Quadriceps contusions and hip pointers are common injuries in sports. Immediate and appropriate action is vital in preventing complications that can keep you from your normal activities for a prolonged time.

Treating quadriceps contusions
Immediately after a direct blow to the front part of the thigh, ice should be placed over the injury site, with the knee bent all the way (Fig. 1). This position should be maintained for 20 minutes. Thereafter, ice should be continued for 20 minutes, every hour for the first 24 hours, with the knee straight. With the doctor's consent, a physical therapist or athletic trainer may use electrical stimulation with the ice to ease pain and swelling (Fig. 2). After the ice is removed, a thick felt or foam compression pad over the injury site and an elastic wrap around the thigh can help provide support and reduce swelling. The compression pad must be in place when the athlete is not using ice. The athlete can start gentle, pain-free quad sets (Fig. 3 - tightening the quadriceps muscle and holding for 5 seconds). Crutches are used; however, the athlete is encouraged to walk as normally as possible, while placing minimal weight on the injured leg.

The day after
For 20 minutes, every hour when possible (3 times per day minimum), ice is applied with the knee straight. Quad sets should be continued, and the athlete can begin to try to bend the knee as far as possible without assistance and without pain. The athlete continues to walk with crutches until walking can be done without pain, limping, or swelling.

Recommendations
The athlete must work to regain full knee bending motion and gradually progress to pain-free strengthening and conditioning exercises, such as leg raises, stationary biking, and straight-ahead jogging. Certain activities, such as squatting, running downhill, and quick stopping and cutting, place a great deal of stress on the quadriceps. These activities should not be started until the athlete has full, pain-free motion and is jogging straight ahead without pain, limping, or swelling.

Preventing re-injury
When the athlete is ready to return to action, a large pad that covers the front and sides of the thigh is used. An impact or pressure relief pad (a foam donut covered by a hard plastic shell, such as Orthoplast) is highly recommended (Fig. 4). Prevention of quadriceps contusions may be possible with the use of large thigh pads that surround the front and sides of the thigh. In football, many position players (such as running backs) have large quadriceps muscles, but wear small pads when larger pads might instead offer better protection. In addition, the correct pants size is important to hold the thigh pad in place. Specialty girdles with built-in pockets for thigh pads can be used by any athlete in almost any sport.

Treating hip pointers
Hip pointers can be very painful and debilitating. Ice and crutches are the recommended immediate treatment. Electrical stimulation to relieve pain can also be used with the ice. Ice is continued for 20 minutes, every hour, until the pain resolves. The athlete can gradually return to jogging and sport-specific drills as the pain allows. When the athlete returns to participation, extreme care should be taken to protect the injured hip with proper padding (below). A good way to prevent a hip pointer is to make sure hip pads are large enough to come up over the crest of the hip bone. Football hip pads can be used by athletes for most sports to protect and prevent hip injuries.

Prevention of quadriceps contusions and hip pointers through appropriate padding should be taken seriously by the athletes, parents, coaches, and athletic trainers. Unfortunately, despite the best precautions, these injuries still can occur and appropriate treatment is important for a quick, safe return to play.

Scott Brackett,
Bruce Getz, ATC, and
Teri Mingee, M.S., P.T.
Columbus , Georgia