Apophysitis of the Hip
The skeletal system of children is unique and makes them more susceptible than adults to certain types of injuries. One example is the presence of apophyses on certain bones.
What is an Apophysis?
An apophysis is an area of growth cartilage found throughout a child's body and serves as an attachment site for muscles and their tendons. When your child is diagnosed with apophysitis it means they have an irritation of this area of growth cartilage. It typically occurs in athletes as a consequence of repetitive use.
What happens in Apophysitis?
With apophysitis, there is a repetitive pulling of the muscle on the bone at its insertion site. This results in irritation and the growth cartilage partially pulls away from where it anchors into the bone.
There are several apophyses that are located in the hip and pelvic region. Some of the more commonly injured apophyses include:
- Iliac crest
- Ischial tuberosity
- Lesser trochanter
Apophysitis in the knee and foot are relatively common as well. The onset of pain typically coincides to the development of the bone. Other areas of apophysitis include:
- Bottom of Knee Cap: Sinding-Larsen-Johansson Syndrome (SLJ)
- Just below knee at Tibial Tuberosity: Osgood-Schlatter Disease (OSD)
- Bottom of Heel: Sever's Apophysitis
Hip and Pelvis Apophysitis
Apophysitis of the Ischial Tuberosity
The ischial tuberosity is the portion of the pelvis bone that one sits on. The hamstring muscles originate in this area. Hamstring muscles function to extend the hip backwards. Similar to the ASIS location, avulsion fractures are more common at this location than apophyseal overuse pains.
Apophysitis of the ASIS
The anterior superior iliac spine (ASIS) is located on the front part of the pelvis bone. It can be felt as a large prominence just underneath the iliac crest, and roughly in line with the kneecap. The sartorius muscle originates at the ASIS and functions to bend the hip up (flex). When this muscle is repetitively stretched in extension, an ASIS apophysitis may develop. It is more common to experience an avulsion fracture in this location.
The iliac apophysis is located on the iliac crest on the upper pelvis. Muscles of the back, abdomen, and sides of the trunk connect onto this iliac apophysis. Athletes who participate in activities that involve repetitive twisting and bending of the trunk, such as a long distance runner, are at risk of developing iliac apophysitis. Symptoms of iliac apophysitis include pain and tenderness over the iliac crest. X-rays are typically normal. Treatment is similar apophysitis injuries – rest, avoidance of painful activities, application of ice, and use of anti-inflammatory medications (such as motrin or ibuprofen). Your physician may also prescribe physical therapy to help with recovery.
This reprents another area at risk for injury. This is a prominence located on the top inside portion of the femur bone. A strong muscle named the iliopsoas inserts on this bony prominence. The iliopsoas is the most powerful flexor of the hip. Apophysitis of the lesser trochanter may occur during activities such as kicking, sprinting, and jumping, when the muscle is repeatedly stretched beyond its limits. Symptoms of an apophysitis of the lesser trochanter include pain in the groin and difficulty walking or bending at the hip when seated.
What You Need To Know As A Parent
If you think your child is suffering from Apophysitis, the first step is getting diagnosed. Schedule an appointment with Children's Orthopaedics of Atlanta today and we can help educate you on your child's options as they get treatment for Apophysitis.