 并且在腰椎的测试中也必须测量髋关节活动度来确定if the hip joint is contributing to the patient's symptoms.

第三呢 当然就是肌肉啦

Iliopsoas(髂腰肌)：most powerful hip flexor, attaches to the hip capsule anteriorly and offers support to the ligments and capsule.

Rectus femoris: flex the hip and extend the knee(屈膝＋伸髋) most effective as a hip flexor when the knee is flexed such as kncking the ball (在膝关节弯曲时是最主要的曲髋肌)

picture1: 臀中肌和臀小肌两兄弟，肌腱附着与股骨大转子，触摸时先放在髋关节的凸起处并向前上方触压，若感到疼痛则及有可能为臀大小肌肌腱炎的问题。但是！髋关节外侧的疼痛也极有可能是股骨大转子滑囊炎哦（偏下方疼痛）。鉴别：臀大小肌肌腱炎在上下楼梯或行走的站立相时会疼痛，为了避免疼痛会出现Trendeliberg步态

picture2: A为代偿的Trendeliberg (臀中肌无力步态)

picture3: 大腿后侧（髋关节后侧疼痛时极有可能是坐骨神经压迫）与前侧内收肌（髋关节前侧腹股沟疼痛可能为内收肌附着处）

第四：也许会导致髋关节疼痛的原因

Lumbosacral pathology(腰骶部病理性改变)/Labural tear/Aricular cartilage lesions(关节软骨损伤)/Bursitis(滑囊炎)/Tendonitis(肌腱炎)/muscle strains/Myofascial pain(肌筋膜疼痛)/Local nerve entrapment(局部神经卡压)/Avulsion injury(撕裂)/Avascular nercrosis(无血管性坏死)/Hernia(疝)

所以在我们诊断髋关节疼痛的病患时可以先分为三类：groin pain(腹股沟/前侧疼痛)，posterior hip pain(髋后侧疼痛)，lateral hip pain(髋外侧疼痛)

①Groin pain:

可能是labral tear(关节唇撕裂？)导致的FAI(Femoralacceta impingement)/hypermobility/hypomobility/DJD(degenerate joint disease)/Arthritis；Femoral stress fracture(股骨应力性骨折)；Adductor Strain；                                              Athletic Pubalgia/Sports Hernia

② posterior hip pain

Lumbar Spine Pathology                                  Sacroiliac joint Dysfunction(骶髂关节功能障碍)                                                                    Sciatic nerve entrapment(坐骨神经卡压)      Pudendal nerve entrapment(阴部神经卡压) Hamstring strain(腘绳肌拉伤)                        Ischiofemoral impingement(坐股韧带撞击)

③Lateral hip pain

Gluteus medius/Minimus Tendonopathy(臀中小肌肌腱病)                                        Greater Trochanteric Bursitis(股骨大转子滑囊炎，上文p1有提到过哦)

第五：接下来就是髋关节的处理啦！

1：首先处理时需要有自信，因为髋关节和肩关节有很多的相似之处，会处理肩关节同时也要有信心可以处理好髋关节（他们的相似处有一下几点）

①Weight bearing vs Non-weight bearing      ② both have ball and socket                  capsular support/Labrum                        ③Deep External Rotation vs Teres minor/Infraspinatus(外旋肌)                            ④Psoas vs Biceps brachialis （屈肌）        ⑤Quadratus Lumborum vs Trapezius/Serratus(腰方肌vs 斜方/前锯肌) ⑥Gluteus Medius vs Supraspinatus(臀中肌与冈上肌，原理可以参考p2图)               

通常在髋关节内的损伤时分为四类，分别是：hypomobility/hypermobility/Impingement/Traumatic(外伤). hypomobility(活动度不足)与hypermobility(活动度过大) 时操作的重点在于关节松动与肌肉训练，Impingement关节撞击要在手法操作和肌肉训练中做平衡，如果是traumatic的话就直接转医生吧。

好啦 今天就先到这里吧！我们明天再见～

ヽ(^㉨^)ﾉ

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