Conditions & Treatments - Hip Pointer

The lack of soft tissue around the area of the iliac crest and greater trochanter makes this region more susceptible to impact injuries (1, 2). One such injury to this area is a hip pointer. Hip pointers are the result of a direct blow or fall onto the side of the hip resulting in a contusion to the iliac crest and surrounding tissues (1, 2). Participants in contact sports such as football, hockey or rugby often sustain this sort of injury (1,2). An epidemiologic study of hip injuries in in the National Football League between 1997-2006 reported 738 hip injuries with 82 (11%) being reported as a hip pointer injury (1, 3). Pain, tenderness, loss of range of motion and limitations with function are associated with this injury and will limit the athlete’s participation in training and sport.

Clinical Presentation
Clinical presentation of a hip pointer injury includes: pain over the iliac crest, pain with rotation of the trunk if abdominal muscles are involved, marked tenderness, muscle spasm, discoloration & edema over the iliac crest, and difficulty or inability with weight bearing& ambulating depending on the severity of the injury (1, 2, 4). Hall & Anderson (1) report the “pathology leading to pain can be subperiosteal edema or bleeding from nutrient vessels of the underlying bone or hematoma formation within the surrounding muscle.” Other diagnoses that should also be considered and differentiated include: fracture to the femoral head/neck & hip, femoral head avascular necrosis, hip dislocation, compartment syndrome, hip tendonitis/bursitis, iliotibialband syndrome, osteitis pubis, sacroiliac joint injury, slipped capital femoral epiphysis, & snapping hip syndrome (2).

Hip Pointer Treatment Options for a PT
• Compression & ice
• Rest
• Gait Training with crutches
• ROM exercises for hip
• Strengthening /Stabilization (see video Z12 for hip/groin/knee)
• Manual Therapy
• Modalities (ie. Ultrasound, TENS)
 

Last revised: December 17, 2013
by Chai Rasavong, MPT, MBA

References
1) Hall M & Anderson J. Hip Pointers. Clin Sports Med. 2013;32:325-330.
2) Martinez J. Hip Pointer Treatment & Management. September 12, 2013. Last Accessed 12/17/2013. http://emedicine.medscape.com/article/87322-overview#a0199
3) Feeley BT, Powell JW, Muller MS, et al. Hip injuries and labral tears in the national football league. Am J Sports Med 2008;36(11):2187–95.
4) Riggs W. The Hip. Last Accessed 12/17/13. http://www.getproactivephysicaltherapy.com/docs/thehip.pdf