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.

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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

Return to Play After Spinal Fusion

Dr. Frank Phillips, co-director of the MOR Minimally Invasive Spine Institute, conductedgolf-spine a study on return to play after spinal fusion that was recently published in SportsHealth.  Dr. Phillips found that more than 50 percent of golfers return to play within one year of lumbar fusion surgery and some were even sooner. In general, most golfers returned to preoperative levels of performance (handicap) and frequency of play.

Read Full Study

MOR300x250

Snowboarding Ankle Injuries

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

Key Points:

  • Snowboarders tend to get more ankle injuries than skiers, and skiers tend to get more knee injuries than snowboarders
  • The “snowboarder’s fracture” is unique to ankle injuries in snowboarding
  • A fracture of the “lateral process of the talus” is sometimes missed on regular x-rays and it’s sometimes necessary to use specialized imaging to make a proper diagnosis
  • When treated early and properly this fracture will typically allow full return of sports participation but a missed diagnosis can result in significant problems

In this post I’m going to discuss a particular type of broken bone seen in snowboarding snowboardoften referred to as “the snowboarder’s fracture.” This particular fracture occurs in one of the ankle bones called “the talus”. A fracture in the lateral process of the talus is called the snowboarder’s fracture.

Patterns of injury are a bit different in snowboarding compared to skiing. Skiers tend to get more knee injuries than ankle injuries, and snowboarders tend to get more ankle injuries than knee injuries. One proposed reason for this difference is due to the less rigid boots used in snowboarding, which provide minimal protection to the ankle joint.

Most ankle injuries in snowboarding affect the lead leg. And about half of all ankle injuries in snowboarding are fractures. The “snowboarder’s fracture” occurs because of sudden upward movement of the foot, combined with the foot turning inwards. This injury typically occurs when landing from a jump. Pain is present on the outer side of the foot and ankle, and is often associated with swelling, bruising and significant tenderness to touch. Unfortunately, this injury is often missed, because regular X-rays don’t always show the fracture very well. If I’m suspicious for a snowboarder’s fracture and the x-rays look normal, I’ll often order a CAT scan as this can be a much more accurate way to diagnose this fracture.

Treatment of the snowboarder’s fracture depends on how big and how displaced the broken fragment is. For a small fracture that is in normal alignment, we can treat these without surgery. This typically means about 4 to 6 weeks of having the foot and ankle in a cast and no weight bearing on the leg. Large and displaced fractures are typically treated with surgery—the fragment is moved back into its normal position and screws are inserted to hold it in place. Recovery after surgery also includes a period of non-weight-bearing, followed by gradual restoration of motion, strength, and function of the ankle joint.

ssd.bannerOutcomes of snowboarder’s fractures are typically good if the injury is diagnosed early and appropriately treated.

Most athletes are able to get back to normal physical activity within 4 to 6 months. However, significant problems can result if this fracture is missed and appropriate treatment is delayed. These include non-healed bony fragments causing pain and poor function, as well as early arthritis of the joint, which can significantly limit movement of the foot. When a snowboarder presents with acute pain on the outer side of the foot or ankle after an injury on the slopes, it’s very important to see a skilled physician for a proper exam and appropriate diagnostic imaging to avoid missing this injury.