HIP POINTERS

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • The term “hip pointer” refers to a bruise of the muscles and soft tissue attachments to the top of the pelvis bone, near the area where your shorts or pants would be
  • A hip pointer occurs from direct contact, such as from an opponent’s knee or fall to the court
  • Most hip pointers heal very well, with full recovery typically expected at about 3 weeks

In the last few weeks there have been several prominent NBA players sidelined for an Rockets v Clippersinjury called a “hip pointer”. We’ll see a fair number of these at all levels of basketball, including at the youth level.

What’s A “Hip Pointer”?

The term “hip pointer” has been used by sports medicine specialists for many decades, and in 1967 Dr. Martin E. Blazina from UCLA specifically noted that the phrase “hip pointer” should be used to describe a deep bruise to an area of the pelvis called the iliac crest (bone on the side of the body roughly near the top of your shorts or pants). So in actuality a hip pointer doesn’t really involve the hip, but the pelvis. Still we use the term somewhat broadly today. A hip pointer is an injury that occurs when there is direct contact to the iliac crest. This can occur by getting hit or falling onto your side and landing on a hard surface.

How the Injury Happens

The pelvic bone can see trauma during basketball if there is a direct blow from an opponent’s knee, or from a fall directly on to the basketball floor.

What’s The Story?

Hip pointers typically result in immediate, intense pain and localized tenderness over the iliac crest or pelvic bone. There will usually be significant bruising and swelling around the front, outside and inside of the hip. Due to the bleeding and swelling, movement of the hip will usually be limited and painful. Decreased range of motion and weakness are also typically seen. In young athletes I’ll typically get an x-ray to look for a fracture around the pelvis. One area particularly vulnerable in the growing athlete is the upper edge of the bone, where growth is still occurring.

Typical Treatment

Treatment starts with a proper diagnosis from a skilled sports medicine professional. These injures can be very uncomfortable, so crutches may be needed for the first several days, along with “RICE”: rest, ice, compression, and elevation. This will help to reduce inflammation and control the swelling. After the initial healing, the focus will shift to soft tissue mobilization. Soft tissue massage can help improve range of motion of the hip joint, further reduce swelling and prevent scar tissue. The athlete can then be progressed to range of motion, flexibility, strengthening, and sport specific exercises. For many young athletes I’ll prescribe physical therapy.

Time To Return To Play

Once pain free gait has been resumed sports specific training can be initiated. Fullssd.banner return to competition usually takes about 1-3 weeks for older teenagers, but may take longer in younger athletes, and longer still if there’s a fracture to the bone. After full healing, you should expect to be able to participate in full activity without restrictions.

New study suggests strategies for keeping off pounds

You’ve succeeded in losing weight. Now, what can you do to keep the pounds off? Most people seem to struggle with long-term weight loss. By some estimates, only about 20% of overweight individuals are successful in keeping off at least 10% of their initial body weight for a year or longer. A new study, however, suggests that using specific strategies — such as weighing yourself regularly and planning for situations in which you might backslide — could modestly slow the rate of weight regain in obese adults who have lost weight.

In the study, employing such strategies in a maintenance program increased theHow to really lose weight proportion of adults who stayed at or lowered their weight, after initial weight loss, by 13.9 percentage points, said Corrine Voils, research career scientist at William S. Middleton Veterans Memorial Hospital in Madison, Wisconsin and lead author of the study. However, more research is needed to determine which specific strategies offered the most benefit and which may have not had much of an impact. The study, which involved mostly men of various races and involved self-reports, was published in the journal Annals of Internal Medicine on Monday.

“We went into this study unsure what to expect,” said Voils, who is also a professor of surgery at the University of Wisconsin-Madison. “We knew that maintaining weight loss is hard and that previous maintenance studies have tended to focus on middle-aged white females. We were unsure if a mainly telephone-based program would work in a population that is primarily men and of mixed race,” she said. “We were happy to see that our strategies reduced the rate of weight regain.”

More than one-third of American adults are considered to be obese, meaning their body mass index is 30 or higher, according to the Centers for Disease Control and Prevention. Obesity has been linked to numerous health problems, including heart disease, stroke, type 2 diabetes and several types of cancer.

Obesity is now recognized as a chronic disease

The new study involved 222 obese patients, of whom only 34 were women. All of the patients had lost at least 8.8 pounds in a 16-week weight loss program. They were randomly assigned to participate in either an intervention group that provided weight maintenance strategies for an additional 42 weeks or a group that received usual medical care, with no emphasis on weight maintenance.

Those in the intervention group participated in three in-person group meetings and eight individual telephone calls, in which they were given a maintenance calorie budget and strategies on how to exercise, get support from their family and friends, and monitor their weight. The phone calls also involved the patients reflecting on how their lives have improved as a result of weight loss, making a plan for situations when they might feel tempted to go back to old habits, and specifying how frequently they weigh themselves and revisit weight loss efforts if they have gained weight.

