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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.
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