Move Forward Guide
Physical Therapist's Guide to
Pelvic Fracture (Hip Fracture)
A pelvic fracture is a break in 1 or more bones in the pelvis. It is sometimes referred to as a "hip fracture" or "broken hip" because it occurs in the bones that make up the hip area. A pelvic fracture causes difficulty walking or standing. It can also cause abdominal pain, bleeding from pelvic cavities, and difficulty urinating. Pelvic fractures in the United States are relatively rare, making up 0.3% to 6% of all fractures. Pelvic fractures are most common in people 15-28 years of age. In people younger than 35, males suffer a higher incidence of pelvic fractures than females. In people older than 35, females suffer pelvic fractures more often than males.
What is a Pelvic Fracture (Hip Fracture)?
A pelvic fracture is a crack or break in one or more of the pelvic bones, which are located at the base of the spine. The pelvis is often referred to as part of the hip. (When you "put your hands on your hips," your hands are actually resting on your pelvic bones.)
A pelvic fracture can result from a low-impact or high-impact event.
Low-impact pelvic fractures most commonly occur in 2 age groups: adolescents and the elderly. Adolescents typically experience fractures of the tips of 1 of the pelvic bones, resulting from an athletic injury (football, hockey, skiing) or an activity such as jogging. Pelvic fractures also can occur after minor falls in people with osteoporosis or even occur spontaneously when bones are weak. The elderly frequently suffer fractures of the thicker part of the pelvic bones. These "pelvic ring fractures" result from falling onto the side of the hip. These falls can be caused by balance problems, vision problems, medication side effects, general frailty, or unintended obstacles such as pets underfoot, slippery floors, or rumpled rugs. Low-impact pelvic fractures often are mild fractures, and they may heal with several weeks of rest. Physical therapy is very helpful in restoring strength and balance in these cases.
High-impact pelvic fractures most commonly result from major incidents such as a motor vehicle accidents, a pedestrian being struck by a vehicle, or a fall from a high place. These pelvic fractures can be life-threatening, require emergency room care, surgery, and extensive physical therapy rehabilitation.
How Can a Physical Therapist Help?
Pelvic fracture recovery often involves surgery or long periods of bed rest. In the case of athletes, avoidance of sport activities is recommended until pain has resolved. During these periods of rest, which are usually weeks to months, a person often loses strength, flexibility, endurance, and balance abilities.
Physical therapists can help you recover from a pelvic fracture by improving your:
- Pain level
- Hip, spine, and leg motion
- Speed of healing
- Speed of return to activity and sport
When you are cleared by your physician to begin physical therapy, your physical therapist will design a specific treatment program to speed your recovery, including exercises and treatments you should do at home. This program will help you return to your normal life and activities and reach your recovery goals.
The First 24-48 Hours
Your physical therapist may help you learn to use crutches so you can move around your home without walking on the leg of the injured side. This will more commonly apply to low-impact pelvic fractures, as in athletes. More severe pelvic fractures will require a wheelchair, in which your physical therapist can instruct your safe usage.
Your physical therapist can use different types of treatments and technologies to control and reduce your pain, including ice, heat, ultrasound, electrical stimulation, taping, exercises, and special hands-on techniques called manual therapy that gently move your muscles and joints.
Your physical therapist will choose specific activities and treatments to help restore normal movement in the leg and hip. These might start with passive motions that he or she applies to your leg and hip joint, and progress to active exercises and stretches that you perform yourself. Treatment can involve hands-on manual therapy techniques called "trigger point release" and "soft tissue mobilization," as well as specific stretches to muscles that might be abnormally tight.
Certain exercises will benefit your healing at each stage of recovery, and your physical therapist will choose and teach you an individualized exercise program that will restore your strength, power, and agility. These exercises may be performed using free weights, stretch bands, weight-lifting equipment, and cardio exercise machines such as treadmills and stationary bicycles. For pelvic fractures, muscles of the hip and core are often targeted by the strength exercises.
The hip area contains many muscles that are vital for balance and steadiness when walking or p
Speed Recovery Time
Your physical therapist is trained and experienced in choosing the treatments and exercises to help you heal, get back to your normal life, and reach your goals faster than you might be able to on your own.
Return to Activities
Your physical therapist will collaborate with you to decide on your recovery goals, including return to work and sport. Your treatment program will be designed to help you reach these goals in the safest, fastest, and most effective way possible. Your physical therapist will use hands-on therapy and teach you exercises and work re-training activities. Athletes will be taught sport-specific techniques and drills to help achieve sports-specific goals.
Prevent Future Problems
Your physical therapist can recommend a home exercise program to strengthen and stretch the muscles around your hip, upper leg, and core to help prevent future problems, such as fatigue and walking difficulty. This program may include strength and flexibility exercises for the hip, thigh, and core muscles. Your physical therapist will also review with you and your family ways to prevent falls in your home. These fall-prevention strategies may include clearing the floors of loose obstacles (throw rugs, mats), using sticky mats or chairs in the shower, preventing pets from walking near your feet, and using non-slippery house shoes, as well as installing grab bars or rails for the shower, toilet, and stairs.
If Surgery Is Necessary
If surgery is required, your physical therapist will help you minimize pain, restore motion and strength, and return to normal activities in the speediest manner possible after surgery.
Can this Injury or Condition be Prevented?
Pelvic fracture can be prevented by:
- Warming up before starting any sport or heavy physical activity. Your warm-up should include stretches taught to you by your physical therapist, including stretches for the muscles on the front, side, and back of the hip.
- Increasing 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 thus increase the risk of incurring a pelvic fracture. Physical therapy can help maintain and improve balance ability, which can help prevent falls.
- Driving safely to avoid motor vehicle accidents.
- Clearing your house of obstacles that you could trip over, and eliminating slippery walking surfaces.
Real Life Experiences
Joe lives near his widowed father, Kent, and frequently visits Kent at his home down the street. One morning, Kent didn’t answer the door when Joe knocked, which was unusual. Joe let himself into the house with his key and found his father lying on the floor in the doorway between the bathroom and the hall. Kent could barely move his legs, reported severe pain in his groin and thigh, and could not stand or walk. Kent told Joe he had slipped on the floor after bathing and had too much pain to get up. Joe called an ambulance, and the paramedics gently lifted Kent onto a stretcher and got him to the local emergency room.
X-rays showed that Kent had sustained a cracked pelvis bone. His condition did not require surgery. He was admitted to the hospital for several days of treatment and observation.
While in the hospital, Kent was visited the first day by a physical therapist who taught him some exercises he could do while lying in the bed, throughout the day. The physical therapist also helped Kent stand up and start walking around his room using a front-wheeled walker.
Kent was soon transferred to a rehabilitation hospital, where he received physical therapy twice daily. After a couple of weeks, he was able to stand by himself and walk a few hundred feet with a cane. The physical therapist helped Kent perform many exercises to regain his balance and stability when standing and walking.
When Kent was released to return home, the physical therapist visited his house to see if there were any conditions that might increase Kent’s risk of falling again. She found a throw rug on a wood floor that slid when walked on, and the edge of a carpet curled up in one doorway. There was no grab bar in the shower, and the bathroom linoleum floor was slippery when it was wet. With Joe’s assistance, the throw rug was removed and the carpet was fastened back down to the floor. Joe installed a grab bar in the shower, and a non-slip mat was placed next to the shower on the linoleum floor.
After Kent returned home from the rehabilitation hospital, he went to a nearby physical therapy clinic 3 times per week for several weeks to work on his strength and balance, and to regain the ability to climb stairs. After a few weeks, Kent was nearly back to his former physical status, and he was walking almost 2 miles per day around the neighborhood.
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 pelvic fracture. Some physical therapists have a practice with an orthopedic, geriatric, or sports rehabilitation focus.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in geriatric or sports physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have 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 in helping people who have pelvic fractures.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider. The following articles provide some of the best scientific evidence related to physical therapy treatment of pelvic fracture syndrome. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Kubota M, Uchida K, Kokubo Y, et al. Changes in gait pattern and hip muscle strength after open reduction and internal fixation of acetabular fracture. Arch Phys Med Rehabil. 2012;93:2015–2021. Article Summary on PubMed.
McCormack R, Strauss EJ, Alwattar BJ, Tejwani NC. Diagnosis and management of pelvic fractures. Bull NYU Hosp Jt Dis. 2010;68:281–291. Article Summary on PubMed.
Southam JD, Silvis ML, Black KP. Sacral stress fracture in a professional hockey player: a case report. Orthopedics. 2010;33:846. Article Summary on PubMed.
Breuil V, Roux CH, Testa J, et al. Outcome of osteoporotic pelvic fractures: an underestimated severity: survey of 60 cases. Joint Bone Spine. 2008;75:585–588. Article Summary on PubMed.
Suzuki T, Shindo M, Soma K, et al. Long-term functional outcome after unstable pelvic ring fracture. J Trauma. 2007;63:884–888. Article Summary on PubMed.
Knobloch K, Krämer R, Sommer K, et al. Avulsion injuries of the anterior inferior iliac spine among soccer players: a differential diagnosis to neoplasm decades following the trauma [article in German]. Sportverletz Sportschaden. 2007;21:152–156. Article Summary on PubMed.
Kobziff L.Traumatic pelvic fractures.Orthop Nurs. 2006;25:235–243. Article Summary on PubMed.
Moeller JL. Pelvic and hip apophyseal avulsion injuries in young athletes. Curr Sports Med Rep. 2003;2:110–115. Article Summary on PubMed.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Acknowledgement: Andrea Avruskin, PT, DPT