An apophysis is a growth plate that provides a point for a muscle to attach. Growth plates are made up of cartilage cells, which are softer and more vulnerable to injury than mature bone. When the muscle attached to the apophysis is excessively tight or overworked, it can put increased tension and stress on the apophysis, which results in irritation and inflammation, a condition called apophysitis. There are several apophyses at the hip and pelvis that can be affected. Pelvic/hip apophysitis most commonly affects adolescents between 14 and 18 years of age.
Apophysitis is an overuse injury that typically occurs after repetitive activities of the muscles attached to the apophysis. Adolescents with excessively tight hip and thigh muscles are more prone to pelvis/hip apophysitis. The apophyses most commonly affected are the anterior superior iliac spine (ASIS), the anterior inferior iliac spine (AIIS), and the iliac crest. The muscles that attach to these apophyses flex the hip and rotate and twist the pelvis and trunk. Apophysitis of the pelvis/hip usually affects runners, sprinters, dancers, soccer players and ice hockey players.
You may have dull pain in the groin or the front or side of your hip that worsens with activity. There will be tenderness over the injury site and sometimes some swelling. Apophysitis may be mistaken for a muscle strain.
Your doctor will review your symptoms and examine the injured area. Your doctor may order an x-ray to determine whether there has been a fracture to the apophysis.
Your doctor will recommend rest from irritating activities until the pain and tenderness go away. Ice should be applied to the painful area for 15-20 minutes as often as every 2-3 hours until the pain goes away. Once you can tolerate daily activities without pain, you can start gently stretching and strengthening the muscles that attach to the affected apophysis (the hip flexors and abdominal muscles). Once your flexibility and strength have improved, you can start sport-specific activities such as jogging and gradually progress to full activity.
The goal is to return you to your sport or activity as quickly and safely as possible. If you return to activities too soon or play with pain, the injury may worsen. This could lead to chronic pain and difficulty with sports. Everyone recovers from injury at a different rate. Return to your sport or activity will be determined by how soon your injured area recovers, not by how many days or weeks it has been since the injury occurred. In general, the longer you have symptoms before starting treatment the longer it will take to get better. You may return safely to your sport or activity when each of the following is true (Begin at the top of the list and progress to the bottom):
