2. Definition:
A hip pointer is a
contusion (bruise) on
the pelvis caused by
direct blow to the iliac
crest.
3. Preventions
o Maintaining excellent
flexibility, strength and
endurance of the hip, pelvis and
lower back muscles may
prevent some hip pointers.
o For athletes it is important to
wear proper padding to prevent
a traumatic blow.
o Most, however, are the
unfortunate result of significant
contact and are not preventable
4. Causes:
Hip pointer injuries
usually occur in contact
sports, from a collision,
or from falling directly
onto the hip.
Hip pointers injuries can
occur in contact sports
such as football or
hockey. It may also be
caused by a fall onto the
hip in sports such as
soccer or skiing.
5. Diagnosis
o Hip pointers present with a
history of a contact injury in
the area.
o Pain and tenderness along
the crest of pelvis is also seen.
o The patient may walk with a
limp and have difficulty
moving the hip away from the
body against resistance. X-
rays are taken to rule out
fractures.
6. Signs/Symptoms
* Severe pain on upper, outside part of the
iliac crest
* Tenderness in the top area of your hip
* Pain with activity
* Swelling
* Bruising
* Soreness
* Muscle spasms
* Decreased range of motion
* Limp/abnormal gait
7. General Treatment
Physical examination in a person with a suspected hip
pointer should include:
- Abdominal examination to exclude trauma to intra-
abdominal organs
- Visual inspection
- Palpation
- Passive and active ROM assessment
- Sensory testing
- Gait analysis
8. General Treatment continued…
Hip pointers may be treated with:
* Rest
* Nonsteroidal antiinflammatory
drugs (NSAIDs)
* Ice
* For severe pain, your doctor may
inject a steroid directly into your
hip
9. Physical Therapy
o On average it takes 1 to 3 weeks to recover from a
hip pointer.
o In more serious cases of hip pointer, the hit can be
so severe that a fracture of the bone results. While
the treatment may not change, a fracture will likely
cause a delay in healing and more painful
symptoms.
o A physical therapist may be recommended to help
you regain mobility and build muscle strength.
11. Possible Treatment Goals
•Improve Fitness
•Improve Function
•Improve Muscle Strength and Power
•Increase Oxygen to Tissues
•Improve Proprioception
•Improve Range of Motion
•Self-care of Symptoms
12. Muscles involved in Hip
Pointers
Sartorious
Rectus Femoris
Abdominals
Tensor Fascia Lata
13. Sartorious
The sartorious is a muscle that has its origin at the
anterior superior iliac spine on the iliac crest.
Injury to the sartorious is the most common cause
of hip pointer.
The sartorious muscle helps with:
• Abduction
• Lateral/External rotation
• Hip flexion
• Knee Flexion
14. Rectus Femoris
The rectus femoris is a
quadriceps muscle that has
its origin near the iliac
crest.
This muscle is responsible
for flexing the hip joint and
extending the knee.
When the rectus femoris is
injured, it may be painful to
flex the hip joint.
15. Tensor Fascia Lata
The tensor fascia lata is
a gluteal muscle that has
its origin at the anterior
superior iliac spine and
on the anterior part of
the iliac crest.
It is responsible for
abducting, flexing and
medially/internally
rotating the femur.
When the tensor fascia
lata is bruised, moving
the hip can be painful.
16. Abdominals
The internal and
external oblique
muscles are
abdominal muscles
that have bony
attachments to the
iliac crest.
These muscles are
responsible for
allowing the trunk to
twist and turn.
When injured during
a hip pointer, moving
the trunk and hip
may be painful.
17. Bibliography
29, Brown June. "Hip Injuries | Injury/Pain | Core Knowledge |
Core Performance." Core Performance | Powered by Athletes'
Performance. 29 June 2009. Web. 22 Nov. 2010.
<http://www.coreperformance.com/knowledge/injury-pain/hip-
injuries.html>.
Waryasz, Gregory. "Hip Pointer Injuries | LIVESTRONG.COM."
LIVESTRONG.COM - Health, Fitness, Lifestyle | LIVESTRONG.COM.
12 May 2010. Web. 22 Nov. 2010.
<http://www.livestrong.com/article/121671-hip-pointer-injuries/>.
Martinez, John M. "Hip Pointer: EMedicine Sports Medicine." EMedicine -
Medical Reference. 6 Mar. 2009. Web. 19 Nov. 2010.
<http://emedicine.medscape.com/article/87322-overview>.
Kellicker, Patricia. "Hip Pointers - EmpowHER.com." Women's Health
and Wellness Information, Tips - EmpowHER.com - Improving Health,
Changing Lives. Nov. 2008. Web. 22 Nov. 2010.
<http://www.empowher.com/media/reference/hip-pointers>.
Editor's Notes
The term hip pointer is somewhat confusing. It can refer to a deep bruise of the muscle and bone, a small chip fracture or even a complete break. Typically, however, this term refers to a severe bruise and not a fracture.
Here you are looking at two different types of padding an athlete may wear that can help in preventing a hip pointer.
Typically, the patient presents with the sudden onset of hip pain in the iliac crest or greater trochanteric region after sustaining trauma.
If you have any of these symptoms do not assume it is due to a hip pointer. These may be caused by other conditions. But these are a few things you may see if you have a hip pointer:
* Severe pain on upper, outside part of the iliac crest
* Tenderness in the top area of your hip
* Pain with activity
* Swelling
* Bruising
* Soreness
* Muscle spasms
* Decreased range of motion pain can limit range of motion (ROM) at the hip joint and/or rotation of the trunk if the abdominal musculature is involved
* Limp/abnormal gait
As you can see in the photo, the patient has severe bruising right around the iliac crest region along with some swelling.
Rest - Rest 24-48 hours to prevent further damage. A hip pointer needs time to heal itself.
Ice - Apply ice packs for 15-20 minutes, 3-4 times a day for the first 24-72 hours, but don’t apply ice directly to the skin.
Core Strengthening
Cryotherapy or Cold Therapy – ice massage
Electrotherapeutic Modalities
Gait Training
Hip AROM
Hip PROM Hip ROM should be performed in all directions (flexion/extension, internal/external rotation, abduction/adduction)
Hip RROM
Hip Joint Mobilization
Isometrics
PNF
Soft tissue mobilization
Stretching/flexibility exercises - standing hamstring stretch, the quad stretch, trunk rotation and double knee to chest stretch will help maintain good range of motion and strength of the hip.
These muscles are muscles that need to be look at for strengthening and stretching in treatments with a hip pointer patient.
A hip pointer injury involving the sartorious muscle can make moving the hip painful.
