Hip Pointer

Hip Pointer

Article by John Miller

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.

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.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.

Tenderness

If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  

Swelling

Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.

Weakness

Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.