Feature Story
The Hockey Doc on hip pointers
QUESTION: I was checked hard in the boards last week in practice and
hit the outside of my hip. It’s very painful and I have difficulty in extending
my stride. What can I do to get back to skating more normally?
ANSWER: What you
described is consistent with a “hip pointer.” They can be very painful injuries
and can make it very difficult to skate and even walk. Hip pointers are caused
by damage to the muscles which allow you to lift your leg away from your body
(hip abductors). Injuries to these muscles can make it very difficult to cross
over your leg when skating and for your trailing leg to have a long stride.
When the hip muscles are crushed between
the boards and your strong pelvic bones, there can be a lot of bleeding into
the muscles which can cause significant pain.
The treatment for a hip pointer depends
upon the amount of symptoms. For the vast majority of injuries, the main focus
of treatment is to try to minimize the swelling which usually occurs in the
first few hours to days after this injury. By controlling the amount of
swelling and bleeding which occurs in the tissues, one can try to get back to
competition sooner.
The best way to try to control the
swelling is to put ice directly on the outside of the hip over the area that
was injured as soon as possible. This can be done up to a maximum of 20 minutes
every hour and is best applied over a towel or your undergarments. The ice is
important because it will make the blood vessels decrease in size (constrict)
and there will be less bleeding into the tissues that were injured. This will
help to decrease the amount of swelling present.
In more severe hip pointers, we recommend
that our athletes be placed on crutches until they can walk without a limp.
While almost all of our players will argue with us that they can tough it out
and limp around with this type of injury, we do emphasize that athletes get
better quicker if they only come off of crutches when they can walk without a
limp.
Pain medicines can also be helpful after
the injury. Our main medications for this are acetaminophen or acetaminophen
with codeine. Generally, we try to avoid aspirin or any of the
anti-inflammatory medications because they can thin the blood and actually increase
the amount of bleeding in the first few days after this injury.
A good compression wrap applied around
the hip and upper thigh can also be very useful to help minimize the amount of
swelling that may occur. This can also be done with a foam pad directly over
the area of the injury to help apply some pressure to minimize further bleeding
into these muscles.
Once the bleeding and swelling have been
controlled, a rehabilitation program can be initiated. Your athletic trainer or
physical therapist may choose to use ultrasound and warm packs to encourage new
blood vessel formation into the damaged tissue and also to decrease the
swelling. In addition, they will work with you to work on hip abduction
exercises to regain the strength in your pelvic muscles.
Since the hip abduction muscles are such
important muscles for an ice hockey player, it’s important that you should gain
your full strength prior to attempting to get back to competition. Otherwise, you will not have the speed and
agility to properly transition for on-ice competition.
While a hip pointer can be a very painful
injury, if they are properly treated and rehabilitated, they generally cause no
long-term problems. The vast majority of these injuries only need to be iced
and rested until the symptoms resolve. In addition, athletes who do sustain a
hip pointer should check their breezers to make sure
that they have appropriate padding over this area to prevent a reinjury to this area of the pelvis.
Dr. Rob LaPrade,
MD, PhD, is the team physician for the