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Ask Dr. Rick – October 2011 – Hip Pointers

October 24, 2011

Football season is here, and with so many high school and college athletes participating in this contact sport, one of the most common injuries that will be seen is a hip pointer. Although most athletes, coaches and parents have heard of a hip pointer, in my experience, very few people really understand or know what a hip pointer is.

A hip pointer is essentially an acute injury to the iliac crest of the pelvis. In short, the bone of your pelvis has a direct injury or an acute injury where there is bleeding because the bone is bruised and the bleeding goes into the abdominal musculature where the muscle and tendons of the hip and pelvis attach.

Hip pointers are extremely painful, and the pain is intense. The athlete will have a difficult time walking, and walking, running and coughing will all be extremely uncomfortable. A hip pointer can be caused by a fall directly on the hip, by a helmet or by a cleat directly on the bony portion of the hip. They are most common in football, but we also see them in soccer and in other sports. This is not a muscle pull; this is a direct blow to the bone.

Treatment for hip pointers is generally conservative; it consists of rest, ice and at first, not putting any weight on the hip. If there is concern for a fracture, an x-ray and possibly a CT scan should be ordered. Physical exam will evidence significant soreness in a very small, isolated area and possibly bruising and swelling in the surrounding area. I find that four to five days on crutches makes a big difference when it comes to allowing the athlete to get back to their sport. After five to seven days, anti-inflammatory medications should be started. Over-the-counter Advil or ibuprofen work well. If there are problems with GI upset, Celebrex also works quite well. If symptoms continue to lag, physical therapy and modalities are ordered, and it generally takes three to four weeks for this to resolve. If the hip pointer is minor, it can be resolved in seven to 10 days. If it is severe, it can take up to six weeks.

To prevent hip pointers, thick hip pads, as well as protective padding directly over the bony prominence of the anterior hip, are helpful. We also recommend teaching the athlete how to avoid the direct traumatic injuries to the hip. These injuries can ruin a young athlete’s season, and the athlete needs to be aware of ways to prevent hip pointers in the first place.

Ask Dr. Rick

“Dear Dr. Rick, When I run, my heel slides out of the back part of my running shoe, and although this does not cause me any pain, it is difficult to continue with my heel sliding in the shoe. Do you have any thoughts?” – Larry N., Ballwin

Larry, appropriate and appropriate-fitting shoes are imperative. I would recommend either seeing someone who professionally fits running shoes or talking to your family physician about possibly getting an orthotic so that your shoes fits better. Eventually, you will start to develop either a stress fracture or plantar fasciitis if you continue to run and your heel is not well-supported in your shoe. This can be a long-term problem. Thank you for your question.

“Dear Dr. Rick, I have a young daughter who is 16 and plays soccer. There have already been two concussions that have occurred on her team in the past year. How common are concussions in female athletes? Thank you.” – Melinda, Creve Coeur

Melinda, thank you very much for your question. This is a hot topic right now. Concussions in male sports continue to be well-studied and are commonly discussed. In female sports, although concussions appear to be less common, they are still prevalent. Concussions in basketball, soccer, women’s hockey and other sports continue to be a problem, and they should be treated equally and as conservatively. It is my opinion, that this will become an issue the more it is discussed and reported in the media, but again, women are as likely to sustain a concussion as males, and the serious nature cannot be underscored.

October Medical Tip: When playing any type of racket sports, wear protective eye wear.

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