An iliac crest contusion, or hip pointer, is often best described as a bruise that happens under the skin around the iliac crest region. These bruises can also cause tearing of the nearby muscles and the bones that they attach too.
This injury usually won't be an immediate problem but can become quite painful and limit movement after a few hours.
A hip pointer is usually caused by a direct blow to the area.
Symptoms and Diagnosis
As is often the case, diagnosis is split into three grades.
- Grade 1
Generally, unaffected gait and movement.
Slight pain on palpation
- Grade 2
Moderate to severe pain on palpation of the area.
Abnormal gait cycle (short swing through on the effected side)
Reluctant to keep the effected foot on the ground
Potentially a slight lean to one side (pelvis tilt)
- Grade 3
Clear swelling and some discolouration
Obvious gait issues, very short strides and swing through
Severe lateral tilt to the effected side
It is also important to clear the chance of iliac crest fractures and avulsion fractures, this can be done via an x-ray.
A grade 1 hip pointer does not tend to stop someone from playing sport or getting on with everyday life. Grade 2 would miss from 5 to 14 days of competition and a grade 3 could be anywhere up to 3 weeks.
It is important to start by icing the area and keeping the area rested.
After this it is wise to start moving the hip around as much as you can pain free, if available a TENS machine, ultrasound of ice massage can assist and increase recovery speed.
Exercises such as lateral hip shifts aimed at the opposite side to the injury to start with (see below)
Lateral Hip Shifts
- Sit on an exercise ball
- Place hands on hips
- Roll laterally to the opposite side of the injury
- Return to the original position
Continue with active range of motion exercises and start some resisted movement or strengthening exercises.
Resisted Hip Flexion
Basically, lifting your leg in front of you with some kind of resistance trying to stop you performing the movement, this can be another person, a TheraBand or ankle weights.
You will be ready to return to play when you are able to achieve full range of motion, the easiest way to test this is to compare it to the unaffected side. You should also be able to perform cutting and direction changing movement without any pain. When you return to sport, a padding should be worn to protect the area.