Anatomy
There are 3 growth zones on the acetabulum (spina iliaca anterior superior, spina iliaca anterior inferior and crista iliaca superrior) where the Sartorius, Rectus Femoris and abdominal muscles attach respectively.
There is also a growth zone on the inside of the femur (trochanter minor) where the iliopsoas muscle attaches.
Cause
Repeated repetitive (over)exertion (running, sprinting, kicking, dancing) overloads the muscle tendon attachments on the growth zones, causing irritation and inflammation in the growth zone (apophysitis).
Training intensity should be reduced during periods of rapid growth (consider measuring the height of young athletes every three months). Training should generally be varied, and repetitive movements should be avoided. Alternate between different exercises over time to reduce the strain. The quality of training is more important than the quantity.
Symptoms
Pain corresponding to (one of) the growth zones. The pain is aggravated by activating the muscles that attach to the growth zone (e.g. hip flexion (Iliopsoas) and knee extension against resistance (Rectus Femoris), knee flexion and external rotation of the hip and knee (Sartorius) and by stretching.
Apophysitis can last from a few weeks to months or even years. Particularly prolonged cases are seen in young people who train intensively and who do not respond to the pain by taking a break from the activity causing it.
Examination
The diagnosis is usually made during a routine clinical examination, during which the characteristic pain can be elicited by applying pressure to the growth plate and by contracting the muscles that attach to it. The severity of the tenderness is not always an indication of the extent of the injury, but in cases of more pronounced tenderness or sudden-onset pain, a medical examination is recommended to ensure a correct diagnosis and treatment.
If there is any doubt about the diagnosis, an ultrasound scan and, if necessary, an MRI scan may be carried out, particularly in cases of sudden, severe pain and suspected avulsion (X-rays often fail to detect avulsions).
Treatment
Treatment involves rest, stretching and rehabilitation within the pain threshold. The sooner treatment begins, the sooner the symptoms subside.
It is important that the athlete, parents and coach are all aware of, understand and respect the need for load management during the rehabilitation period in order to avoid long-term injuries that can last for months or even years (
In some cases with significant tearing of a piece of bone in the growth zone (most commonly the anterior inferior iliac spine), it may be necessary to surgically reattach the torn piece of bone, while cases with modest tearing are usually treated with weight bearing and gentle rehabilitation (Calderazzi F, et al. 2018).
Rehabilitation
As it is often not possible to return to hip-straining sports, it is important to find other sports that can be done without triggering hip pain, such as cycling, swimming etc.
Complications
If the progress is not smooth, you should consider whether the diagnosis is correct or if there are complications.
In particular, the following should be considered: