Physical Therapist's Guide to Pelvic Fracture
A pelvic fracture is a crack or break in one or more bones in the pelvis. These types of fractures can cause pain and difficulty walking or standing; some may also cause bleeding from pelvic cavities due to the fracture’s close proximity to major blood vessels, and difficulty urinating. Pelvic fractures in the United States are relatively rare, making up 0.3% to 6% of all fractures. They are most common in people aged 15 to 28 years. Before the age of 35, males experience a higher incidence of pelvic fractures than females. After 35, females experience pelvic fractures more often than males. Physical therapists help people with pelvic fractures reduce their pain and restore their strength, mobility, balance, and function.
What is a Pelvic (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. (When you "put your hands on your hips," your hands are actually resting on one of your pelvic bones, the ilium.)
The pelvis consists of 3 bones: the ilium, ischium, and pubis. The acetabulum (hip socket) connects the pelvis to the hip bone, which forms the hip joint. The pelvis can fracture in any of these locations.
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 ilium resulting from an athletic injury (eg, football, hockey, skiing) or an activity, such as jogging. Pelvic stress fractures also can occur from repetitive impact activities, such as ballet or gymnastics.
Elderly people can experience pelvic fractures after minor falls if they have osteoporosis, or simply because their bones have weakened. Spontaneous fractures (without an apparent outside cause) can occur in people with weakened bones; cancer also can weaken the pelvic bones and lead to a fracture. The elderly frequently have fractures of the thicker part of the pelvic bones. These "pelvic ring fractures" result from falling onto the side of the hip. These types of falls can be caused by balance problems, vision problems, medication side effects, general frailty, or by encountering unintended obstacles such as pets underfoot, slippery floors, or unanchored throw rugs.
Low-impact pelvic fractures often are mild fractures; they may heal with several weeks of rest. Physical therapists help individuals with low-impact pelvic fractures restore their strength, range of motion, and balance.
High-impact pelvic fractures most commonly result from major incidents such as a motor vehicle accident, a pedestrian being struck by a vehicle, or a fall from a high place. These pelvic fractures can be life-threatening, require emergency care, surgery, and extensive physical therapy rehabilitation. Physical therapists work with people recovering from pelvic fractures immediately following surgery, and continue treatment until their movement, strength, and balance are restored to their fullest potential.
How Can a Physical Therapist Help?
Pelvic fracture recovery may involve surgery, prolonged immobilization, or long periods of relative inactivity. Athletes should avoid all sport activities until their pain has resolved. During these periods of rest, which usually last for 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 can do at home. This program will help you reach your recovery goals and return to your normal life and activities.
First 24 to 48 Hours
Following a pelvic fracture, your physical therapist may help you learn to use an assistive device 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. More severe pelvic fractures may require you to initially use a wheelchair; your physical therapist can instruct you in its safe usage.
Your physical therapist will design an individualized rehabilitation program to address your specific condition and goals. It may include treatments to:
Reduce pain. Your physical therapist may 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.
Restore movement. 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 the therapist applies to your leg and hip joint, and progress to active exercises and stretches that you perform yourself. Treatment can involve manual therapy to improve muscle flexibility and to increase mobility in your hip, spine, and pelvis.
Improve strength. Certain exercises will benefit your healing at each stage of recovery. As your healing progresses, and based on your age, strength, and health status, your physical therapist will choose and teach you an individualized exercise program that will help to restore your strength, power, and agility. These exercises may be performed using free weights, resistance bands, weight-lifting equipment, and cardio exercise machines, such as treadmills and stationary bicycles. Muscles of the hip and core are often targeted following a pelvic fracture.
Improve balance. The hip area contains many muscles that are vital for balance and steadiness when walking or performing any activity. Your physical therapist will teach you effective exercises to restore their strength and endurance to help you regain your balance.
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 do on your own.
Promote a safe return to activities. Your physical therapist will collaborate with you to decide on your recovery goals, including your return to work and sport. Your treatment program will be designed to help you reach your goals in the safest, fastest, and most effective way possible. Your physical therapist may teach you sport-specific exercises and work retraining activities, depending on your specific situation. Athletes will be taught sport-specific techniques and drills to help achieve their goals.
Prevent fatigue and promote walking. 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. Your program may include strength and flexibility exercises for the hip, thigh, and core muscles.
Prevent falls. Your physical therapist will 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 (eg, throw rugs, mats), placing sticky mats in the shower and on the bathroom floor, installing grab bars or rails for the shower, toilet, and stairs, wearing nonslip house shoes, and preventing pets from walking near your feet.
If Surgery is Necessary
Can this Injury or Condition be Prevented?
Pelvic fracture can be prevented by:
- 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 you maintain and improve your 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 at home.
- Walking with caution on uneven surfaces or in bad weather, such as on icy pavements.
Real Life Experiences
Kent is a 72-year-old retired construction foreman who lives down the street from his son Joe. Kent’s wife passed away a year ago. Joe frequently visits Kent at his home. One recent morning, Kent didn’t answer the door when Joe knocked, which was unusual. Joe let himself into the house 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 immediately called an ambulance; the paramedics gently lifted Kent onto a stretcher and got him to the local emergency room.
X-rays showed that Kent had cracked the pubic bone in his pelvis. Due to the nature and location of the fracture, his condition did not require surgery. Kent was admitted to the hospital for several days of treatment and observation.
Kent was visited on his first day in the hospital by a physical therapist who taught him some gentle exercises he could do while lying in bed. He 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, including gentle treatments and exercises to build his strength and improve his movement.
After a couple of weeks, Kent was able to stand by himself and walk a few hundred feet with a cane. His physical therapist helped him perform exercises to regain his balance and stability when standing and walking.
When Kent was released to return home, his physical therapist visited his house to see if there were any conditions there that might increase his risk of falling again. She found a throw rug on a wood floor that slid when walked upon, and the edge of a carpet curled up in a doorway. There was no grab bar in the shower, and the bathroom linoleum floor was slippery when it was wet.
Following the physical therapist’s advice, Joe removed the throw rug and fastened the edge of the carpet back down to the floor. He installed a grab bar in the shower, and placed nonslip mats in the shower and on the linoleum floor.
After Kent returned home from the rehabilitation hospital, he went to a nearby physical therapy clinic 3 times a week for several weeks to work on his strength and balance, and to regain his ability to climb stairs.
After a few weeks of focused work, Kent noticed he was feeling stronger and steadier on his feet than he had in years. He was happy to join Joe on daily walks around the neighborhood.
This evening, Kent was proud to report to his neighbor that he had just walked 2+ miles pain free!
This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.
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, geriatric, or sports rehabilitation focus.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in geriatric, orthopaedic, or sports physical therapy. This physical 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.
Revised by Susan Clinton, PT, DPT, board-certified orthopaedic clinical specialist and Daniel J. Kirages, PT, DPT, board-certified orthopaedic clinical specialist. Authored by Andrea Avruskin, PT, DPT. Reviewed by the MoveForwardPT.com editorial board.
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