Avulsion fracture – hip/pelvis

Immediately after an avulsion fracture in the hip, it is important to manage it correctly, it is very important to keep your leg moving as best as possible as well as try to reduce the pain and swelling.

The current guidance on treating a minor avulsion fracture is to follow the PEACE and LOVE principles.

PEACE

• Protection – Avoid activities and movements that increase pain during the first few days after injury.
• Elevation – Raise the injured limb higher than the heart as often as possible.
• Avoid Anti-Inflammatories – Avoid taking anti-inflammatory medications as they reduce tissue healing. Avoid icing.
• Compression – Use elastic bandage or taping to reduce swelling.
• Education – Your body knows best. Avoid unnecessary passive treatments and medical investigations and let nature play its role.

LOVE

• Load – Let pain guide your gradual return to normal activities. Your body will tell you when it is safe to increase the load.
• Optimism – Condition your brain for optimal recovery by being confident and positive.
• Vascularisation – Choose pain-free cardiovascular activities to increase blood flow to repairing tissues.
• Exercise – Restore mobility, strength and proprioception by adopting an active approach to recovery.

What if I need pain relief?

To manage your pain and keep your hip moving it is advised that you initially take regular simple pain relief. This can be bought over the counter from a pharmacist.

If you have any allergies or conditions which affect the use of pain relief or any questions or concerns please seek advice from your GP or a pharmacist.

If you follow this advice leaflet your injury should take around 6-8 weeks to heal.

However, everyone recovers from injuries at different rates and it is dependent on the severity of the injury, the soft tissue that was involved and the presence of any other medical problems.

If you follow this advice leaflet your injury should take around 8-10 weeks to heal.

However, everyone recovers from injuries at different rates and it is dependent on the severity of the injury, the soft tissue that was involved and the presence of any other medical problems.

0-2 weeks after injury

If you have been given crutches in the Emergency Department (ED) use these as required in the early stages.

You should attempt to wean off them as soon as possible and resume normal activities as soon as your hip feels comfortable and you feel able to.

It is safe to move and put as much weight through your leg as soon as you feel able to both with or without crutches.

2-4 weeks after injury

Start to try and add in some gentle cardiovascular activity like cycling or swimming as you feel able to as well as keeping other parts of your body moving like doing core stability exercises or upper body exercises if you have access to a gym.

If after 2-3 weeks, you are still struggling with any of the following, please contact the physiotherapy department on 0131 3121079 and ask to make a self-referral:

• Still having difficulty fully bending and straightening your hip and knee
• Are unable to put all of your weight through your leg without crutches

4+ weeks after injury

If you have followed all of the exercises within this guide and gradually built up your activity levels it is safe to start re-introducing more challenging activities such as gentle running and jumping.

You can also start adding in more sport-specific activities as you feel able to and make a gradual return to training.

Remember to always be guided by your hip – a little bit of pain that goes away quickly is normally nothing to worry about but if you are experiencing high levels of pain that don’t settle quickly you should contact the physiotherapy department on 0131 3121079.

Try and start working through the following exercises as soon as you can – it is safe to start these exercises right from the day after your injury.

Exercise 1

• Lie on your stomach and bend your knee, hold onto your foot with your hand and gently pull your heel down towards your bottom.
• Hold for 30 seconds and repeat 3 times on each leg, twice daily.
• Keep doing this exercise daily until you can comfortably get your heels to touch your bottom.

Exercise 2

• Lie on your back with your hands holding the back of your thigh, and gently straighten your knee until you feel a stretch down the back of your leg and behind your knee.
• Hold for 30 seconds and repeat 3×10 times, twice a day.

Exercise 3

• Lie on your back and place your ankle across your other thigh.
• Gently pull your leg towards you as shown until you can feel a stretch across your bottom.
• Hold for 30 seconds and repeat 3×10 times, twice a day

Exercise 4

• Lie on your back with a ball or cushion between your knees.
• Gently lift your bottom up off the floor.
• Hold for 5 seconds.
• Lower back down to the floor again.
• Repeat 3×10 a day.

Physiotherapy video

Start these exercises as soon as your movement has returned and your pain has settled.

Exercise 1

Stand on one leg whilst lifting the other up, out and forward as shown in the picture like you are lifting your leg over a block, then reverse the movement.

Repeat 5-10 times on each leg and repeat 2-3 times a day.

Exercise 2 ‘Dead bug’

• Lie on the floor with your arms and legs lifted as shown in the picture.
• Slowly lower your right arm and your left leg as shown, return to the starting position and repeat with your other arm and leg.
• Try and keep your lower back gently pressed into the floor as you move your arm and leg and only stretch them out as far as is comfortable.

Exercise 3

• Stand on your affected leg in front of a sturdy chair.
• Slowly sit down into the chair until you touch it with the bottom or backs of your legs then stand back up again.

Repeat 3×10 times a day.

Exercise 4

• Stand at the bottom of your stairs or in front of a high step.
• Place your injured leg up onto the step and step up like in the picture, try to keep your other leg off the step.
• Step then slowly step back down keeping the movement smooth and controlled.

Repeat 3×10 times each day.

Physiotherapy video

Once your hip is no longer painful and the movement is much better you can gradually return to gentle activities.

As your leg or hip continues to feel better you can gradually return to your usual activities ensuring you warm up and cool down fully.

If you feel as though you are able to, you do not have to wait for the go-ahead from a health professional to return to your normal activities.

If you have regained full movement at your hip, are able to walk and run pain-free and have been able to return to your normal sports and activities you don’t need any further assessment or treatment.

If you do have any concerns or are struggling to return to your normal activities please call the physiotherapy department to make a self-referral.