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.
Article by Zoe Russell
How Do You Diagnose Arthritis In The Hip?
Hip osteoarthritis is a progressive degenerative condition that results in pain, joint weakness, instability and restrictions of movement that interfere with daily activities, such as walking, climbing stairs or driving.
Your physiotherapist can diagnose hip osteoarthritis clinically through your subjective reporting. Symptoms may develop suddenly or gradually progress over time. Common symptoms include:
- Hip joint pain or tenderness that comes and goes.
- Typically there will be sharper pains in the groin and sometimes an ache in the front of the thigh. Many people present with hip arthritis thinking that it is a knee problem.
- Hip stiffness, particularly in the mornings.
- Limping when walking
- Inability to stand on one leg without pain. For example, putting on underpants or clothes
- Hip joint movements are restricted, especially inward rotation and hip flexion.
- Weak hip muscles, especially during sit to stand, squatting and stair climbing.
This helps direct your PhysioWorks physiotherapist to perform physical tests to confirm the suspicion of osteoarthritis and to exclude other conditions that may present similarly:
Standard tests used to diagnose hip osteoarthritis include:
Range of Motion Testing
- Performed in all planes of motion of the hip, this is helpful to see how much range of motion is available and if this is sufficient to perform your daily activities. This will also include assessing whether your movement is limited by lack of range or your pain.
Muscle Strength Testing
- It is complementary to your range of motion testing to assess enough strength to support the painful joint.
- There is good evidence to show that strengthening the muscles around the hip can improve symptoms and reduce the disability associated with a painful hip. Knowing which direction to enhance it is a crucial element to the assessment.
- This is a crucial element to your assessment to identify your inability to perform daily activities due to your hip osteoarthritis and help guide your treatment.
Assessment of Adjacent Joints and Muscles
- To ensure that your symptoms are only coming from your hip, your physiotherapist may assess other joints such as your Lower Back and SIJ to ensure that they are not the cause or contributing to your symptoms.
If hip osteoarthritis is suspected from your assessment, your physiotherapist may also request a hip radiograph or X-Ray to confirm the diagnosis. In some cases, you may require further 3D imaging with CT or MRI to plan adjunct therapies or surgical replacement of the hip.
If you are concerned that your hip pain may be related to osteoarthritis, call PhysioWorks today. With same-day appointments, their expert staff can assess your hip pain and put a plan in place to help you get back to your best!
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, 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.
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.
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.
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.
Elite Sports Injury Management
You probably already know that a sports injury can affect not only your performance but also your lifestyle. The latest research continues to change sports injury management considerably. Our challenge is to keep up to date with the latest research and put them to work for you.
How we treated you last year could vary significantly from how we treat you this year. The good news is that you can benefit considerably from our professional knowledge.
What Should You Do When You Suffer a Sports Injury?
Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases. The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days. After that, you need to get it moving, or other problems will develop.
Ice or Heat?
We usually recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.
Once the "heat" has come out of your injury, you can use heat packs. We recommend 20-minute applications a few times a day to increase the blood flow and hasten your healing rate. The heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to discuss your situation specifically.
Should You Use a Compressive Bandage?
Yes. A compressive bandage will help to control swelling and bleeding in the first few days. In most cases, the compressive dressing will also help support the injury as you lay down the new scar tissue. This early healing should help to reduce your pain. Some injuries will benefit from more rigid support, such as a brace or strapping tape. Would you please ask us if you are uncertain about what to do next?
Gravity will encourage swelling to settle at the lowest point. Elevation of an injury in the first few days is beneficial, especially for ankle or hand injuries. Think where your damage is and where your heart is. Try to rest your injury above your heart.
What Medication Should You Use?
Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek professional advice as certain medications can interfere with other health conditions, especially asthmatics.
When Should You Commence Physio?
In most cases, "the early bird gets the worm". Researchers have found that the intervention of physiotherapy treatment within a few days has many benefits. These include:
- Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
- Improving your scar tissue using techniques to guide the direction it forms
- Getting you back to sport or work quicker through faster healing rates
- Loosening or strengthening of your injured region with individually prescribed exercises
- Improving your performance when you return to sport - we'll detect and help you correct any biomechanical faults that may affect your technique or predispose you to injury.
What If You Do Nothing?
Research tells us that injuries left untreated take longer to heal and have lingering pain. They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve. The sooner you get on top of your symptoms, the better your outcome.
What About Arthritis?
Previously injured joints can prematurely become arthritic through neglect. Generally, there are four main reasons why you develop arthritis:
- An inappropriately treated previous injury (e.g. old joint or ligament sprains)
- Poor joint positioning (biomechanical faults)
- Stiff joints (lack of movement diminishes joint nutrition)
- Loose joints (excessive sloppiness causes joint damage through poor control)
What About Your Return to Sport?
Your physiotherapist will guide you safely back to the level of sport at which you wish to participate. If you need guidance, ask us.
What If You Need Surgery or X-rays?
Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, but they'll also refer you elsewhere if that's what's best for you. Think about it. You could be suffering needlessly from a sports injury. Would you please use our advice to guide you out of pain quicker? And for a lot longer.
If you have any questions regarding your sports injury (or any other condition), don't hesitate to get in touch with your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.