Halfway into the 2nd decade of the 21st century, it seems that the pace of nearly everything has accelerated. Although there is a movement that seems to be focusing on slowing down and living more deliberately, in many places, the tick is constantly upwards.

This has resulted in some extraordinary advances in culture and society, however a negative result is that our young people are increasingly pushed to achieve more at an earlier age. For some, this push is primarily in athletics. Following in the footsteps of Tiger Woods and the Williams sisters, young people are pushing their bodies at an accelerated pace, with sometimes disastrous results.

Young, growing bodies need healing time as much as they need activity, but this increase in year-round competitive sports has produced a new phenomenon: hip pain in adolescents.

Unfortunately, hip pain in adolescents can be difficult to diagnose. Many will hide their pain or ignore it, believing that it is simply the price of being a year-round athlete (or avoiding the appointment since they’re worried that there is something seriously wrong). Others may make their way to the doctor’s office, only to be told that a few days of rest will solve the problem. Often, these patients can continue to suffer with symptoms and end up with a total hip replacement in their 30s or 40s, and then again in their 60s or 70s when that hip wears out. Traditionally, young patients were told to rest or take time off from their sport and use over-the-counter (OTC) anti-inflammatory medicines to help with the pain.

There are other causes of hip pain in adolescents, but a major culprit seems to be year-round athletics.

When young people play a competitive sport year round, not allowing the body to rest, growing joints and bones have trouble forming properly. The constant activity and repetitive motion can cause injuries and damage so severe that surgery may be called for.

Puberty is the time when the hip growth plate fuses.  When teens are excessively active in a particular sport, there is the possibility that the ball of the femur be damaged or distorted and may not fit perfectly into the hip socket. This can be caused by other things–a bone that is naturally misshapen, bone spurs, or excessive cartilage that effectively seals the socket and prevents the femur from resting in it–but the vast majority of hip pain in adolescents is caused by high levels of activity, with a singular focus on 1 type of activity.

This condition of the femur not resting comfortably in the socket of the hip is called femoral acetabular impingement (FAI), and the resulting hip pain can be excruciating and debilitating. Other symptoms of FAI include pain in the lower back and groin. The symptoms can be misleading and are often misdiagnosed as bursitis, generic back pain, stress on the hip flexor, and endometriosis in women. If this condition is ignored, it can become very serious, resulting in arthritis and the need for either partial or total hip replacement. Some people who experience FAI have an underlying condition such as osteoarthritis or a deformity in the hip structure that can exacerbate the hip pain.

Surgery is 1 way to address FAI, especially more advanced cases when the hip pain makes everyday activities difficult.

John C. Clohisy and his colleague Perry L. Schoenecker, MD, professors of orthopaedic surgery at Washinton University St. Lewis School of Medicine created a surgical technique called the Bernese Per-Acetabular Osteotomy that is used to completely alter the hip joint’s structure. In this surgery, doctors will take 2 to 4 hours to cut into the hip bones, repositioning them to correct the ill-fitting femur bone. Patients do not need a cast for recovery but will be in the hospital for a few days after surgery and require crutches for several weeks after the operation.

Only young, healthy patients are recommended for Bernese Per-Acetabular Osteotomy. Obese or elderly patients may not have the same success rate and may want to investigate other treatment options.

A total hip replacement is difficult to prescribe in adolescent patients because it is highly likely that they will need another surgery later. Artificial hips wear out, just as regular hips do. Clohisy writes:

“For patients in the 15 to 50 age group, a hip replacement is sub-optimal due to activity restrictions and the fact that the synthetic hip joint is going to wear out with time. A patient who gets a hip replacement at a very young age may require multiple hip surgeries over the course of his or her lifetime.”

A potentially better approach to surgical treatment is hip debridement which trims and smoothes the bones around the hip socket to allow the femur to rest comfortably. This can offer significant pain relief and is a relatively common surgery for hip pain in adolescents, but also patients of any age. Recovery time is minimal, and with other supportive treatments and exercise, may effectively solve the problem. This is not possible for all conditions causing hip pan, but it can be a good option when a rest-and-see approach offers minimal relief.

Contrary to the rest-and-see method, many doctors advocate more activity–in another sport.

Cross-training can be an effective way to condition the body of the year-round athlete to prevent hip pain in adolescents, building up the muscles in the core and the legs to support the bones as they grow and the muscles as they strengthen. Early detection of FAI is key, though.

If your teen suffers from pain, check out GrowingPains.org, a site dedicated to helping adolescents living with pain.

Image by Chris Hunkeler via Flickr


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