Hip Injury

First aid for a hip injury

1. Stop the activity. Do not try to "run it off".
2. Check if you can bear weight. If you cannot stand, or the leg looks deformed, stay still, keep warm and call 911 or your local emergency number. Do not let an older person who has fallen be pulled up if they have hip pain.
3. Ice the area for 15 to 20 minutes every 2 to 3 hours for the first 2 days, with a cloth between ice and skin.
4. Rest and protect it. Use crutches if walking causes a limp.
5. Pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose. Avoid NSAIDs if you have kidney problems, stomach ulcers or take blood thinners.
6. Gentle movement within pain limits after 2 to 3 days helps strains heal. Avoid heat, alcohol and massage in the first 48 hours, which can increase swelling.

Types of hip injury

Bruises and hip pointers

A hip pointer is a bruise to the iliac crest, the bony ridge you feel at your waist. It is common in contact sports and very painful, especially with twisting, coughing or laughing. A contusion usually settles over 1 to 3 weeks.

Muscle and tendon strains

A muscle strain is a tear of muscle fibers, graded from mild (grade 1) to complete (grade 3). Hip flexor and groin (adductor) strains are common in soccer, hockey and sprinting. Hamstring tears high up near the sitting bone can be severe and sometimes need surgery.

Labral tears

The labrum is a rim of cartilage around the hip socket. A hip labral tear often happens with abnormal bone shape (femoroacetabular impingement) plus twisting. It causes deep groin pain and mechanical symptoms.

Fractures

• Hip fracture: a break at the top of the thigh bone, mostly in older adults with osteoporosis. Nearly all need surgery, ideally within 24 to 48 hours.
• Pelvic fracture: ranges from minor breaks of the pubic bone after a fall to life-threatening fractures after high-energy trauma.
• Avulsion fracture: a piece of bone pulled off by a tendon in teenagers whose growth plates are still open.
• Stress fracture: a femoral neck stress fracture on the tension side can progress to a complete break, so it is treated seriously.

Dislocation

A hip dislocation needs a large force in a normal hip, and is an emergency because the blood supply to the femoral head can be cut off. It is reduced (put back) under sedation, ideally within 6 hours. Dislocation of an artificial hip happens with much less force.

How a hip injury is diagnosed

The doctor asks how the injury happened, where it hurts and whether you can bear weight. They look at the leg's position and length, press on bony landmarks, test movement and strength, and check pulses and sensation.

• X-rays of the pelvis and hip are the first test for any suspected fracture or dislocation.
• MRI finds fractures that X-rays miss, which is common in older adults with osteoporosis who still cannot walk. It also shows stress fractures, tendon tears and labral tears (often with an MRI arthrogram).
• CT is used for complex pelvic and socket fractures.
• Ultrasound can assess tendons, bursae and fluid.

Treatment and recovery time

Physical therapy focuses on regaining range of motion, then strengthening the glutes, core and thigh muscles, and finally sport-specific training. Returning too soon is the main cause of re-injury.

Preventing hip injuries

• Warm up and include strength work for the hip flexors, adductors and glutes in training.
• Increase running distance gradually and eat enough to fuel training, to prevent stress fractures.
• For older adults, reduce falls: strength and balance exercise such as tai chi, a medication review, eye checks, good lighting and removing trip hazards.
• Treat osteoporosis, and ask about hip protector pads in care homes.

Frequently asked questions

How do I know if my hip injury is serious?

Signs of a serious hip injury include not being able to stand or walk, a leg that looks shorter or turned outward, severe groin pain after a fall, or numbness in the leg. These suggest a fracture or dislocation and need emergency care. Pain that steadily worsens over days also needs a doctor.

Can you walk on a broken hip?

Sometimes, briefly. A small or impacted fracture may let a person limp with pain, which is why some hip fractures are missed. Anyone, particularly an older adult, with persistent groin or hip pain after a fall should have an X-ray, and an MRI if the X-ray is normal but pain continues.

How long does a hip injury take to heal?

Bruises take 1 to 3 weeks, mild strains 2 to 4 weeks, and moderate strains up to 8 weeks. Labral tears and severe tendon injuries may take several months. Hip fractures usually need surgery and 3 to 12 months of rehabilitation to regain the best function.

What is a hip pointer?

A hip pointer is a bruise of the iliac crest, the top ridge of the pelvis, usually from a direct blow in contact sports. It causes sharp pain, swelling and bruising and hurts with twisting or coughing. It heals with ice, rest and padding, but an X-ray may be needed to rule out a fracture.

Should I use ice or heat on a hip injury?

Use ice for the first 48 to 72 hours to limit pain and swelling. After that, gentle heat before exercise can relax tight muscles, and ice can still help after activity. Avoid heat in the first two days, as it may increase swelling and bleeding in the tissues.