Should hip protectors be used?

An analysis of the use of hip protectors in aged care facilities (institutional settings) and community-dwelling individuals.


Hip fractures are a significant contributor to morbidity and mortality in older adults. Studies have shown that people aged 65 and over who have suffered a hip fracture are up to 3.5 times more likely to die within a year of surgery. (1) 95% of hip fractures are caused by falls, usually sideways direction. (2) With the aging population, and prevalence of hip fractures globally, it is estimated that the incidence of hip fractures will rise to greater than 6 million worldwide by 2050. (3)

The most common form of hip fracture is a neck of femur fracture, which accounts for over half of hip fractures. (4) Hip protectors are designed to reduce the risk of hip fractures from falls.

Hip Protectors – What are they and how do they work?

Hip protectors are normally worn within specifically designed underwear. There are three different types of hip protectors:

  • Hard plastic shields – form a protective barrier over the side of the greater trochanter. This allows the force of the fall to be shunted away from the hip and towards the soft tissues of the thigh.
  • Soft pads – form a soft compressible padding over the side of the greater trochanter. This design is to be shock absorbing. These are the most commonly used pads, particularly in residential aged care.
  • Mixed hard and soft shields – hard shell inserted between two soft compressible pads. Forms a protective barrier over the side of the greater trochanter. This design is to be both shunting and shock absorbing.

Do they Work? The Evidence 

There have been many studies over the years looking at the effectiveness of hip protectors in preventing fractures in older peoples. The current evidence is as follows:

  • “There is moderate quality evidence for a small reduction in hip fractures with hip protectors in institutional settings” (5)
  • The evidence also showed that there was a small increase in pelvic fractures with the use of hip protectors.
  • “There is moderate quality evidence that hip protectors probably had little or no effect on hip fractures in community” (6)
  • Compliance was a large issue identified in all studies, with roughly only 30% compliance reported on average

However a new study has been released which provides evidence that hip protectors can reduce the risk of fracture three fold in residential aged care in residents who are compliant and meet certain criteria. (7) This study does have a number of limitations including who was included, what type of hip protectors were used and only evaluating those residents that were compliant however still has value in showing hip protectors can be effective in reducing fractures when used in residential care and following specific criteria.

Clinical Application

There are a number or barriers around compliance and precautions which need to be considered on a case by case basis including:

  • Falls History: Are they a high falls risk? What type of falls are they having, does this include falling sideways, could hip protectors assist in preventing injury?
  • Cognitive impairment: Do they have a cognitive impairment and will it affect their ability to understand why and how to use hip protectors, and consent to their use?
  • Continence: If they are independent with toileting, do they have urge incontinence or frequency and will it be difficult for them to don and doff the hip protectors for toileting thus causing the potential for increased falls risk? Could it cause an increased burden of care for staff or carers?
  • Skin integrity: Do the hip protectors have the potential to cause irritation, pressure areas or sores?
  • Individual clients, family and carer beliefs and feelings: Are they comfortable wearing the hip protectors? Are they uncomfortable with the appearance of the hip protectors?
  • Cost: Although the Cochrane Review found that hip protectors may be an effective way to manage healthcare costs (8), it is important to consider the burden of cost on the client. Hip protectors can cost anywhere between $100-$400 dollars a pair. Considering most people require 2-3 pairs of hip protectors a year, and would be required to self fund the purchase of these, the burden of cost could be anywhere from $300-$1200.

Considering the evidence around fracture prevention and poor compliance, hip protectors should not be common practice for falls prevention, particularly in community dwelling individuals. However if all of the above barriers have been considered and the client is deemed likely to be compliant they may be considered as an adjunct to other falls prevention measures.

Hip Protector FAQ

What exercises do Physiotherapists prescribe for hip prehabilitation?

A person who has been prescribed hip protectors is often at a high risk of falls. Exercises would therefore focus on falls prevention.

This can be achieved through a program for the hip or lower limb. A combination of exercises would be put in place to improve strength, balance and stepping reactions, all of which work together to minimise someone’s falls risk.

