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 load should be reduced during periods of rapid growth (measure the height of young athletes every 3 months). Training should generally be varied and avoid repetitive movements. Alternate between different exercises over time to reduce strain. Quality of training is more important than 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 and years. Prolonged courses are particularly common in young people who exercise a lot and do not respond to the pain with relief from the pain-inducing activity.
Examination
Diagnosis is usually made by general clinical examination, where the known pain can be caused by pressure on the growth zone and activation of the muscles that attach to the growth zone. The severity of the soreness is not always a measure of the extent of the injury, but if the soreness is more pronounced or the pain comes on suddenly, medical examination is recommended to ensure proper diagnosis and treatment.
If there is any doubt about the diagnosis, an ultrasound scan and possibly an MRI scan can be performed, especially in cases of sudden onset of severe pain and suspected tears (X-rays often miss tears).
Treatment
Treatment includes relief, stretching and rehabilitation within the pain threshold. The sooner treatment is started, the sooner the symptoms subside.
It is important that the athlete, parents and coach are informed, understand and respect the need for load management during the rehabilitation period in order to avoid long-term injuries that can last six months to a year (Longo UG. et al., 2016 ).
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:
