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Hip check taking on new meaning

New York Daily News—February 1, 2009

By Dr. Josh Dines and Dr. Rock Positano

Hip pointers don't just refer to the hip; and they don't just affect football players. As the Knicks' Wilson Chandler is finding out, hip injuries also affect basketball players. One of the most common types of injury is a "hip pointer," a catch-all term that refers to a contusion to the iliac crest (part of the pelvic bone), the greater trochanter of the femur (hip bone), or the surrounding soft-tissue structures.

Because athletes are bigger and stronger than most people, and because play is becoming more physical, there seems to be an increasing number of hip pointers occurring among basketball players.

Classically, hip pointers occurred in contact sports such as football or hockey as a result of a direct blow to the hip region. But more and more frequently, these injuries are being reported by basketball players who have fallen on their hip or side or who have taken a charge in the lane.

The pelvic and hip bones are at particular risk for contusions because there isn't much overlying muscle or fat in those regions to protect the athletes.

Diagnosing these injuries is usually pretty straightforward because the player can recall an acute, precipitating event that resulted in localized pain to the hip region. The pain is typically exacerbated by running and jumping; and if the abdominal muscles are affected, twisting can be painful.

According to Dr. Anil Ranawat, an orthopedic surgeon at Hospital for Special Surgery who has a particular interest in hip and knee injuries, injuries inside the hip joint can mask themselves as hip pointers. He recommends a careful workup to diagnose the injury properly. Though not always part of the initial evaluation, imaging studies can be helpful in patients with continuing pain. And X-rays can rule out the presence of a fracture. Sometimes, more advanced imaging tools such as CT scans or MRI are used to rule out stress fractures and muscle or ligament tears.

The initial treatment for hip pointers involves rest, ice, compression and the use of anti-inflammatory medication. If walking is painful, crutches may be needed. Gradually, stretching and strengthening exercises are incorporated into the rehabilitation process. These injuries usually resolve fairly quickly with athletes getting back to play in a few days. Dr. Ranawat adds that though "these are best treated with conservative measures, if symptoms persist, evaluation by an orthopedic surgeon is warranted to rule out more serious injury."

For many common sports injuries, preventative measures are recommended but in sports that involve contact, hip pointers may be unavoidable. More and more players are wearing padded compression shorts underneath their uniforms to provide a bit of protection, but given the amount of these injuries that we see, it probably isn't enough to eliminate them.

When they do occur, do not neglect them.

This story originally appeared at nydailynews.com.

Drs. Dines and Positano write a new weekly column on sports injuries called X-Ray Vision in the New York Daily News and practice sports medicine at Hospital for Special Surgery.


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