What is a Hip Pointer?
A hip pointer is a contusion (bruise) on the iliac crest (top of hip bone) or across the greater trochanter (most prominent aspect on the outside of the hip) as a result of direct trauma. Sometimes this can be accompanied by an avulsion injury, where a small fragment of bone is torn away by the attached muscle. Bleeding and swelling are a result of the injury and cause pain with hip movements.
What Causes a Hip Pointer?
A hip pointer injury is usually the direct result of a blow to the hip (iliac crest or greater trochanter) or from a fall onto a hard surface.
What are the Symptoms of a Hip Pointer?
A characteristic feature of a hip pointer is iliac crest pain.
- Pain will be of a sudden onset following a direct blow or fall
- Pain will worsen with running, jumping, twisting or bending
- The affected area will be tender
- Associated bruising or swelling
- The range of motion of the hip may be limited by pain
- You may walk with a limp due to pain
How is a Hip Pointer Diagnosed?
A hip pointer is diagnosed mainly through the mechanism of injury. Your physiotherapist will conduct a thorough examination to ensure an accurate diagnosis.
How is a Hip Pointer Treated?
Initially, a hip pointer is treated using rest, ice and compression. Ice can be applied for 15-20mins every 2-3 hours in the initial 24-72 hours following injury. A hip pointer requires adequate recovery time to allow the injured structures to heal. If walking is difficult, crutches may be supplied to allow for mobilisation. Return to play will be determined by pain levels, hip mobility, and your previous function level. It may take 1-3 weeks to heal.
While you are waiting for the contusion to heal, your physiotherapist will provide you with some simple exercises to maintain the hip joint range of motion and prevent stiffness. Aquatic-based exercises can help maintain hip joint range whilst unload the area.
How to Return to Sport after a Hip Pointer
Once the pain and tenderness settle, you can consider a return to sport. If you return to a contact sport, padding over the area may be favoured to prevent further injury. It is important that you can run and perform the activities (in particular tackling) of your chosen sport without pain.
Common Causes of Hip & Groin Pain
Hip Joint Pain
- Hip Arthritis - Hip Osteoarthritis
- Hip Labral Tear
- Hip Pointer
- Femoroacetabular Impingement - FAI
- Perthes Disease
- Slipped Femoral Capital Epiphysis
- Stress Fracture
- Avascular Necrosis of the Femoral Head
Lateral Hip Pain
Adductor-related Groin Pain
Pubic-related Groin Pain
Inguinal-related Groin Pain
- Inguinal hernia
- Sportsman's hernia
Iliopsoas-related Groin Pain
- Hip Flexor Strain
Other Muscle-related Pain
- Piriformis Syndrome
- Muscle Pain -Muscle Strain
- Poor Hip Core
- DOMS -Delayed Onset Muscle Soreness
- Core Stability Deficiency
Hip Pain Treatment
A thorough analysis of WHY you are suffering hip pain from a movement, posture, or a control aspect, is vital to solving your hip pain.
Only an accurate diagnosis of the source of your hip pain can solve the pain, quickly improve your day to day function, prevent a future recurrence, or improve your athletic performance.
The first choice of short-term therapy has been symptomatic hip treatment. This approach could include local chemical modalities such as cortisone injections or painkillers. Ice or heat could also assist along with some gentle stretching or exercise.
However, persisting hip problems will require additional investigations to assess your joint integrity or range of motion, muscle length, strength, endurance, power, contraction timing and dynamic stability control.
You should consult a healthcare practitioner who has a particular interest in hip pain and injury management to thoroughly assess your hip, groin, pelvis, lower limb and spine. Due to the kinetic chain, they all impact, especially at the high athletic performance end. A quality practitioner will educate you on your condition and combine it with exercise and manual therapy as per the Clinical Practice Guidelines. (Cibulka et al., 2017) Hip pain education should also include teaching you specific activity modification, individualised exercises, weight-loss advice (if required), and methods to unload any arthritic joints.
Recent research evidence-backed approaches have modernised physiotherapy treatment approaches to effectively managing hip pain. Together with a thorough hip assessment, your hip treatment can progress quickly to restore you to a pain-free hip and perform your regular sport or daily activities in the shortest time possible.
For specific rehabilitation advice regarding your hip pain, seek the professional advice of high quality and up-to-date physiotherapists experienced in the assessment, treatment, prevention and optimisation of hip pain and related conditions. After assessing you, they will individually prescribe therapeutic activities based on your specific needs for daily living, values, and functional activities or point you in the direction of the most suitable healthcare practitioner for you and your hip condition.
Hip Pain Treatment Options
Your hip physiotherapist may consider an extensive range of treatment options, including manual joint therapy to improve your joint mobility, muscle stretches or supportive taping. Your physiotherapist is also likely to add strengthening and hip joint control exercises as they deem appropriate for your specific functional and sporting needs. Please consult with them for advice.
Common Youth Leg Injuries
Why are Children's Injuries Different to Adults?
Adolescent Leg Injuries
Adolescent injuries differ from adult injuries, mainly because the bones are still growing. The growth plates (physis) are cartilaginous (strong connective tissue) areas from which the bones elongate or enlarge. Repetitive stress or sudden large forces can cause injury to these areas.
