Question: I was checked hard into the boards and have a big bruise on the outside of my hip. It’s very painful and I have difficulty in extending my stride. How can I get back to skating normally?
Answer: The injury you have described is consistent with a “hip pointer.” Hip pointers are very painful and can make it extremely difficult to skate and even walk. Hip pointers are caused by damage to the muscles that allow you to lift your leg away from your body (hip abductors). Injuries to these muscles can make it difficult to cross over your leg when skating, perform on-ice transitions, and for your trailing leg to have a long stride.
When your hip collides with a hard object like the boards, your hip muscles can be crushed between the object and your strong pelvic bones. This can cause the rupture of small blood vessels within the crushed tissue leading to painful bleeding into the muscles.
The treatment for a hip pointer depends upon the amount of symptoms. The main focus of the initial treatment is to try to minimize swelling and bleeding into the tissues, which will allow you to return 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 will make the blood vessels decrease in size (constrict) and will decrease the swelling and bleeding into the injured muscles.
Rest is one of the most important parts of the treatment plan. In more severe hip pointers, we place our athletes on crutches until they can walk without a limp. While almost all of our players will argue that they can tough it out and limp around with this type of injury, athletes get better quicker if they do not aggravate the badly injured muscle and only stop using 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 are counterproductive because they actually increase the amount of bleeding and swelling 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 of the injured 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.
Because the muscles that control hip abduction are essential to the skating motion 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 it is properly treated and rehabilitated it will rarely result in any long-term problems. Most 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.
Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado. He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it to firstname.lastname@example.org.