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• What Is a Pelvic Fracture (Hip Fracture)?
• Signs and Symptoms
• How Is It Diagnosed?
• How Can a Physical Therapist Help?
• Can This Injury or Condition Be Prevented?
• What Kind of Physical Therapist Do I Need?

What Is a Pelvic Fracture (Hip Fracture)?

A pelvic fracture is a crack or break in one or more of the pelvic bones. The pelvic bones are located at the bottom of the spine. (When you "put your hands on your hips," they are resting on one of your pelvic bones, the ilium.)

The pelvis consists of three bones: ilium, ischium, and pubis. The acetabulum (hip socket) connects the pelvis to the femur, which forms the hip joint. The pelvis can fracture in any of these locations.

How Does a Pelvic or Hip Fracture Happen?

A pelvic fracture can result from a low-impact or high-impact event.

Low-impact pelvic fractures most commonly occur in two age groups: teens and older adults. Teens typically experience fractures of the ilium due to an athletic injury (such as from football, hockey, or skiing). Pelvic stress fractures also can occur from repeated impact activities, such as ballet, jogging, or gymnastics.

Older adults often have fractures of the thicker part of the pelvic bones due to falling onto the side of the hip. These types of falls can be caused by balance problems, vision problems, medication side effects, weakness, or slipping or tripping over obstacles such as pets, slippery floors, or throw rugs.

Osteoporosis can also increase the risk of pelvic and hip fractures. Osteoporosis is essentially weakened bones. Older adults with osteoporosis can experience a pelvic fracture even after minor falls. They can also have spontaneous fractures (a fracture without a clear, physical cause) due to the bones not being as strong as they used to be. Lastly, cancer also can weaken the pelvic bones and lead to a fracture. Low-impact pelvic fractures often are mild. They may heal with several weeks of rest. Physical therapists help people with low-impact pelvic fractures restore their strength, range of motion, and balance.

High-impact pelvic fractures most often result from major trauma such as a car accident or a fall from a high place. This type can be life-threatening and require emergency care, surgery, and extensive physical therapy to recover. Physical therapists work with people recovering from pelvic fractures right after surgery. Physical therapy treatment will continue until movement, strength, and balance are restored to their fullest potential.

Signs and Symptoms

A person with a minor pelvic fracture will usually experience:

• Tenderness or pain in the groin, hip, or lower back.
• Difficulty walking or doing other movements.
• Pain that gets worse when walking or moving the legs.
• Possible numbness or tingling in the groin area or legs.

If a fracture is more severe and the pelvic bones are displaced, bearing weight on the leg or walking will not be possible.

How Is It Diagnosed?

If you see your physical therapist first, they will conduct a thorough evaluation that includes taking your health history. They will ask you questions about your injury and conduct a physical exam. Physical therapists can identify the signs and symptoms of a mild pelvic fracture, such as pain and tenderness, bruising, a creaking sound of the pelvic joints with movement, or swelling. They may suggest you have diagnostic imaging, such as an X-ray, to confirm a diagnosis.

If you see your physician first or visit the emergency room for treatment of a more severe fracture, an X-ray, CT scan, or other imaging of your pelvic region can help with diagnosis and to find if there are other injuries to nearby organs or surrounding tissue.

How Can a Physical Therapist Help?

Whether your pelvic fracture needs surgery or not, your physician may require a long period of restricted mobility. During these rest periods, which often last weeks to months, you can lose strength, flexibility, endurance, and balance.

When you are cleared to begin physical therapy, your physical therapist will design a personalized treatment program to help your recovery by:

• Decreasing pain level.
• Increasing hip, spine, and leg motion.
• Increasing strength and flexibility.
• Potentially increasing the speed of healing.
• Increasing your chances of returning to activity and sport.

Physical therapists will use various treatment options, including movement retraining, exercise, modalities, and hands-on techniques. They also can provide exercises and treatments that you can do at home. They work with you to help you reach your recovery goals and return to your everyday life and activities.

During the First 24 to 48 Hours

After a pelvic fracture, your physical therapist may help you learn to use crutches or a walker to safely move around your home. This will more commonly apply to low-impact pelvic fractures. More severe pelvic fractures may require you to use a wheelchair initially.

During the Next Few Months

Your physical therapist will personalize a treatment program to address your needs and goals. It may include treatments to:

Reduce pain. Your physical therapist may use various treatments and technologies to control and reduce your pain. These may include ice, heat, ultrasound, electrical stimulation, taping, and exercises. Your physical therapist also may provide manual therapy (a skilled hands-on technique to gently move your muscles and joints).

Restore movement. Your physical therapist will choose specific activities and treatments to help restore normal movement in your leg and hip. These might start with your physical therapist moving your leg and hip joint for you. They will then progress to active exercises and stretches that you can do yourself. They may also use manual therapy to improve muscle flexibility and increase hip, spine, and pelvis movement.

Improve strength. Certain exercises will benefit your healing at each stage of recovery. As your healing progresses, your physical therapist will choose and guide you through an exercise program to help restore your strength, power, and agility based on your previous function, goals, and current limitations. They may have you use weights, resistance bands, weight-lifting equipment, and cardio exercise machines (such as treadmills and stationary bicycles). Physical therapy often targets the muscles of the hip and core after a pelvic fracture. These exercises can also prevent fatigue throughout the day and promote a normal walking pattern.

Improve balance. The hip area has many muscles that are vital for balance and steadiness. Your physical therapist will teach you effective exercises to restore your strength and endurance and help you regain your balance. Speed recovery time. Working with a physical therapist can help you to heal, get back to your everyday life, and reach your goals faster than you might be able to do on your own.

Promote a safe return to activities. Your physical therapist will work with you to create your recovery goals, including return to work, leisure activity, and sport. They will design your treatment program to help you reach your goals in the safest, fastest, and most effective way possible. Depending on your situation, they may teach you sport-specific exercises and work retraining activities.

Prevent falls. Your physical therapist will review ways to prevent falls at home with you and your family.

• Clear loose obstacles (such as throw rugs or mats).
• Place sticky mats in the shower and on the bathroom floor.
• Install grab bars or rails for the shower, toilet, and stairs.
• Wear nonslip house shoes.
• Take measures to prevent pets from walking near your feet.

Can This Injury or Condition Be Prevented?

It is possible to prevent a pelvic fracture by:

• Being careful to increase the intensity of an activity or sport gradually, not suddenly. Avoid pushing yourself too hard, too fast, too soon.
• Following a reasonable and safe nutritional plan. Nutritional factors can contribute to osteoporosis, which can put you at higher risk of pelvic fracture.
• Maintaining good balance skills. Balance problems can increase the risk of falling and the risk of a pelvic fracture. Physical therapy can help you maintain and improve your balance to help prevent falls.
• Driving safely to avoid motor vehicle accidents.
• Clearing your house of obstacles you could trip over and eliminating slippery walking surfaces at home.
• Walking with caution on uneven surfaces or in bad weather, such as on icy pavements.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat pelvic fractures. However, you may want to consider:

• A physical therapist who is experienced in treating people with a pelvic fracture. Some physical therapists have a practice with an orthopedic, older population, or sports rehabilitation focus.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in geriatric, orthopedic, or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists with these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family and friends or from other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience helping people with pelvic fractures.
• Be prepared to describe your symptoms in as much detail as possible and say what makes your symptoms worse and better.