A hip pointer is a bruise of the iliac crest, the bony rim at the top of the pelvis that you can feel at your waistline. It happens from a direct blow, typically in contact and collision sports, and can be surprisingly painful because several core and hip muscles attach there.1
- Caused by a direct blow to the top of the hip
- Common in football, hockey, rugby, lacrosse and soccer
- Pain, swelling and bruising along the waistline; walking, coughing and twisting hurt
- Treated without surgery
- X-rays rule out a fracture or, in teens, a growth-plate avulsion
Symptoms
- Sharp pain and tenderness over the top of the pelvis
- Swelling and bruising, sometimes appearing a day or two later
- Pain with walking, running, twisting, coughing or laughing
- Difficulty lifting the leg or bending to the side
Diagnosis
Dr. Dold examines the area and checks hip and core strength. X-rays are often taken to rule out a fracture. In teenagers, whose growth plates are still open, a similar hit or a hard sprint can pull off a piece of the growth area instead; see ASIS and AIIS avulsion injuries. Severe pain, inability to bear weight, or abdominal symptoms after a hit should be checked the same day.
Treatment
Conservative treatment works for hip pointers:1,2
- Ice and compression in the first days
- Relative rest, with crutches for a short time if walking is painful
- Anti-inflammatory or other pain medicine when safe for you
- Gentle motion, then core and hip strengthening as pain allows
- Protective padding when returning to contact sport
In some athletes, a local anesthetic injection is used to control pain and allow a quicker return to play.1 Dr. Dold will discuss whether that is appropriate.
Return to sport
The timeline depends on severity, from days for a mild bruise to several weeks for a severe one. Athletes are ready to return when they can run, cut and twist without pain and have normal strength, with padding over the area.
What the research shows
- What it is: a hip pointer is a deep bruise of the bone and the muscles that attach to the top of the pelvis (iliac crest), usually from a direct blow in football, hockey, soccer or a fall. The literature is mostly reviews and case reports, but treatment principles are well established.
- Rule out other injuries: severe pain, a pop or significant weakness can signal an avulsion fracture (especially in teenagers, whose growth plate on the crest is vulnerable) or a muscle tear from the crest. X-rays and sometimes ultrasound or MRI help, and reviews caution against assuming every hip injury is “just” a hip pointer.
- Early care: ice, compression, relative rest and pain control in the first days, then gentle stretching and strengthening as pain allows. Most athletes return within one to three weeks, depending on severity.
- Return to play: a protective pad over the iliac crest helps prevent re-injury. Significantly displaced avulsions or muscle detachments are uncommon but may need surgery.
- Adolescents: repeated traction from running can cause iliac crest apophysitis, which usually settles over a few months with activity modification.
Frequently asked questions
How long does a hip pointer take to heal?
It depends on severity: from days for a mild bruise to several weeks for a severe injury.
Do I need an X-ray?
Often, to rule out a fracture. In teenagers, an X-ray also checks for a growth-plate avulsion.
Can I play with a hip pointer?
Returning too early often prolongs the injury. Return when you can run, cut and twist without pain, ideally with padding.
Research cited on this page
- Hall M, Anderson J. Hip pointers. Clin Sports Med. 2013;32(2):325-330. PubMed
Conservative management with compression, ice, anti-inflammatories and rehabilitation is successful; local anesthetic injection can help some athletes return to play. - Varacallo MA, Bordoni B. Hip pointer injuries. In: StatPearls. StatPearls Publishing; 2023. PubMed
- Blazina ME. The “hip-pointer”, a term to describe a specific kind of athletic injury. Calif Med. 1967;106(6):450. PubMed
Original description of the hip pointer as a specific athletic injury. - Frank RM, Slabaugh MA, Grumet RC, et al. Hip pain in active patients: what you may be missing. J Fam Pract. 2012;61(12):736-44. PubMed
Review: in active patients, do not label hip pain a hip pointer too quickly; consider other causes. - Yeager KC, Silva SR, Richter DL. Pelvic Avulsion Injuries in the Adolescent Athlete. Clin Sports Med. 2021;40(2):375-384. PubMed
Review of pelvic avulsion injuries in adolescents, including iliac crest avulsions. - Calderazzi F, Nosenzo A, Galavotti C, et al. Apophyseal avulsion fractures of the pelvis. A review. Acta Biomed. 2018;89(4):470-476. PubMed
Review: conservative treatment for minimally displaced apophyseal avulsions; surgery for major displacement. - Lombardo SJ, Retting AC, Kerlan RK. Radiographic abnormalities of the iliac apophysis in adolescent athletes. J Bone Joint Surg Am. 1983;65(4):444-6. PubMed
Study: iliac crest apophysitis in adolescent athletes resolved over 1 to 8 months in most. - Peck DM. Apophyseal injuries in the young athlete. Am Fam Physician. 1995;51(8):1891-5, 1897-8. PubMed
Review (American Family Physician): apophyseal injuries in young athletes result from repetitive traction and muscle imbalance. - Casabianca L, Rousseau R, Loriaut P, et al. Iliac Crest Avulsion Fracture in a Young Sprinter. Case Rep Orthop. 2015;2015:302503. PubMed
Case report: iliac crest avulsion in a sprinter during the acceleration phase. - Lohrer H, Höferlin A. Successful Repair of M. obliquus Internus Abdominis Avulsion at the Iliac Crest-Operative Technique in Professional Soccer Players. Orthop Surg. 2023;15(5):1399-1404. PubMed
Case series: surgical reattachment of an abdominal oblique muscle avulsion from the iliac crest allowed full return to sport. - Halvorsen J. Hip Pointer Padding for Women. Phys Sportsmed. 1983;11(12):123. PubMed
Report on protective padding of the iliac crest for athletes.
Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 2026. This page is general information, not medical advice. Your own diagnosis and treatment plan depend on your exam and imaging.