All participants, in both groups, were scheduled for assessment appointments at the beginning of the study and then after 14, 26, 42 and 56 weeks. After 56 weeks, Voils said, 58.6% of patients in the intervention group either regained some weight or saw no change in weight, while 72.5% of patients in the other group regained or saw no change, a difference of 13.9 percentage points.

The average weight regain in the intervention group was only about 1.6 pounds, compared with about 5.2 pounds in the other group, the researchers found. “Although this may not seem like a lot of weight, given the low program costs and the high benefit of carrying less weight over the longer term, this is an important finding that adds to our understanding about how best to help patients with obesity,” said Dr. Jennifer Kraschnewski, associate professor at the Penn State College of Medicine, who was not involved in the new study.

What might help weight control the most?


It remains unclear in the study whether regular weighing, planning for high-risk situations or obtaining outside support was most effective in weight loss management, Voils said. “Our study design did not allow us to say which component of our intervention was most effective,” Voils said. “There is evidence that self-weighing and relapse prevention help people maintain weight loss. Our intervention incorporates those skills and adds having patients reflect on the benefits they experienced with weight loss and talking with a support person about what they can do to support weight maintenance efforts,” she said.

Though it remains difficult to establish which part of the intervention had the most impact on patients, having constant interaction with a supportive coach probably played a significant role in weight maintenance, said Dr. Samuel Grief, associate professor of clinical family medicine at the University of Illinois College of Medicine at Chicago, who was not involved in the study.

“Group dynamics tend to be more helpful, or a team-based approach using care coordination,” Grief said. “That would be my answer. Because strategies like food journaling or diaries or writing out what activities you do every day or emotions that you’re feeling, all that is relevant, but there’s not a lot of science behind those causing weight loss or mitigation of weight regain. Otherwise, everybody would do it,” he said. “Also, it would have been helpful to gauge their self-efficacy.”

Studies suggest that having self-efficacy, or believing that you will be successful in losing weight, has been linked to greater success in weight management, Grief said.
Additionally, the researchers were unable to assess longer-term weight maintenance and relied on self-reports about dietary intake and physical activity. “Our population was primarily middle-aged men who were white or African-American, and results may not generalize to other populations,” Voils said.

Tips for keeping the weight off

The National Weight Control Registry, which has tracked more than 10,000 individuals who have maintained significant weight losses, offers some recommendations on how to maintain weight control.

Rena Wing, a professor at Brown University’s Warren Alpert Medical School, and James Hill, director of the Center for Human Nutrition at the University of Colorado Health Sciences Center, established the registry in 1994. “To maintain weight loss, there must be continued adherence to a low-calorie diet and high physical activity,” Wing said. She said the registry suggests that the following strategies may help someone who is trying to maintain their weight loss:

>Maintain high levels of physical activity, in which the recommended goal is 250 minutes per week of moderate-intensity activity, such as brisk walking.
>Monitor your weight by weighing yourself frequently.
>Monitor and keep track of your diet and activity.
>Take immediate action in the face of small weight regains.

By Jacqueline Howard, CNN

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The Ergonomically Correct Home Office

By Grace Wang and Dr. Chris E. Stout for  ATI Physical Therapy

home-officeWhether or not you realize it, you probably have a home office. You might not telecommute, and you might not have a corner, L-shaped desk or a computer with dual monitors, but most likely, there is a place in your home where you browse the web, check Facebook, answer emails, update your blog, or write the next chapter of your 200,000 word fan-fiction novel. There is a place in your home where you spend a lot of time sitting down, facing a screen. You’re thinking about it right now, aren’t you?

The fact is, people are spending more time in front of screens than ever before. According to a recent BBC article, adults in the UK are now spending more time on devices than sleep, and the New York Times reports that statistics in the U.S. are similar. Studies have shown, and it’s not too difficult to believe, that people are not just dependent on their devices, but also emotionally attached to the connectivity that they provide.

“But,” some might say, “I’m not wasting time on my device. I’m forced to be in front of my screen for work/school.” This may very well be true, but whether screen time is due to stacks upon stacks of paperwork or due to an unhealthy emotional attachment to connectivity with the virtual world, the result, at least for the human body’s ergonomic health, is the same. If we can’t tear ourselves away from our screens (for whatever reason), the very least we can do is make sure that our “home office” allows for the body posture that is least harmful to our health.

The Chair
Mayo Clinic says that the height of a chair should allow for feet to rest on the floor and for knees to be level with hips. A good chair also provides lumbar/lower back support.

The Phone
Mayo Clinic also says that if one regularly uses a phone at the same time as a computer, the phone should have a headset so as to protect the neck from strain.

The Monitor
The same article indicates that the monitor should be an arm’s length away and the top of the screen should be just below eye level.

Posture
No matter how flawlessly a workspace is set up, joint health still relies heavily on correct body posture. In other words, we can easily find ways to sit in our ergonomically correct home office that are not ergonomically correct. Three few helpful posture rules are:

  1. Don’t slouch. It sounds obvious, but still difficult to remember!
  2. Center your body in front of your monitor/keyboard.
  3. Keep your thighs and knees level with your hips.

