Hip pain in sporty teens is challenging, with many possible causes. The commonest is hip apophysitis — swelling of a growth plate (a traction apophysis) where the tendons attach to the pelvic bones. So who gets hip apophysitis, and how do we manage teenage hip pain?
Hip apophysitis is one of several pediatric sports injuries we assess.
What is traction apophysitis?
An apophysis is a growth plate that anchors a tendon to bone, different from the larger growth plates in the long bones that drive height. It contains cartilage cells, which are softer and more prone to injury than mature bone. When the attached muscle and tendon are tight or overused, those cartilage cells swell, causing apophysitis.
Apophysitis affects different sites at different ages: the heel (Sever’s disease) around age 10, the knee (Osgood-Schlatter) at 12–14, and the hip at 15–16.
Common sites of hip apophysitis
Several apophyses sit around the hip and groin. The most commonly affected are:
- Anterior inferior iliac spine (AIIS) — where the quadriceps attaches at the front of the hip
- Iliac crest — where the abdominal muscles attach to the pelvis
- Ischial tuberosity — where the hamstrings attach to the sitting bone
How do we diagnose hip apophysitis?
Hip apophysitis occurs in active teens — running, football, rugby, hockey, tennis, and dance. Teens typically report hip or groin pain during and after activity; in more severe cases, pain occurs at rest and at night. Rest settles it, only for it to flare on return to sport. There’s often a recent jump in training, a change of drills, or a new coach.
Examination is essential. We usually find tenderness at the apophysis and pain when the attached muscle contracts. We also check the hip joint and lumbar spine to ensure the pain isn’t referred.
Sometimes a sudden muscle contraction pulls the apophysis off the bone instead of just inflaming it — an avulsion fracture. These present with sudden pain, a limp, and an inability to continue, and are often misdiagnosed as a muscle strain.
Imaging for hip apophysitis
A plain X-ray shows the changes of traction apophysitis — a fluffiness to the apophysis — and rules out an avulsion fracture. When the diagnosis is unclear, and the X-ray is normal, ultrasound or MRI can help, and MRI can exclude more serious causes.
Other causes of teenage hip pain
Slipped upper femoral epiphysis (SUFE) — a growth-plate injury at the femoral neck, usually in overweight or sporty teens, causing severe hip pain and a limp. Early diagnosis is essential, as it can cut off the blood supply to the femoral head; treatment is surgery.
Perthes disease — disrupted blood supply to the femoral head, typically at 10–12 years, causing hip pain and limping. Early diagnosis prevents bone death and early arthritis.
Other, less common causes include hip impingement, hip dysplasia, tumours (rare), and pars stress fractures.
How do we treat hip apophysitis?
Rest from the offending activity is the most important step, including school sports in mild cases. Talented multi-sport teens may need to pick one sport for a few months. In more severe cases, we advise complete rest from swimming, cycling, and excessive walking, with crutches for a short period (1–4 weeks) if needed. Good communication with parents, coaches, and the school matters throughout.
Simple measures include ibuprofen and ice (10 minutes every 4–6 hours). As the pain settles, daily activities such as walking, cycling, and swimming resume. We then stretch and strengthen the hip and pelvis, focusing on the muscles attached to the apophysis, before progressing to sport-specific training — jogging, then sprinting, change of direction, and full training.
When can I return to sport after hip apophysitis?
Return should be driven by what the teen can do, not a fixed timeframe — everyone heals at a different rate, and returning too soon risks recurrence. We suggest returning only once they have:
- Full hip range of motion
- Full strength
- Pain-free jogging
- Pain-free acceleration and deceleration
- Pain-free change of direction and figure-8 sprints
- Pain-free hopping and jumping
Avulsion fractures of the hip in teenagers
An avulsion fracture happens when the apophysis separates from the bone, pulled off rather than the tendon or muscle tearing (as happens in adults). Common sites are the rectus femoris, iliopsoas, and iliac crest. Teens describe sudden, sharp pain, often with a crack, usually during sprinting or kicking, and cannot continue. An X-ray shows the avulsed bone fragment.
How long does a hip avulsion fracture take to heal?
Treatment mirrors that for apophysitis, but return to sport takes longer — usually at least 3 months. Teens typically use crutches for 4–6 weeks, then build up weight-bearing and rehab over another six weeks. We treat avulsions with less than 2 cm of separation without surgery; those over 3 cm are usually operated on, and some between 2 and 3 cm are too.
Frequently asked questions about hip apophysitis.
What is the difference between hip apophysitis and an avulsion fracture?
Hip apophysitis is inflammation and swelling of the growth plate from repetitive traction. An avulsion fracture occurs when a sudden, forceful contraction pulls the apophysis off the bone. Apophysitis builds gradually; an avulsion is sudden, often with a crack and an inability to continue.
At what age does hip apophysitis occur?
Usually around 15–16, later than heel apophysitis (about 10) and knee apophysitis or Osgood-Schlatter (12–14). It reflects when the hip and pelvic growth plates are most vulnerable.
How long does hip apophysitis take to recover?
It varies with severity. Mild cases settle in a few weeks of relative rest and rehab; more severe cases take longer. Return is guided by function — full strength, range, and pain-free running and jumping — not a fixed date.
Can hip apophysitis come back?
Yes, especially if a teen returns to sport too early or ramps training up too fast. Meeting the return-to-sport criteria and gradually increasing load reduce the risk.
Final word from Sport Doctor London about hip apophysitis
Think of hip apophysitis in any active teen with hip pain — but don’t forget the other causes, including Perthes disease, slipped epiphysis, and labral tears. Accurate diagnosis and a function-led return to sport give the best result.
If your child is an active teen with hip pain, Dr Masci can assess them in London. Contact the team here or call +44 (0) 203 488 0350.
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