Hip Pointer

1. Hip Pointer Emily Carda & Holly Zimmer

2. Definition: A hip pointer is a contusion (bruise) on the pelvis caused by direct blow to the iliac crest.

3. Preventions Maintaining excellent flexibility, strength and endurance of the hip, pelvis and lower back muscles may prevent some hip pointers. For athletes it is important to wear proper padding to prevent a traumatic blow. 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 Hip pointers present with a history of a contact injury in the area. Pain and tenderness along the crest of pelvis is also seen. 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 On average it takes 1 to 3 weeks to recover from a hip pointer. 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. A physical therapist may be recommended to help you regain mobility and build muscle strength.

10. Physical Therapy Treatments Core Strengthening Cryotherapy or Cold Therapy Electrotherapeutic Modalities Gait Training Hip AROM Hip PROM Hip RROM Hip Joint Mobilization Isometrics PNF Soft tissue mobilization Stretching/flexibility exercises

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>.