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.

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
• Strength
• Flexibility
• 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.

Rehabilitation

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

If surgery is required, your physical therapist will help you minimize pain, restore motion and strength, and return to normal activities in the safest and speediest manner possible after surgery.

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.

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.
• Be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.