How are the characteristics of the hip measured?

When undertaking a comprehensive assessment of someone’s hip movements, or prescribing hip protectors, we will consider many factors including:

  • Circumference of the hip or waist
  • Range of motion (completed with a goniometer, a specialised device used to measure joint angles)
  • Strength of muscles for movement in different directions (usually measured via manual muscle testing)
  • Coordination and reflexes

What is the best course of action for someone to prevent falls and subsequent injuries?

A comprehensive assessment by a Physiotherapist or Occupational Therapist is indicated to decrease someone’s risk of falls.

Extensive research suggests that the most effective approach to decreasing someone’s falls risk is a combination of:

  • Strength exercises
  • High-level balance exercises
  • Step reaction exercises

There are also other factors to consider. Research indicates that someone’s vitamin D levels can impact their falls risk, as can their environment and the equipment they use (such as footwear or glasses).

Do Physiotherapists teach people impact minimization strategies, such as how to fall correctly?

Yes. Community Therapy has invested in several pieces of technology such as:

  • BlazePods (a light system designed to improve step reaction)
  • The Clock Yourself App (cognitive and physical challenges designed to assist in step reactions)

We also work on external perturbations. This involves the clinician moving someone to simulate a loss of balance in order to teach them how to correctly step and save themselves.

Our Physiotherapists also aim to improve someone’s ability to get down onto the ground and back up again.

All of these things in combination help someone to decrease their risk of falling and also decrease their risk of injury if they do fall.

Does Community Therapy have experience on a falls committee?

Yes. When we partner with a residential aged care facility or a home care provider we usually engage in a falls committee as part of that partnership.

Committee meetings are weekly, fortnightly or monthly depending on the cohort of clients or residents that we are supporting. The meetings examine any trends in falls (such as time of day, location or mechanism involved) to determine strategies at a group level that can decrease fall rates. The committee will also look at any cases that need individualised strategies as well.

Does a hip fracture occur during falling or on impact?

A hip fracture can occur in either of those ways.

Fractures can obviously occur through impact, either with the floor during a fall or with something else such as a motor vehicle.

Fractures that occur without a fall often indicate a pathology which could be weakening the bone, such as osteoporosis or cancer in the bone.

Would it be beneficial to have soft flooring, such as rubber gym mats?

Theoretically, softer flooring can cushion the impact of a fall. However, careful consideration needs to be given to the other risks this can introduce. For example, a change in flooring can create a trip hazard.

A common strategy (particularly in residential aged care facilities or hospitals) is to place a falls mat next to someone’s bed if they are at a high risk of falls. While this may be suitable for someone who is bed bound and at risk of rolling out, in many cases it will not be suitable for someone who is still walking as the mat introduces a change of threshold that the person may not be able to navigate safely.

These factors need to be evaluated by an Occupational Therapist and decided on a case by case basis.


  1. “Mortality risk among older Australians hospitalised with … – NCBI.” 19 Jul. 2017, Accessed 5 May. 2020.
  2. “Important Facts about Falls | Home and Recreational Safety ….” Accessed 29 Apr. 2020.
  3. “Hip fractures in the elderly: a world-wide projection. – NCBI – NIH.” Accessed 29 Apr. 2020.
  4. “Hip fracture incidence and hospitalisations in Australia – AIHW.” 2 Oct. 2018, Accessed 29 Apr. 2020.
  5. “Hip protectors for preventing hip fractures in older people ….” 31 Mar. 2014, Accessed 29 Apr. 2020.
  6. “Hip protectors for preventing hip fractures in older people ….” 31 Mar. 2014, Accessed 29 Apr. 2020.
  7. “Effectiveness of Hip Protectors to Reduce Risk for Hip Fracture ….” 30 Aug. 2019, Accessed 30 Apr. 2020.
  8. “Hip protectors for preventing hip fractures in older people ….” 31 Mar. 2014, Accessed 8 May. 2020.