Take Breaks
Taking a break to move around, even if it’s just to stand up and walk or stretch, is not only good for the body, but it’s been proven to increase the ability to focus, to decrease fatigue, and to improve mood.

So, do your best to separate yourself from your computer, phone, and television when possible, and when you can’t find enough willpower to say no to Facebook, or when deadlines are approaching, do your body a favor and relax or work in a position and location that optimize skeletal and muscular health.

Our Approach
A great way to improve health (and productivity) is to incorporate a culture of fitness. ItATI 300x250 does not need be anything too challenging to get things going. At ATI Physical Therapy’s Corporate Offices we have a fully equipped fitness center on the premises and encourage all to take advantage of it. We also do a simple and easy set of exercises each day at 1:55pm. We call it the “ATI-5.” It is five minutes of five one minute exercises that most anyone can do in any attire at their work area or office. At 1:55pm each day employees hold a plank position for one minute, then do one minute’s worth of squats, followed by a minute of in place lunges, then a minute of wall (or regular) push-ups, and ending with a one minute set of tricep dips using the edge of their desk. The comradery and mutual encouragement helps to make everyone feel more comfortable than if they were to do it one their own or without having the corporate recognition that it’s a fine thing to be doing.

For more information on avoiding pain at your desk and more quick tips on office ergonomics click here.

5 Ways to Stop Knee Pain in Runners

By Ryan Domeyer PT, DPT, CMPT for Athletico

Between 20 to 93 percent of runners suffer from knee pain, making it the most common lower extremity injury.  When knee pain occurs, one of the treatment options is physical therapy. Physical therapists are trained to examine, diagnose and treat knee pain to help patients return to the activities they love.

The majority of knee pain associated with running is not caused by direct trauma butknee-pain rather improper loading. Running requires the ability to absorb the weight of the body when the runner’s foot hits the ground in order to propel the runner forward. Although it might not seem like it, running is actually a complicated skill that most people do not actively practice prior to their recreational run. Knee pain can start during a run, but most commonly is experienced after running longer distances. Research shows the more miles you run the higher risk of sustaining a knee injury. The most common causes of knee pain in runners are iliotibial (IT) band syndrome, chondromalacia patella (runners knee) and patellar tendon pain.

It is common for runners to treat their knee pain with rest and ice and hope it goes away on its own. Although rest can help during the initial stages of knee pain, there are many ways that runners can take load off their knees and prevent future injuries, including the five listed below:

  1. Improve Hip Flexor and Quadriceps Mobility

Americans spend on average 13 hours per day sitting.1 Sitting for long periods of time during school, work or watching TV causes the front of the hip to shorten, which leads to tightness in the hip flexor and quadricep muscles. Stretching or foam rolling are the most efficient ways to improve hip flexor and quadriceps mobility to lessen knee pain. For more information on stretching and foam rolling, read:

Stretching: It’s All in the Hips Part 3

Foam Rolling: 3 Ways to Roll Away Muscle Tension

  1. Improve Hip Strength

Another adverse effect of sitting during the day is the inefficient use of our gluteal muscles. The gluteal muscles are the largest muscles in the body and when trained properly, can lessen the load on the knee. The easiest way to improve strength of the gluteal muscles is with bodyweight exercises including bridges, planks, side planks, bird dogs and hip abduction raises.

  1. Improve Balance

As previously mentioned, running requires the ability to land on one leg repeatedly to propel the body forward. The knee is the middle connection between the ground and the body. A loss in balance can lead to poor force absorption from the ground with each step taken during running.

To test balance, try standing on one leg without using your arms for 30 seconds. If this is difficult, balance can be improved by practicing. To take this balance exercise a step further, try balancing on one leg without holding onto anything with your eyes closed. If balance continues to be a problem, consider scheduling a complimentary injury screening at your nearest Athletico Physical Therapy.

  1. Improve Core Position and Stability

Another way to improve muscle imbalances is to improve core strength and the ability to run with a neutral spine. To do this, begin your run on the right track with a neutral neck aligned over your shoulders, neutral low back without a large backward curve and feet straight forward. Awareness of your low back and core position is important at the start of a run, as it becomes more difficult to maintain as fatigue sets in.

  1. Increase Number of Steps

Running technique is the most significant way to decrease the load on the knee to prevent or improve an injury. A simple way to improve technique is by increasing the number of steps taken. Although it may seem counterintuitive to take more steps, this will prevent a poor foot strike position and set the body in a good position to fall forwardathletico300x250 rather than absorb the force.

If you need help with running technique, request a video gait analysis at Athletico, which provides real-time audio and visual feedback on your running style. This will enable your physical therapist to provide feedback that not only helps improve efficiency, but also helps to prevent injuries.

Click to Schedule a Complimentary Injury Screen