In this installment of The Dynasty Doctor, we will discuss iliac crest contusions (otherwise known as hip pointers) and how this might impact players on dynasty franchises.
The iliac crest is the highest part of the hip bone. It is easy to identify, just feel the bottom of your rib cage, then slide your fingers down until you feel the top of the hip bone. That is the iliac crest. As you might tell, it is exposed to contact and, for athletes who lack sufficient padding in this area (read: fat), it is vulnerable to blunt force trauma. These injuries might occur from direct impact of a helmet or shoulder pads. Another mechanism of injury is a fall on a hard surface, such as turf.
Here is a diagram of the iliac crest:
In most cases, hip pointers are not serious injuries, but they can be excruciatingly painful. Bone has sensory nerves in its outer layer, called periosteum, and forceful impacts can lead to intense pain. When contusions, or bruises, in bone irritate the periosteum, inflammation, swelling and bleeding can occur, resulting in severe pain.
Complicating matters, the iliac crest serves as a point of insertion for several very strong muscles in the hip, pelvis and upper extremities. The latissimus dorsi muscle, also knowns as “lats,” has an insertion on the iliac crest, and helps the shoulder joint internally rotate and pull backwards (extension). The iliacus muscle is a thick, powerful muscle that originates from the iliac crest and helps to move the leg upwards at the hip joint (hip flexion). Severe pain typical of hip pointers can be exacerbated with movement of these muscles, such as rotational movements or raising the upper leg of the injured side. Bleeding can also arise from muscles, leading to blood clots (hematoma), forming noticeable masses that can be painful. The worst case scenario is a fracture of the hip bone, similar to that suffered by Frank Gore, but fortunately these injuries are rare.
Hip pointers are not well studied, but appear to be uncommon relative to other injury locations, such as ankles and knees. A study of NFL players reported on hip injuries from 1997 to 2006, and 82 of 738 injuries were reportedly hip pointers (11%).1 The overall incidence of hip pointers was 0.3% and the mean loss of training was 5.6 days.1
Treatment focuses on pain management, control of swelling and bleeding. Rest, ice, compression and elevation (RICE) are one of the first strategies, as is typical for musculoskeletal injuries involving athletes. Pain medication with acetaminophen (Tylenol) is preferred acutely, as non-steroidal anti-inflammatory drugs (NSAIDs) can inhibit platelet function and worsen bleeding in the first 48 hours. Hip pointers can be treated with injections of numbing agents (lidocaine) and steroids, allowing athletes effective pain control for immediate return to play. X-rays are done to ensure no fracture is present, as that would be a long-term injury. Pain control with lidocaine and steroid injections achieves adequate or better pain control in most cases.
Prognosis is excellent.
The likelihood of any long-term complications or loss of function from a hip pointer is very low. Depending on the intensity of pain, players might return to the same game, or might need one to three weeks to recover. Rehabilitation focuses on range of motion with a goal of no significant pain with movement. Proper padding might help reduce risk of injury. In fact, the NFL will now enforce a rule that players must wear proper padding, including thigh pads, or will be removed from the game.
Examples of NFL players with hip pointers in 2012 include Ray Rice, Jeremy Maclin, Jarius Byrd and Bryan Bulaga. Maclin missed one game (week three), but his production suffered for three games (weeks 2-to-4). Bulaga missed the final three games of 2012 with a fractured hip. Rice, Ponder and Byrd did not miss a game from hip pointers. Frank Gore fractured his hip in 2010 and missed the season. Based on this limited data set, a fractured hip is likely season-ending. If there is no fracture, a hip pointer might take 0 to 3 games before a player returns to expected fantasy production. Either way, a hip pointer should not adversely impact the value of dynasty assets with this injury.
For more on hip injuries (and Percy Harvin, specifically), make sure you check out the last edition of The Dynasty Doctor.
- Feeley BT, Powell JW, Muller MS, et al. Hip injuries and labral tears in the national football league. Am J Sports Med 2008;36(11):2187-95.
- Hall M and Anderson J. Hip Pointers. Clin Sports Med 2013;32:325-330.