HIP POINTERS

WHAT IS A HIP POINTER:     The hip pointer is a contusion or deep bruise to the bone called the iliac crest.  This is the bone you feel at the top of your hips on either side.   This area of the body is relatively unprotected and often takes direct blows from an opponent's football helmet during a downfield run or jumping to catch a pass.

The athlete with a hip pointer experiences instant pain and disability.  He or she will be bent forward and turned toward the side of injury.  walking may be difficult because of muscle spasm in the hip muscles.  The athlete may be unable to cough or take a deep breath due to abdominal muscle spasm.  these symptoms occur because the hip and abdominal muscles attach to bone at the iliac crest.

Swelling usually increases over 1-2 days and bruising may become visible.  The doubled-up posture may last for several days and the area of injury can be tender for weeks.

WHAT YOUR TEAM DOCTOR OR TRAINER WILL DO:    The main concern is that no fracture to the hip has occurred and no damage to abdominal organs has occurred.  Often, hip pointer pain is so intense that the abdomen is held rigid and there may be concern for ruptured intestine.  X-rays may be taken to look for compression or if a piece of bone has broken off with the muscle.

TREATMENT:     Treatment includes ice and compression although a tight ace wrap is poorly tolerated.  Pain and anti-inflammatory medication should be started right away and may require prescription type medicines.

RETURN TO ACTION:     Return to non-contact can occur as soon as muscle tenderness and pain allow.  Abdominal muscles stretching should begin early and strengthening added as tolerated.  A protective hip pad should be used over the injured area.  Note: many of the hip pads provided are inadequate for protection.  An elongated donut that surrounds the iliac crest provides the best protection against injury.

Article by
Matt A. Murdoch, M.D.
Sports Medicine Plus
October, 1999

REFERENCES:

Garrick, JG and DR Webb, Sports Injuries: diagnosis and management, 2nd edition, Saunders, 1999.

McMillan, JA, et al, Oske's Pediatrics, 3rd edition, Lippincott, Williams, and Wilkins, 1999.

Hoppenfeld, Stanley, Physical Examination of the Spine and Extremities, Appleton asd Lange, 1976.

Safran, MR et al, Manual of Sports Medicine, Lippincott-Raven, 1998.