In the adolescent leg, common injuries include:
Pain at the bump just below the knee cap (tibia tubercle). Overuse injuries commonly occur here. The tibia tubercle is the anchor point of your mighty quadriceps (thigh) muscles. Because of excessive participation in running and jumping sports, the tendon pulls bone off and forms a painful lump that will remain forever. This type of injury responds to reduced activity and physiotherapy.
More info: Osgood Schlatter's Disease
Pain at the lower pole of the knee cap (patella). Overstraining causes Sinding-Larsen-Johansson disease. Because of excessive participation in running and jumping sports, the tendon pulls bone off the knee cap. This type of injury responds to reduced activity and physiotherapy.
More info: Sinding Larsen Johansson Syndrome
Anterior Knee Pain
Anterior knee pain or patellofemoral syndrome frequently gets passed off as growing pains. Cause of this pain includes overuse, muscle imbalance, poor flexibility, poor alignment, or more commonly, a combination of these. Anterior knee pain is one of the most challenging adolescent knee injuries to sort out and treat. Accurate diagnosis and treatment with the assistance of a physiotherapist with a particular interest in this problem usually resolves the condition quickly.
More info: Patellofemoral Pain Syndrome
The cartilage between the leg bones has a better blood supply and is more elastic in adolescents than adults. As adolescents near the end of bone growth, their injuries become more adult-like. Hence more meniscal and ACL (anterior cruciate ligament) injuries are likely. MCL (medial collateral ligament) injuries result from a lateral blow to the knee. Pain felt on the inner side (medially) of the knee. MCL injuries respond well to protective bracing and conservative treatment.
More info: Knee Ligament Injuries
ACL (Anterior Cruciate Ligament) Injuries
This traumatic knee injury is significant. Non-contact injuries of the ACL are becoming more common than contact injuries of the ACL. Adolescent females are at high risk. Combination injuries with MCL or menisci are common. Surgical reconstruction is needed if the adolescent wishes to continue participating in "stop-and-start" sports.
More info: ACL Injury
Your meniscus is crescent-shaped cartilage between the thigh (femur) and lower leg (tibia). Meniscal injuries usually result from twisting. Swelling, catching, and locking of the knee are common. If physiotherapy treatment does not resolve these damages within six weeks, they may require arthroscopic surgery.
Heel pain is commonplace in young adolescents due to the stresses of their Achilles tendon pulling upon its bony insertion point on the heel (calcaneum). It is a common overuse injury due to excessive training and competition, particularly when loads are increased dramatically in a short period. Diminished flexibility and muscle-tendon strength mismatching may predispose you. Physiotherapy, reduced activity, taping and orthotics are the best ways to manage this debilitating condition for the active young athlete.
More info: Sever's Disease
An ankle sprain is probably the most common injury seen in sports. Ankles sprains involve stretching of the ligaments and usually occur when the foot twists inward. Treatment includes active rest, ice, compression and physiotherapy rehabilitation. With the correct treatment, a low ankle sprain usually improves in two to six weeks. Your ankle physiotherapist should check even simple ankle sprains to eliminate high-ankle sprains. A residually stiff ankle post-sprain can predispose you to several other lower limb issues.
More info: Sprained Ankle
Patellar (kneecap) instability can range from partial dislocation (subluxation) to dislocation with a fracture. Partial dislocation treatment is conservative. Dislocation with or without fracture is a much more severe injury and usually will require surgery.
More info: Patella Dislocation
The separation of a bone from its bed in the knee joint is Osteochondritis Dissecans (OCD). This injury is usually due to one major macro event with repetitive macro trauma that prevents complete healing. This injury is potentially severe. Treatment varies from rest to surgery. An Orthopaedic Surgeon's opinion is vital.
Growth Plate Fractures
A fracture through the growth plate can be a severe injury that can stop the bone from growing correctly. These fractures should be treated by an Orthopaedic Surgeon, as some will require surgery.
Image source: https://radiologyassistant.nl/pediatrics/hip/hip-pathology-in-children
An avulsion fracture occurs when a small segment of bone attached to a tendon or ligament gets pulled away from the main bone. The hip, elbow, and ankle are the most common locations for lower limb avulsion fractures in young sportspeople.
Treatment of an avulsion fracture typically includes active rest, ice and protecting the affected area. This active rest period is followed by controlled exercises that help restore range of motion, improve muscle strength and promote bone healing. Your physiotherapist should supervise your post-avulsion exercises. Most avulsion fractures heal very well. You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. An avulsion fracture to your foot or ankle may require a cast or walking boot.
An excessive gap between the avulsed bone fragment and main bone may not rejoin naturally in rare cases. Surgery may be necessary to reunite them. In children, avulsion fractures that involve the growth plates also might require surgery. All avulsion fractures should be reviewed and managed by your trusted physiotherapist or an Orthopaedic Surgeon.
For more information regarding your youth sports injury, please consult your physiotherapist or doctor.
Youth Leg Injuries
Pelvis & Hip
- Osgood Schlatter's Disease
- Sinding Larsen Johannson Disease
- Patellofemoral Pain Syndrome
- Patella Dislocation
- Meniscus Tear
- Discoid Meniscus
- Juvenile Osteochondritis Dissecans