Overview of Hip Pointer Injuries

Causes, Diagnosis, Treatment, and Prevention

closeup of the legs and hips of a football player in uniform
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A hip pointer injury is an extremely painful injury to the iliac crest of the pelvis. The iliac crest is the upper ridge of the ilium, the largest part of the hip bone. A hip pointer injury is characterized by bruising and usually causes bleeding into the hip abductor muscles. The pain may be felt when walking, laughing, coughing, or even breathing deeply.

Hip pointer injuries are most commonly associated with contact sports, although they can occur with any blunt force injury or severe fall.

Causes

Hip pointers are the result of a direct blow to the iliac crest, whether from a direct blow or a hard fall to the ground. Hip pointers are common in football and soccer but also occur in hockey, skiing, cycling, rugby, lacrosse, volleyball, and even basketball.

Hip pointers are referred to as contusions (the medical term for bruising) and caused by the crushing of soft tissues along the iliac crest.

Many hip pointer injuries are caused by the absence or improper placement of protective sports equipment, especially with football and hockey.

Symptoms

Hip pointer injuries are characterized by immediate and often excruciating pain. This will be followed by localized swelling and bruising, sometimes severe. Within a short span of time, there will be a rapid decline in the strength and range of motion of the affected hip and leg. There may also be muscular spasms. The pain will tend to worsen with movement.

Diagnosis

A hip pointer injury is usually self-apparent and readily diagnosed with a physical exam. However, your doctors will likely order imaging studies to determine the severity of your condition if they are concerned about serious injury. Among the options:

  • X-rays can help identify a bone fracture. X-rays can also show if there is bone tissue forming inside the injured muscle, a condition referred to as myositis ossificans.
  • Computed tomography (CT) scans may be ordered if the pain is especially severe or there is persistent pain following treatment.
  • Bone scans (bone scintigraphy) may be ordered to exclude a fracture if the X-ray findings are inconclusive.

Laboratory tests are usually unhelpful in diagnosis of a hip pointer injury.

Treatment

Most hip pointers will heal with conservative treatment. Like other soft tissue injuries, a hip pointer can usually benefit from a POLICE treatment plan. POLICE is the acronym for protection, optimum loading, ice, compression, and elevation. The general guidelines for the POLICE plan are as follows:

  1. Protect: As soon as you are injured, stop the activity and rest for a few days if needed. After a few days, gentle motion can be started while you still maintain a level of protection for the injured area. During this time you may require some sort of assistive device, like crutches, to walk if you're experiencing a lot of pain and discomfort
  2. Optimum Loading: While you are protecting your injury, gentle motion can, and should, be started. For example, going for short walks and performing some active range of motion exercises for the hip (within pain tolerance) would be beneficial. This progressive loading of your injury can help promote optimal healing. It can also help prevent the joint and muscle tightness and muscle atrophy that can delay your return to your prior level of function.
  3. Ice, Compression, and Elevation: Elevate the injured hip and leg above your heart by lying in bed when you can. Doing so can help with reducing pain and discomfort. Because the area involved is so large, compression of the injury is usually not practical. However, you can ice the area. Apply an ice pack to the injury for 10 minutes, then remove for 10 minutes. Repeat this as often as possible for the first 24 to 48 hours. To avoid frostbite, place a cloth barrier between the ice and your skin, keeping the ice pack moving.

    To ensure the injury heals properly, avoid any aggravating activities that cause significant pain or discomfort for the first one to two weeks. Ice and nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation for the first seven to 10 days. Moderate activity, including walking and range of motion exercises, may be used to restore joint mobility once you are fully on the mend.

    If it does not heal with conservative treatment, some doctors will treat a severe hip pointer injury with an anesthetic injection. However, this should be a last resort. 

    The one thing you will want to avoid is returning to sports too quickly. This is why doctors are reluctant to treat a hip pointer with cortisone shots, as they can mask symptoms and increase the risk of re-injury. If you're having trouble getting back to sports and activities, seek out personalized physical therapy for additional treatments and rehabilitation.

    Prevention

    It is often impossible to avoid an impact during a sports competition, so being well-protected is the best way to prevent serious injury. Wearing properly fitted protective equipment, including hip pads, is the first and best step.

    Athletes who wear hip pads need to ensure that the pads are large enough to cover the crest of the hip bone. Today, you can buy compression shorts with built-in hip and thigh pads. They are available at many sporting goods stores and can be used by athletes in nearly every sport.

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    Article Sources

    • Hall, M. and Anderson, J. Hip Pointers. Clinics Sports Med. 2013; 32(2):325-30. DOI: 10.1016/j.csm.2012.12.010.