How the hip is injured on the road, in a fall or at work

The hip is a deep ball-and-socket joint, and the forces that damage it usually arrive from a distance. In a frontal crash, a knee that strikes the dashboard drives the thigh bone straight back toward the socket. With the hip bent in a seated position, that push can force the ball out of the back of the socket or crack the socket rim. A dislocated hip is an emergency room injury, but lesser versions of the same force can bruise the joint surface or strain the tissue around it. The knee is examined alongside the hip for this reason.

• Side-impact collisions. A door pushed inward in a T-bone crash strikes the outer hip and pelvis directly, causing deep bruising over the bony point of the hip or, with more force, a pelvic fracture.
• Falls onto the side. Landing on an icy driveway, a wet store floor or a parking-lot curb can fracture the hip, particularly in older adults or anyone with thinning bone. See traumatic hip fracture and what to do after a slip and fall.
• Twisting and catching yourself. A foot that slips while the body pivots can injure the ring of cartilage around the socket or strain the groin and hip flexor muscles; see muscle strain.
• Work injuries. Falls from ladders, loading docks and truck beds load the hip through the leg, and repeated heavy lifting with a twist aggravates it.

Our general page on hip injury and pain covers the common conditions by name.

Hip, lower back or both

Where the pain sits is one of the most useful clues. Pain deep in the groin or the crease at the front of the hip usually comes from the hip joint itself. Pain over the outer point of the hip tends to come from the tendons and bursa that lie on the bone. Pain in the buttock that travels down the back of the thigh past the knee, especially with numbness or tingling, is more often an irritated lower back nerve — see sciatica and pinched nerve.

After a crash or fall it is common to have both a hip problem and a back problem. The orthopedic physician examines the lower spine at the same visit, orders EMG nerve testing when a nerve cause is suspected, and coordinates with orthopedic spine care or back injury care when the spine is involved.

What the orthopedic hip exam checks

• How you stand and walk. A limp, a trunk that leans over the injured side, or difficulty standing on that leg is noted before anything is touched.
• Leg length and position. A leg that rests shortened or rolled outward can indicate a fracture.
• Rotation of the joint. Gently rolling the leg and turning the hip inward and outward reproduces pain from the joint, the socket rim or the cartilage ring.
• Tendons and muscles. Resisted movements test the hip flexors, the groin muscles and the gluteal tendons on the outer hip.
• The lower back and nerves. Reflexes, strength and sensation in both legs, plus pulses at the foot.

Findings are recorded in detail so that the same measurements can be repeated and compared at each follow-up visit.

Imaging the hip and pelvis

X-rays of the pelvis and hip are taken first, using digital X-ray (on site at select offices). A normal X-ray does not always settle the question: a fracture in older or thinner bone can be invisible on the first film. When you cannot stand on the leg comfortably or groin pain comes with every step and the X-ray looks normal, the physician orders an MRI to look for a hidden fracture. MRI also shows the cartilage ring of the socket, tendons and bone bruising. CT is used to map fractures of the socket and pelvis. See diagnostic imaging coordination and do I need an MRI after a car accident.

Non-surgical hip care

Your written plan is built around what the exam and imaging show. It may include:

• Protected walking with a cane, crutches or a walker, as directed by the examining physician. How much weight to put on the leg is a clinical decision made at your visit.
• Physical therapy focused on the gluteal muscles that keep the pelvis level, hip motion and gait.
• Image-guided injections into the joint or around the outer hip tendons, and pain management when pain limits rehabilitation.
• Chiropractic care for an associated lower back injury, when appropriate.

If you work, restrictions on stairs, ladders, prolonged standing and lifting are spelled out for your particular job and revised whenever your exam changes. The course of a hip injury depends on which structure was damaged; your physician discusses what to expect once the exam and imaging are complete.

When a hip injury needs a surgeon

A displaced hip fracture, a dislocation or a fracture of the socket is normally recognised and managed in the hospital. In the office, a surgical opinion may be recommended for a tear of the cartilage ring that keeps catching or locking, a fracture that shifts on follow-up X-ray, or changes in the ball of the joint after a dislocation. A referral is a request for an opinion, not a decision to operate.

