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Hip Pointer Injury

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Hip Pointer Injury

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Hip Pointer Injury ,or Iliac Crest Contusion, is a subcutaneous contusion results from a direct impact or collision of the iliac crest and/or the greater trochanteric region of the femur.

The iliac crest is rich with multiple muscle attachments, blood vessels, and nerves. The major trunk muscles, the internal oblique, external oblique, latissimus dorsi, paraspinals, and many of the hip muscles, including the gluteus medius, gluteus minimus, the fascia of the gluteus maximus, and TFL attach to the iliac crest.

Contusion to the iliac crest (hip pointer) results in a seemingly disproportionate amount of pain, swelling, discoloration, and subsequent loss of function. After injury, any trunk and/or hip motions stress these muscle attachments, causing pain.

See Also: Pelvic Anatomy
Iliac Crest Contusion

Hip Pointer Injury Grading

The contusion is graded depending on the extent of damage:

  1. Grade I hip pointers functionally limit the patient for about 5–14 days,
  2. Grade II and III hip pointers can functionally limit the patient for 14–21 days

Hip Pointer Symptoms

Acute Pain at the Iliac crest, possibly radiating into the internal and external oblique muscles. Sometimes Paresthesia over the anterolateral thigh.

All muscles having an origin or insertion along the iliac crest may be affected by this injury. In most cases, the internal and external obliques elicit pain when the trunk is flexed away from the involved side. In more severe instances, hip flexion and abduction and movement of the trunk in any direction also cause pain.

Inspection: a rapid onset of swelling and redness Ecchymosis develops over time. With more severe contusions, swelling can appear in the lower extremity or testicular region

Hip Pointer Injury contusion
Contusion to the iliac crest. This injury, the so-called “hip pointer,” results in gross discoloration, swelling, pain, and loss of function.

Palpation: Crepitus felt during palpation of the iliac crest, Point tenderness elicited along the iliac crest and associated muscles, and Spasm of the associated muscles may also be present.

On examination: The pain is increased with passive hip extension, resisted hip flexion, external rotation and abduction, active trunk motions, and with such activities as laughing, coughing, or sneezing.

A complete sensory check of the involved lower leg is necessary to rule out trauma to the nerves about the hip. The lateral femoral cutaneous nerve, supplying sensation to the anterolateral thigh, is most commonly involved.


Radiographs is used to rule out fracture of the ilium.

iliac crest fracture
iliac crest fracture

Differential Diagnosis

  1. Ilium fracture,
  2. Muscle tear (gluteus medius, gluteus minimus, internal oblique, external oblique),
  3. Avulsion fracture,
  4. Bursitis.

Hip Pointer Injury Treatment

Individuals with iliac crest contusions require immediate removal from competition or other potential stress (Early intervention within 2–4 hours is critical to avoid severe pain and limited trunk motion). The early Hip Pointer Treatment includes:

  1. Ice,
  2. Compression,
  3. Rest,
  4. Anti inflammatory measures.

Hip pointer exercises and stretching which emphasize trunk side flexion to the side opposite the injury, should be initiated as tolerated and can be accompanied with transcutaneous electrical nerve stimulation (TENS). As the symptoms subside, gentle-graded stretching exercises are added in addition to trunk-strengthening exercises. Especially effective Hip pointer exercises include:

  1. Long sitting,
  2. Straight leg raises with the hip externally rotated,
  3. As well as the PNF diagonal flexion adduction,
  4. External rotation to extension, abduction, and internal rotation.

If the hip pointer injury is minor and occurs during a game situation, the athlete may be allowed to return to competition, provided that full lower extremity and torso function is demonstrated. In this case, the injured area is padded to protect against further injury, with treatment following the competition.

Prophylactic prevention of the injury with adequate padding of the iliac crest using materials such as high-density foam and orthoplast is recommended.


  1. Anderson K, Strickland SM, Warren R. Hip and groin injuries in athletes. Am J Sports Med. 2001 Jul-Aug;29(4):521-33. doi: 10.1177/03635465010290042501. PMID: 11476397.
  2. Lambert SD: Athletic injuries to the hip. In: Echternach J, ed. Physical Therapy of the Hip. New York,NY: Churchill Livingstone, 1990:143–164.
  3. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
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