Hip pain in young athletes: Q&A with a sports medicine specialist

hip pain thriving runner mininder kocher

When your child plays a sport, it’s often hard to tell where everyday aches and pains end and a potentially serious injury begins. Bumps and bruises are anything but rare in contact sports, and muscle soreness can be a common complaint for any young athlete — especially given the rigor of youth athletics these days. So how do you know when your child’s hip pain is due to an actual injury?

Dr. Mininder Kocher, orthopedic surgeon and Associate Director of the Sports Medicine Division at Boston Children’s Hospital, helps answer parents’ questions about hip pain in young athletes.

What are some of the more common hip injuries you see in young athletes?

The hip is a complex joint, so we see many types of injuries, both outside and inside the joint. Some of the injuries outside the joint are more minor, like muscle strains, tendinitis, or bursitis.

Then we have problems inside the joint that can cause hip pain, like a labral tear — which is when the cartilage on the outside rim of your hip socket is torn. The labrum is typically torn in the front of the hip, usually from repetitive overuse. Labral tears are often associated with underlying anatomical issues, such as hip impingement and hip dysplasia.

Hip impingement is when either one or both of the bones in the hip joint is deformed, causing damaging friction inside the joint.
Hip dysplasia occurs when the hip socket doesn’t properly cover the ball of the femur, so increased pressure is put on the outside of the labrum.

The exponential growth in the number of patients we’ve seen with labral tears is almost epidemic — in part because kids are playing highly competitive sports at a younger and younger age while also focusing more on a single sport. I’ve done over 1,700 hip arthroscopies, and most of those are for patients with labral tears.

Are there any hip injuries that tend to be associated with certain sports?

Each sport has a unique stress on the joint and unique injury patterns. For hip injuries, it’s common to see hockey players with labral tears and impingement. Hockey goalies especially are a unique set of patients that are constantly in a butterfly position that puts stress on the hip.

We see a lot of overuse injuries from high hip demand in performance sports like dance, figure skating and gymnastics. This often occurs in females that have some loose-jointedness and underlying hip dysplasia, so that’s a unique pattern that we’ve noticed.

We’ll see other groups as well. In fact, we’ve published papers on rowers and field hockey players who get labral tears. Rowers get into a hyper-flex position and then push off, putting stress on their hips. Field hockey players often bend at the hip when they’re sprinting, effectively getting even more flexion in their hip.

What are some common concerns parents have when their child suffers a hip injury?

Parents’ concerns usually start with wanting to make sure their child gets the right diagnosis. Many of my patients have had hip pain for a while, and have been treated for various things. The key to hip injuries is quickly getting to the right diagnosis, which comes from multiple sources: history, physical exam, and imaging. Then from the right diagnosis comes treatment.

When it comes to surgical treatment, families are often concerned about getting the child back to sports and activities. That’s important to us as well in Sports Medicine, but we’re also thinking about the long-term health of the hip.

Hip pain is not normal. So if your child has hip pain, you should seek medical attention and not encourage playing through it, as that can often make the injury worse.

I do occasionally see patients with labral tears or impingement that already have early arthritis of the hip. In those patients, we can fix the hip — but going back to a high impact sport is not going to be the best for the hip in the long term, and those can sometimes be difficult conversations.

What can young athletes and parents of young athletes do to minimize the risk of hip injuries?

For the hip, understanding injury prevention is in the earlier stages of development.

It’s important to look for intrinsic risk factors in a young athlete that could lead to a hip injury. Some of the areas we focus on are tightness of muscles, posture of the hips, tilt of the pelvis and weakness of the gluteus medius. Kids who are stiffer and lack flexion or internal rotation of the hip are at increased risk for impingement and labral tears. To better prevent these injuries from occurring, they need to build their flexibility.

Playing the same sport year-round, especially a high-risk hip sport, also increases the risk of hip injuries. Cross-training or playing multiple sports helps give the hip a break and focus on different sets of movements, which will ultimately be beneficial to the athlete.

What type of care is provided for a young athlete with a hip injury at Boston Children’s?

Managing young athletes with hip pain and hip conditions really requires a comprehensive center that has multiple modalities of treatment, and between the Sports Medicine Division and our Child & Young Adult Hip Preservation Program, that’s what we have here.

Our treatments can be non-surgical, such as specialized physical therapy. We also do a lot of corticosteroid injections under ultrasound guidance, which is an excellent way of injecting to the appropriate spot without any more radiation exposure, and it helps us see pathology dynamically.

We offer minimally invasive surgical treatments, such as arthroscopic labral repair, treating femoracetabular impingement, loose bodies, and cartilage and ligament injuries. And finally, we have open surgical treatments, such as surgical dislocations or osteotomies where we cut the bone and realign structurally.

At Boston Children’s, we have a comprehensive approach and can provide a range of treatment options to care for each patient individually and effectively.

Learn more about our Sports Medicine Division and Child & Young Adult Hip Preservation Program