Apophysitis of the pelvis/hip
An apophysis is a growth plate that provides a point for a muscle to attach. Growth plates are made up of cartilage cells, which are softer and more vulnerable to injury than mature bone. When the muscle attached to the apophysis is excessively tight or overworked, it can put increased tension and stress on the apophysis, which results in irritation and inflammation, a condition called apophysitis. There are several apophyses at the hip and pelvis that can be affected. Pelvic/hip apophysitis most commonly affects adolescents between 14 and 18 years of age.
How it occurs
Apophysitis is an overuse injury that typically occurs after repetitive activities of the muscles attached to the apophysis. Adolescents with excessively tight hip and thigh muscles are more prone to pelvis/hip apophysitis. The apophyses most commonly affected are the anterior superior iliac spine (ASIS), the anterior inferior iliac spine (AIIS) and the iliac crest. The muscles that attach to these apophyses flex the hip and rotate and twist the pelvis and trunk. Apophysitis of the pelvis/hip usually affects runners, sprinters, dancers, soccer players, and ice hockey players.
Signs and symptoms
There may be dull pain in the groin or the front or side of the hip that worsens with activity. There will be tenderness over the injury site and sometimes some swelling. Apophysitis may be mistaken for a muscle strain.
Diagnosis
Your doctor will review your symptoms and examine the injured area. Your doctor may order an x-ray to determine whether there has been a fracture to the apophysis.
Treatment
The doctor will recommend rest from irritating activities until the pain and tenderness go away. Ice should be applied to the painful area for 15-20 minutes as often as every 2-3 hours until the pain goes away. After daily activities can be tolerated without pain, gentle stretching and strengthening the muscles that attach to the affected apophysis (the hip flexors and abdominal muscles) can begin. Once flexibility and strength have improved, sport-specific activities such as jogging can begin with gradual progress to full activity.
Return to activity and sports
The goal is to return to sport or activity as quickly and safely as possible. Returning to activities too soon or playing with pain may cause the injury to worsen. This could lead to chronic pain and difficulty with sports. Everyone recovers from injury at a different rate. Returning to sport or activity will be determined by how soon an individual's injured area recovers, not by how many days or weeks it has been since the injury occurred. In general, the longer an individual has symptoms before starting treatment the longer it will take to get better. Safe return to sport and activity may happen when each of the following is true (Begin at the top of the list and progress to the bottom):
- Full range of motion in the injured leg compared to the uninjured leg.
- Regained normal strength in the injured leg compared to the uninjured leg.
- Ability to jog straight ahead without pain or limping.
- Ability to sprint straight ahead without pain or limping.
- Ability to perform 45-degree cuts, first at half-speed, then at full-speed.
- Ability to perform 20-yard figure-of-eight runs.
- Ability to perform 90-degree cuts
- Ability to perform 10-yard figure-of-eight runs.
- Ability to jump on both legs without pain and can hop on the injured leg without pain.
Preventing apophysitis of the pelvis/hip
- Perform a proper warm-up before starting any activity. Ten minutes of light jogging, cycling, or calisthenics before practice will increase circulation to cold muscles, making them more pliable so that they put less stress and tension on their attachment sites (apophyses). Studies have shown that an active warm-up is associated with better athletic performance than a warm-up that consists only of static stretching.
- Stretch tight muscle groups. The ideal time to stretch is after your workout. Be sure to include all major muscle groups. Hold each stretch for 30 seconds. Don't bounce.
- Do not play through pain. Pain is a sign of injury, stress, or overuse. Rest is required to allow time for the injured area to heal. If pain does not resolve after a couple days of rest, consult your physician. The sooner an injury is identified, the sooner proper treatment can begin. The result is shorter healing time and faster return to sport.