With football season underway, this is the time of year that we tend to see many football-related injuries come to HSS, particularly ones related to hip pointers. In fact, in a study done by the American Journal of Sports Medicine, looking at hip injuries in the NFL between 1997 and 2006 it was found that hip contusions were the second most common injury (the first being muscle strains).
What is a hip pointer?
In 1967, Dr. Martin E. Blazina from UCLA coined the term “hip pointer.” A hip pointer is an injury that occurs when there is direct contact to the iliac crest, or the “pelvis.” This can occur by getting hit or falling onto your side and landing on a hard surface. This is typically the result of compression of soft tissue between a hard object (ie, a helmet) and the iliac crest (pelvic bone). Fractures are also diagnosed separately and confirmed by x-ray.
Why do football players get this injury?
The pelvic bone can see trauma during football if there is a direct blow from an opponent’s helmet, knee or shoulder. Along with a contusion to the pelvic bone there is usually tearing or stretching of the surrounding muscles. Inadequate or poorly fitting hip pads can be a contributing factor to this type of injury.
What are the symptoms?
Hip pointers result in immediate, intense pain and localized tenderness over the iliac crest or pelvic bone. There will usually be significant bruising and swelling around the front, outside and inside of the hip. Due to the bleeding and swelling, movement of the hip will usually be limited and painful. Decreased range of motion and weakness are also typically seen. If the healthcare provider suspects that there may be a fracture, x-rays can be obtained.
Can this injury be avoided?
Additional padding to the pelvic area may help limit injury to this site. Padding must be sized and positioned properly. Maintaining proper flexibility of all the muscles attaching around the pelvis is recommended.
How can this be treated?
After an athlete has been diagnosed with a hip pointer treatment begins with rest, ice and compression to the site of the injury. This will help to reduce inflammation and control the swelling. If it is painful to walk, crutches may be of assistance until full weight bearing can be achieved without pain. Soft tissue massage can help improve range of motion of the hip joint, reduce swelling and prevent scar tissue. The athlete can then be progressed to range of motion, flexibility and progressive strengthening exercises as tolerated.
Once pain free gait has been resumed sports specific training can be initiated. Full return to competition usually averages 1-3 weeks but depends on the severity of the injury.
Terrance Sgroi, Clinical Supervisor at the HSS Sports Rehabilitation and Performance Center, is a Doctor of Physical Therapy, Sports Certified Specialist, and certified in manual therapy. He has worked with a spectrum of sports medicine patients with a focus on the overhead thrower. His interests lie in the treatment of the shoulder and sports elbow, ACL pathology and hip arthroscopy. Terrance is both lead and co-author on multiple baseball biomechanical research initiatives published in peer-reviewed journals.