Injury Recovery MD does not perform surgery. You choose the surgeon. IRMD assembles the pre-surgical work-up documentation and provides physical therapy and follow-up afterward, with your operating surgeon setting the rehabilitation protocol and milestones. The surgery overview and ORIF fracture surgery pages explain what those procedures involve.

Paying for hip care: No-Fault and workers’ compensation

A hip injured in a New York car crash is billed to No-Fault. The application to the insurer must be filed within 30 days of the accident; our page on the 30-day deadline explains how. You choose your own treating provider, and a No-Fault doctor page covers what the carrier pays for. Under workers’ comp, that choice is among providers authorized by the New York Workers’ Compensation Board, and Injury Recovery MD is one.

A hip injured at work goes through workers’ compensation; see workers’ comp orthopedic doctor and No-Fault vs. workers’ comp if you were driving for work. IRMD bills both directly, with $0 out of pocket for covered patients.

Where to be seen for a hip injury

Every Injury Recovery MD office has orthopedic physicians seeing patients: Medford, the main office; Mineola, the only Nassau County location; and Islandia, East Islip, Bohemia, Smithtown and Stony Brook in Suffolk. Visits the same day or the next day are often available at (631) 560-8357, and addresses are on the locations page.

More about crash injuries is on car accident orthopedic care, and every body area is listed under orthopedic care.

Where to see an orthopedic physician

• Medford3243 NY-112, Bldg 1, Suite 4, Medford, NY 11763Suffolk County
• Islandia1717 Veterans Memorial Hwy, Suite 100, Islandia, NY 11749Suffolk County
• East Islip11 Carleton Ave, East Islip, NY 11730Suffolk County
• Mineola300 Old Country Rd, Suite 321, Mineola, NY 11501Nassau County
• Bohemia1690 Washington Ave, Bohemia, NY 11716Suffolk County
• Smithtown732 Smithtown Bypass, Suite 200, Smithtown, NY 11787Suffolk County
• Stony Brook2500 Nesconset Hwy, Building 10A, Stony Brook, NY 11790Suffolk County

Orthopedic physicians see patients at every Injury Recovery MD office. Intake books the office and time that suit you. Call (631) 560-8357 — answered 24/7.

Frequently asked questions

Why does my groin hurt after a car accident when it was my knee that hit the dashboard?

When a bent knee strikes the dashboard, the force travels up the thigh bone into the hip socket. That can bruise or injure the hip joint even though the knee took the visible impact. Groin pain after a dashboard strike should be examined by an orthopedic physician, who checks the hip and the knee together and takes X-rays when indicated.

I fell on my side and I can still walk. Could my hip be broken?

It is possible. Some hip and pelvic fractures, especially in older adults or people with thinning bone, still allow walking with pain, and some do not show on a first X-ray. Deep groin pain with each step after a fall should be examined the same day. An older adult who cannot get up or stand after a fall needs an emergency department.

Is my pain coming from my hip or my lower back?

Location helps. Deep groin pain usually points to the hip joint, pain over the outer hip to the tendons there, and buttock pain running down the leg with numbness to a lower back nerve. Many people have both after a crash or fall. An orthopedic exam checks the hip and spine at the same visit, and EMG testing may be ordered if a nerve is suspected.

What happens if imaging shows a tear in the cartilage around my hip socket?

A tear of the cartilage ring around the hip socket, called the labrum, is often treated first with physical therapy, activity changes and sometimes an image-guided injection. If the hip keeps catching or locking, a surgical opinion may be recommended. Injury Recovery MD does not operate; you choose the surgeon, and IRMD provides the documentation and the rehabilitation.

Does workers’ comp cover a hip injury from a fall at work on Long Island?

A hip injured on the job in New York is generally handled through workers’ compensation, and Injury Recovery MD bills the carrier directly, with $0 out of pocket for covered patients. Report the injury to your employer, and bring any claim information you have to your first visit. Any work restrictions are spelled out for your particular job and revised whenever your exam changes.