Hip Pain in a Young Athlete: When Is It More Than Just a Sore Muscle?

Hip and groin pain in young athletes can be confusing.

A teenager may come home from soccer, basketball, dance, gymnastics, track or another sport and say:

“My hip hurts.”

Sometimes it really is a minor muscle strain that settles down with a little rest.

But in a growing athlete, hip pain deserves attention—especially when it persists, changes the way the athlete runs or walks, or keeps returning.

Why hip pain is different in growing athletes

Children and teenagers are not simply smaller adults.

Their bones are still developing, and areas where muscles and tendons attach to growing bone can be vulnerable to injury.

That means pain that sounds like a “pulled muscle” can occasionally involve a growth-related injury or an avulsion injury, where a forceful muscle contraction pulls on the area where the tendon attaches to bone.

These injuries can occur during explosive activities such as:

• Sprinting

• Kicking

• Jumping

• Cutting or changing direction

• Forceful stretching

This is one reason I don't love the idea of repeatedly telling a young athlete to simply “stretch it out” when hip or groin pain isn't improving.

Where does it hurt?

The location of the pain can provide useful clues.

Front of the hip or groin: This can be associated with hip flexor irritation, adductor injuries, growth-related injuries, or problems involving the hip joint itself.

Side of the hip: Pain here may involve muscles and tendons around the outside of the hip.

Back of the hip or buttock: This may involve the hamstrings, surrounding muscles, the pelvis, or occasionally referred pain from another area.

Location alone doesn't diagnose the problem, but it is useful information to give your physician or physical therapist.

One question I always want to know: How did it start?

There is a big difference between:

“It gradually started bothering me after practice.”

and

“I sprinted for the ball, felt a pop, and immediately couldn't run.”

A sudden pop or sharp pain during sprinting, kicking or jumping—particularly in an adolescent athlete—deserves more attention.

When should a young athlete be evaluated?

Consider having the athlete evaluated when there is:

• Significant pain or pain that isn't improving

• A limp

• Difficulty bearing weight

• Pain that repeatedly returns with sports

• Loss of hip motion

• Pain with running, jumping or kicking

• A sudden pop followed by pain

• Noticeable weakness

• Pain that wakes the athlete at night

• Inability to return to normal activity

Severe pain, inability to bear weight, significant trauma, fever or an obviously abnormal-looking hip/leg warrants prompt medical evaluation.

Does every athlete with hip pain need an MRI?

No.

A good evaluation starts with the history and physical examination.

Depending on the athlete's age, symptoms, mechanism of injury and examination, a physician may recommend an X-ray or other imaging. MRI can be extremely useful in certain situations, but imaging shouldn't replace a good clinical examination.

What about physical therapy?

Physical therapy can be very helpful for many musculoskeletal causes of hip pain.

Treatment may address mobility, strength, balance, movement mechanics and a gradual return to sport.

But the first goal isn't simply to make the athlete stronger.

The first goal is to understand what we're treating.

If something about the history or examination doesn't fit a routine muscle injury, the appropriate next step may be referral back to a physician or orthopedic specialist.

Don't rush the return to sports

Feeling better walking around the house isn't the same thing as being ready for competition.

Before returning to sport, an athlete may need to tolerate progressively more demanding activities such as running, accelerating, decelerating, jumping, cutting and sport-specific movements without recurrence of symptoms.

The exact progression depends on the diagnosis and the athlete.

The takeaway

Most hip pain in young athletes does not mean something catastrophic is wrong.

But persistent hip or groin pain shouldn't simply become something an athlete learns to play through.

When you're unsure, the question doesn't have to be:

“Is this serious?”

A better first question is:

“Who should evaluate this, and what do we need to rule out?”

That is often the best place to start.

— Dr. Michelle Starks, DPTThe Ortho DPT

Clear orthopedic guidance when you don't know where to start.

General educational information only; not individualized medical advice.

Young athletes with new or persistent symptoms should be evaluated by an appropriate healthcare professional.