1324 Brown Street, Suite A

Waxahachie, Texas 75165

Phone: (972) 937-8900

Sports Line: (888) 487-0449

 

 

Hip and Pelvis II

Vague hip or groin pain is a very common complaint among young athletes. In fact some studies have reported that as many as 28% of soccer players will sustain a groin injury in their career and that 5% of all soccer injuries involve the hip or groin.

When athletes complain about "hip pain" the location of the pain is very important. Most people think that pain on the outside or lateral portion of the leg near the pelvis is from the hip joint. In reality, pain from the hip joint is rarely if ever felt there. While there are several structures that may cause pain in that region, hip joint pain itself is generally felt in the groin area or in the front of the thigh.

Like most other weight bearing bones of the body, the hip and pelvis are subject to stress injury. Stress fractures of the femoral neck are arguably the most commonly missed serious overuse injury involving the hip. A study of military recruits looked at stress fractures. Of the 257 stress fractures reported in that study, nine involved the hip.

If a stress fracture of the femoral neck is not identified and treated in a timely manner, it may progress to a displaced fracture. This often necessitates operative repair and may place the athlete at risk for the development of potentially serious complications.

Symptoms of a stress fracture of the femoral neck are frequently very vague and begin as a mild ache. The pain is located in the groin or front of the thigh and will progress from mild ache to a severe pain if left untreated. The progressive nature of symptoms may lead athletes to delay seeking treatment until the pain significantly interferes with their training.

Diagnosis of a stress fracture can be challenging as well. Plain X rays of the area usually don't show evidence of a fracture at the time of presentation. For this reason, the sports doctor suspecting a stress fracture must perform other imaging of the hip.

Fortunately, if diagnosed early, stress fracture treatment is straightforward. These injuries are treated with decreased weightbearing until symptoms resolve. Six to eight weeks are required before repetitive stresses can again be placed in this area. Arm bicycles, water exercises, and stationary bikes can be used to maintain aerobic fitness while the stress fracture heals.

Some stress fractures depending on their location and length of progression will require operative repair. Furthermore, a study of elite athletes who had femoral neck fractures reported that most ended their careers because of this injury. The caveat was that most had delayed seeking treatment. The moral is that with hip pain it is very important not to delay seeking treatment.

Also in the overuse category, pain at muscular origins can slow an athlete down. Tendonitis of the muscles that move the hip is fairly common. The muscles of the groin and muscles of the outside of the hip are at risk. Symptoms of overuse involve pain with motion which may become worse with increasing use.

Treatment for these sorts of injuries involves the mainstay treatments for tendonitis with emphasis on the physical modalities. Ice after activity and moist heat prior to workout when combined with an oral anti-inflammatory medicines usually do the trick. Ultrasound and electrical stimulation are sometimes helpful as well.

In young and growing athletes and entity known as apophysitis can occur in the hip and pelvis region. The apophysis is a growth center made up of cartilage and bone. It is the weakest point in the course of bony development and is prone to inflammation. These injuries are similar to Osgood-Schlatter's injury in the knee and Sever's disease in the heel.

Diagnosis of apophysitis is made from physical exam findings of tenderness over the apophysis combined with a history of an adolescent patient and classic Xray findings.

Treatment of apophysitis involves protecting the painful area from loading while the inflammation resolves and healing occurs. After a period of rest, a gradual return to activity is permitted. It is important to stretch adequately to help prevent further recurrences.

 

Office Hours:     Monday - Friday 8 a.m. to 5 p.m. • Saturday appointment availability varies.

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