Hip Pointer Rehabilitation

							Hip Pointer Rehabilitation
   By Taryn Decoste, Matt Wakeham, &
              Shauna Kelly
                Outline

Anatomy
Causes
Hypothetical Situation
Rehab Program
Complications
What is a Hip Pointer Injury?

A hip pointer injury is generally a bruising
  of the iliac crest.
• Examples Include:
  • Falling on hard surfaces (gym floors, ice, etc.)
  • From receiving a direct hit to that area
    (football, hockey, etc.)
       Anatomy of the Hip

The anterior iliac crest area of the hip and
 the greater trochanter of the femur have
 minimal overlying tissue or muscle, and as
 a result are more susceptible to injury.
          Anatomy of the Hip




The iliac crest is the origins and insertions for
  many different muscles, as seen above.
 What Causes a Hip Pointer?

Any direct blow or fall onto the iliac crest or
 greater trochanter
          Contributing factors
   Limited protective equipment

   Highly physical sports

   Blows to the iliac region
         Who’s Vulnerable?
Any athlete involved
  with a contact sport,
  especially football,
  hockey
Any athlete prone to
  falls on hard surface,
  like volleyball, figure
  skating
Or, anyone who falls on
  a hard surface
         Hypothetical Situation
  A senior StFX quarterback starts the first game of the season.
-   gets sacked by an opposing player.
-   the players helmet strikes directly on the QB's right hip
-   goes down with a sharp pain going through his hip, right leg and
    abdomen
-    experiences spasms throughout the injured area.
             Patient History

-   No previous injuries of this type
-   Has no complicating conditions
-   Patient can remember the collision that led
    to the onset of the condition
                  Assessment
   Assessments will include:
        -visual inspection
        -palpation
        -passive and active ROM assessment
        -sensory testing
        -gait analysis.
                  Assessment

   Upon entering the clinic it is noticed that the
    athlete is walking with a distinctive gait.
   swelling is evident upon visual inspection
   reports increased pain with palpation of the
    affected iliac crest and greater trochanter
   Limited ROM due to pain
   Muscular strength is intact but is limited by pain
   X-ray to ensure that no fracture is present
        Rehabilitation Program
Day 1:
PIER: Pressure pad for contusion,
       Ice 15-20min every hour for first week


Eliminate all physical activity, as movement
is painful

Ultrasound – pulsed: 2MHz at 1W/cm²

IFC with Scan Feature - for pain reduction: lower pps (~25) while swelling
   persists, then go higher (~100 for pain)

NSAIDs right away to control inflammation and pain
- acetaminophen or acetaminophen with codeine
        Rehabilitation program

Day 1:
X ray done for fractures to femur or pelvic bones and scans are done for
   any other internal damage that could have been done by the blow,
   such injuries to spleen and other internal bleeding

Cardio activities such as the upper-body bike or
Swimming (arms only) can be done as pain allows



Crutches are to be worn until athlete can walk
without pain or limping for faster healing
     Rehabilitation Program

Day 8:
- Continue with icing

- Introduce heat as swelling decreases

- Continue the use of NSAIDs

- Continue use of ultra sound

- Introduction of light stretching as pain
  allows
     Rehabilitation Program

Day 14:
-Begin to return to lower body activities
-lower body strength/cardio activities as pain
   allows
-Heat prior to and ice after training
- If swelling persists NSAIDs will be
   continued
      Rehabilitation Program
Day 28:

-Athlete can return to practice, however with minimal
  contact (modifications to practice – different colored
  shirts).
-Combination of heat and ice prior and post practice.
-Swelling is reduced to normal, and ROM is approaching
  full recovery by this point.
        Rehabilitation Program

Day 42:
Athlete is able to return
to competition

Extra padding is worn
to prevent further injury

Warm up with stretching to
prevent strains                     http://www.youtube.com/watch?v=0TQOv
Ice/heat after practice as needed   f0Tl6w
        Cautions & Concerns

   Complications include:
    -hematoma formation (myositis ossificans)
    -scar-tissue formation
    -chronic bursitis
                          References

http://sportsinjuries.suite101.com/article.cfm/hip_pointer_injury
http://www.sportsdoc.umn.edu/Patients_Folder/Askdoc/askdoc2que10.htm
http://www.wellsphere.com/men-s-health-article/improve-your-hip-and-core-
    strength-
    withhipcircles/172636;jsessionid=5E67827CF61CA709D39EFA6835DEA1C2?q
    uery=Hip+Pointer
http://emedicine.medscape.com/article/87322-treatment
http://www.empi.com/healthcare_professionals/detail.aspx?id=114