PELVIS STRAIN, ISCHIUM
DEFINITION--Injury to the muscles or tendons of the lower pelvis (ischium), or injury at places where muscles attach to pelvic bones. Tendons, muscles and bones comprise units. These units stabilize the pelvis and allow its motion. A strain occurs at the weakest part of a unit. Strains are of 3 types:Mild (Grade I)--Slightly pulled muscle without tearing of muscle or tendon fibers. There is no loss of strength.
Moderate (Grade II)--Tearing of fibers in a muscle, tendon or at the attachment to bone. Strength is diminished.
Severe (Grade III)--Rupture of the muscle-tendon-bone attachment with separation of fibers. Severe strain requires surgical repair. Chronic strains are caused by overuse. Acute strains are caused by direct injury or overstress.
BODY PARTS INVOLVED
Tendons and muscles of the lower pelvic region, including thigh, abdominal and back muscles.
Bones of the pelvis, thigh and lower spine.
Soft tissue surrounding the strain, including nerves, periosteum (covering to bone), blood vessels and lymph vessels.
SIGNS & SYMPTOMS
Pain when moving or stretching the thigh.
Spasm in muscles that attach to the pelvis.
Swelling in the lower pelvic area.
Loss of strength (moderate or severe strain).
Crepitation ("crackling") feeling and sound when the injured area is pressed with fingers.
Calcification of the muscle or tendon (visible with X-rays).
Inflammation of the tendon sheath.
Prolonged overuse of muscle-tendon units in the pelvis.
Single violent injury or force applied to the muscle-tendon units in the lower pelvis. Strains of pelvic muscles are common in sports in which the hip is bent and the knee is straight, as with a hurdler's leading leg. Forceful straight leg-raising exercises also lead to pelvic strain.
RISK INCREASES WITH
Hurdling, high-jumping, vaulting or long jumping.
Sports that require quick starts.
Any cardiovascular medical problem that results in decreased circulation.
Medical history of any bleeding disorder.
Previous pelvic injury.
Poor muscle conditioning.
HOW TO PREVENT
Participate in a strengthening and conditioning program appropriate for your sport.
Warm up before practice or competition.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Self-care during rehabilitation.
Physical therapy (moderate or severe strain).
Surgery (severe strain).
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of pelvic bones to rule out fractures.
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Unstable or arthritic hip and lower back following repeated injury.
Inflammation at the attachment to bone (periostitis).
Prolonged disability (sometimes).
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Torn ligaments and tendons require as long to heal as fractured bones do. Average healing times are:
Mild strain--2 to 10 days.
Moderate strain--10 days to 6 weeks.
Severe strain--6 to 10 weeks. If this is a repeat injury, complications listed above are more likely to occur.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION (if possible). See Appendix 1 for details.
Use ice massage 3 or 4 times a day for 15 minutes at a time. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
After the first 24 hours, apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Wrap the injured pelvic muscles loosely with an elasticized bandage or wear a corset between treatments.
Massage gently and often to provide comfort and decrease swelling.
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Injection of a long-acting local anesthetic to reduce pain (rare).
Injections of a corticosteroid, such as triamcinolone, to reduce inflammation (rare).
For a moderate or severe strain, walk with crutches for at least 72 hours. See Appendix 3 (Safe Use of Crutches).
Resume your normal activities gradually.
DIETEat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when supportive wrapping is no longer needed. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a moderate or severe lower pelvic strain, or a mild strain persists longer than 10 days.
Pain or swelling worsens despite treatment.