By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
• Muscle strains are the most common hip and groin injuries in young athletes and will typically improve with simple measures
• An “avulsion fracture” can occur in the growing athlete, and can also result in excellent healing without surgery
• Femoroacetabular impingement (FAI) can be a source of hip pain in older adolescents and teenagers. This condition often requires surgery, with typically excellent outcomes.
Hip and groin injuries are fairly common in young athletes, and the type of injury is often influenced by the age of the young athlete. In the very young player, hip and groin injuries tend to be mild tendon or muscle strains. In the 11-17 year old age group a large percentage will also be tendon or muscle strains but a type of fracture through one of the growth plates around the hip and pelvis can also occur. In older players, stress fractures, athletic pubalgia (also known as sports hernia or core muscle injury), FAI, and hamstring tears can happen.
Muscle strains can happen in any of the muscles crossing the hip joint but we tend to see the highest number of muscle strains in the group of muscles in front of the hip called the “hip flexors”. A hip flexor can be strained when it contracts forcefully, especially when the leg is fully extended or prevented from moving. Kicking and sprinting are the most common movements that cause strained hip flexors.
The athlete will typically feel soreness or pain in the front of the hip along with a sense of weakness. If pain is significant or you are having difficulty putting weight on the leg see a sports medicine physician soon. For most mild strains, there will generally be a good recovery with initial rest and ice, followed by stretching and strengthening, and eventually gradual return to sports. Some athletes find that a compression wrap is helpful in recovery.
A more serious injury sometimes confused with a hip flexor strain is called an “avulsion fracture”. In the young athlete the bones are growing through areas called growth plates. The growth plates are a site of weakness and occasionally a tendon attaching to the growth plate can pull off a piece of bone attached to the tendon. This injury is typically accompanied by a “pop” at the time of injury, can be quite painful, and can be very difficult to put weight on the leg. If you experienced a “pop” and are having a lot of pain and difficulty walking on that leg, then we recommend you see your pediatrician or a sports medicine physician quickly for proper evaluation. These injuries will usually have a full recovery without surgery if they are treated correctly from the start.
We are becoming more aware of a condition called “femoroacetabular impingement”, sometimes simply referred to as “FAI”. FAI typically affects the older adolescent or teenage athlete. FAI is a condition in which abnormal bone growth on the femur (the large bone in the upper leg) and / or the acetabulum (the socket part of the pelvis) repetitively contacts each other.
Sports involving forceful rotation place the athlete at risk of developing pain from FAI. Golf, football, baseball, volleyball, soccer, hockey, lacrosse, field hockey, martial arts, and tennis are the sports most likely to aggravate the FAI.
For reasons not completely understood, some people develop excessive bone growth at the top of the femur and/or around the edge of the hip socket. These people are not born with FAI but it appears to develop early in life with growth. The movement that aggravates FAI is deep bending, or a forceful rotation of the core, including the hips. The longer that repetitive rotational movement occurs over a period of years, the more irritated the area becomes, the more pain can be felt because of bone bumping into bone, leading to damage of other, non-bony, tissues.
FAI requires careful evaluation by a sports medicine specialist with expertise in hip injuries. The pain may decrease with a period of rest and rehabilitation but unfortunately surgery is often needed for return to sports. The good news is that arthroscopic surgery for FAI is becoming much more common, and with very high success rates. In next week’s post we will outline the basics of FAI surgery.