The DJO Surgical Hip Replacement, Direct Anterior Approach Patient Flipbook is an interactive, digital magazine that can be viewed on digital devices such as iPads and other tablets, laptops and smart phones. The Flipbook is designed to be flipped through like a magazine but with interactive image pop-ups, patient testimonial videos, and surgical procedure animations.
- 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 injury 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.
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. Full 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.
By Matt Aaronson
I had never been physically active prior to 2010. In fact, at one point I weighed more than 200 pounds. But with three kids at home, I needed to make some serious changes in my lifestyle and get healthy for myself and my family.
So I started to run for fitness. I was fortunate and began losing a lot of weight. And as I lost weight, I became a faster runner. I signed up for some races and noticed that I was commonly in the top 10 or even in the top three. I got into triathlons to try something different and realized my results were excellent. I even qualified for the World Championships in 2011, in my first half Ironman.
I ran my first marathon in 2013 in under three hours, during which I qualified for the Boston Marathon. However, while I was training for the Boston Marathon my hip started really bothering me. I thought I would be fine if I just ran a little bit less. Initially for my training I was up to 60 miles a week. But once I injured my hip, I went back down to less than 30 miles a week, even in the mid-20s per week. But the pain still got worse and worse.
After seeing a couple doctors without any improvement or definitive diagnosis, I knew I needed to elevate the level of care. So I went to see a sports medicine doctor at Rush’s orthopedics program. The doctor reviewed my prior MRIs and results from the last eight months of battling through physical therapy and other exams, reports and treatments. He ordered an MRI arthrogram to get to a diagnosis of hip impingement.
For me, deciding to have surgery was a really big decision because it made me nervous. I did a lot of research to ensure two things: Did I truly need surgery? And, was Rush’s orthopedics department, where I’d been referred for surgery, the right place to go?
I made sure to consult a variety of different medical professionals, not just surgeons, to make sure that surgery was the right option. I saw seven specialists in all. And one thing I found out through all of those consultations is that the doctors at Rush had steered me in the right direction in terms of a diagnosis and course of action.
The other thing was I met with a number of different surgeons who did this particular procedure and got a feel for how they differed. Through that process I really got a sense that Dr. Nho at Rush would be the best option for me. Dr. Nho was highly recommended by my physical therapist as well as other doctors who were friends of mine who knew him. In addition, Dr. Nho does a high volume of minimally invasive hip arthroscopy procedures, and that made a big difference for me. A lot of the other hip surgeons I met with also operate on knees and shoulders, but Dr. Nho is focused only on hips.
It made me comfortable and gave me confidence that my surgeon was so specialized that he’d probably already seen any complex issues that might arise.
Dr. Nho performed my hip arthroscopy in December 2015. The level of care and responsiveness during the recovery process was amazing. There were a number of times when I sent an email to Dr. Nho or one of his physician assistants, and they responded almost immediately.
In the course of my research, I learned that Dr. Nho’s rehab protocol is very precise and quite conservative relative to the other surgeons I consulted. He is in close communication with the physical therapist to ensure it is being followed and is effective.
And it was effective! I didn’t start running until about five months after the surgery. And when I started running, I was running for one minute at a time and walking for four minutes. However, within six weeks I was able to run a 5K race in just over 19 minutes, only about a minute slower than before I got injured.
After I ran that 5K I was so encouraged with my recovery process that I decided to sign up for a half Ironman, which was about nine months out from surgery. I trained a lot less than typical for a half Ironman because I wanted to ensure no risk to the surgery recovery. But I was able to complete it in just over four and a half hours, which was within a few minutes of my personal best time.
People in the running and triathlon community who know me always ask me for recommendations when they are injured. They know I have seen many doctors for injuries over the years. I recommend the orthopedics department at Rush without hesitation.
Physical therapist Karena Wu couldn’t help notice a trend in patients visiting her New York City office this year. Many were under age 35, enjoyed strenuous workouts and were suffering immense hip pain.
The millennials had pushed themselves in endurance races such as the Tough Mudder or weekly CrossFit and metabolic conditioning classes that placed wear and tear on their bodies, she said. And with little downtime between routines or adherence to proper form, they were putting the long-term health of their hips at risk.
“A lot of millennials are doing all of these high-intensity exercises that are great for the mental and physical components of health, but if you’re not as conditioned as you think, you’re going to put excessive stress on the soft tissue and the joint,” said Wu, owner of ActiveCare Physical Therapy.
It’s not uncommon for active young adults to experience some joint pain, but orthopedic specialists worry that regimens that rely on heavy weightlifting or intense aerobic exercises are causing more hip injuries. There are no definitive studies that correlate the two, but research in the Journal of Orthopaedic & Sports Physical Therapy says high-intensity activities appear to increase the risk of hip osteoarthritis, a degenerative joint disease.
What’s more, specialists at the Ohio State University Wexner Medical Center have reported a rise in cases of young adults with femoral acetabular impingement, a condition that occurs when the ball of the femur fails to fit securely into the hip socket. High levels of activity, they say, can cause the plate to fuse in an abnormal shape and result in a hip impingement.
Shane Nho, an orthopedic surgeon at Rush University Medical Center in Chicago, recalls a spike in hip, shoulder and knee injuries as CrossFit gyms sprung up several years ago. These days, he said, patients are coming in with hip ailments from high-intensity interval training, even some barre classes.
“We probably see at least a couple patients a week with injuries related to those types of intensive classes,” Nho said. “The types of workouts these guys are doing . . . they’re doing it at all costs, despite poor form, mechanics, fatigue or their actual baseline level of conditioning.”
Neuromuscular imbalances, or weakness in certain muscle groups, are often the root cause of the pain that Nho’s patients experience, he said. If patients come in as soon as they start feeling discomfort, he said, it’s easier to connect them with the right physical therapist to improve their stability and flexibility.
Hips are built to withstand tremendous force, but they need full range of motion to work properly, hence the importance of flexibility and stability, Wu said. She encourages her clients to do yoga or attend a Pilates class if they are dead set on physically taxing workouts.
“Flexibility is critical in trying to prevent injuries,” she said. “The body has a tendency to overemphasize larger muscles because they are easier to activate, so sometimes they get a little overused and smaller stabilizing muscles get underused. You create an imbalance.”
A weight-room regular since high school, Niranjan Nagwekar, 28, figured there was no need to spend much time warming up before squatting 250 pounds. But as the New Yorker ramped up his lifting, he started feeling a deep pain in his left hip.
“For the longest time, I thought I just had tight hip flexors, so I started stretching a little more, but the pain persisted,” Nagwekar said. “I didn’t feel much discomfort walking or sitting down, so it was kind of a strange thing to explain to a doctor because they were like, ‘If you could walk, you could sit, you’re fine.’ But I couldn’t lift as much as normal.”
It turns out Nagwekar had developed a hip impingement. Doctors recommended surgery, but he decided to opt for physical therapy. Nagwekar became a patient five months ago at ActiveCare, where Wu has guided him through mobility exercises involving foam rolling, core conditioning and stretching with resistance bands.
“I’m back to about 80 percent capacity,” Nagwekar said. “Any kind of power lifting that requires dynamic movement of the hips takes me a little longer. My hips don’t move as fluidly as before, but I can still do them.”