Hip pointer

If you place your hand on the side of your body below your waist and press, you can feel the edge of a bone at belt level. This is the iliac crest. It is the uppermost rim of the pelvic bone, and because it lies just beneath the skin, it does not have a thick layer of soft tissue to cushion it. A direct collision with another player's knee or helmet, or with a hard floor, therefore transmits the impact straight to the bone.

The term “pointer” has long been used in sports. Literature from the 1960s also described it as a term for injuries to this area sustained in contact sports. Medically, it can be understood as a contusion caused by a blunt impact to the iliac crest.

Several muscles that move the abdomen, lower back, buttocks, and thighs attach to the iliac crest. A hard blow to this area can cause several things to happen at once.

• The muscles covering the bone and the tissues beneath the skin are compressed, causing bruising and swelling.
• Blood can collect or swelling can develop beneath the periosteum, the thin membrane covering the bone.
• The bone itself can also be bruised.

Even when the injury results from a single collision, the tissues affected vary depending on the direction and force of the impact, your position at the moment of impact, and whether you were wearing protective equipment. The severity of pain and the extent of bruising can therefore differ considerably from person to person.

• It hurts when pressed. Touching the iliac crest causes sharp pain, and swelling and bruising may appear over time.
• It hurts when you move. Walking, climbing stairs, twisting your trunk, or coughing or sneezing can cause a pulling pain around your side and buttock. Because both the abdominal and buttock muscles attach to this rim, moving your trunk or legs puts stress on the area.
• Your walking pattern changes. You may limp or lean to one side to protect the painful side.

Pain is usually worst during the first few days, then gradually decreases. Returning to play is generally reported to take around 2–3 weeks, although it can take longer depending on the severity of the injury. It is also common for bruising to spread down toward the thigh over time.

• Rest from painful movements for the first few days. Temporarily stop activities that increase pain, such as running, jumping, and physical contact, and start with gentle walking.
• Try cold compresses. Applying ice wrapped in a towel for 15–20 minutes at a time can help reduce swelling and warmth. For detailed instructions, see Cold compresses and ice packs.
• Find a comfortable position. Lying on the opposite side to avoid pressure on the painful area, or placing a pillow between your knees, can make you more comfortable.
• Gradually increase movements you can do without pain. Walk and gently stretch your buttock and thigh muscles within a pain-free range. If you rush back while still in pain, another blow to the same spot can make the pain worse and cause it to last longer.
• Use protective padding when you return. In sports with frequent contact, wearing pelvic padding can help reduce repeat impacts to the same spot.

Return gradually once you can walk and run without pain, and the movement range and strength of your hips and legs have returned to their previous levels.

Most cases improve with time, but seek an assessment from a professional in the following situations. Occasionally, a small fracture or an injury to another structure can occur around the iliac crest, and similar symptoms can make these difficult to distinguish from the outside.

• The pain is severe enough to make it difficult to bear weight on the injured leg
• Pain and swelling are getting progressively worse
• There is little sense of improvement even after 2 weeks
• You have numbness or tingling in the leg, or it feels weak

Not all pain on the side of the hip is a hip pointer. If you remember a collision and pressing the upper rim of the pelvic bone hurts, a hip pointer is more likely. Pain around the bony prominence on the outer side of the hip when lying down or walking is often due to Greater trochanteric pain syndrome, while a deep ache in the groin can sometimes be related to a problem inside the hip joint. Pain originating in the lower back can also be felt around the buttock. In adolescents, the ends of bones where muscles attach are not yet fully hardened, so a similar impact or pull from a tendon can sometimes lead to a different type of injury.