Hip Pain

When young people experience hip pain, it is often a symptom of an injury or underlying disorder.

Some conditions that cause hip pain can be treated with rest, ice, and physical therapy. Other conditions may require surgery. Whatever the cause, early treatment can have a long-term positive effect on the health and mobility of your child’s hip. Often, it can prevent the condition from becoming more severe.

Hip anatomy

To understand why hips can become painful, it helps to know a little bit about the hip joint and what it’s made of:

• Hip bones include the top of the thighbone (femur) and the pelvis. The ball-shaped structure called the femoral head and the socket portion (acetabulum) that is part of the pelvis form the hip joint.
• Muscles in the leg (quadriceps), buttocks (gluteus maximus and medius), and pelvis (psoas and piriformis) drive the motion of the leg and hip.
• Tendons, including the rectus femoris tendon, connect the muscles to the bones of the hip and support movement.
• Ligaments connect the bones of the pelvis to each other and the femur. This helps stabilize the joint.
• The labrum is at the edge of the hip socket and provides stability and shock absorption to the joint.
• Nerves, including the femoral nerve and sciatic nerve, carry messages to and from the brain, down the spine, to the hip and leg.
• Bursae are fluid-filled sacs that reduce friction between the bones and other moving parts of the hip.

Different people experience hip pain in different ways, depending on the underlying cause and its severity. Your child may experience one or more of the following:

• Pain that comes and goes and may become more frequent over time (possible sign of an overuse injury)
• Pain that comes on suddenly, possibly accompanied by a popping noise (possible sign of an acute injury)
• Pain that interferes with your child’s ability to participate in sports
• Pain in the groin or side of hip
• Pain in the buttock
• Stiffness in the groin or front of the thigh
• Tenderness around the hip
• Shooting pain or numbness
• Limping
• Bruising around the hip
• Difficulty moving the hip
• Inability to walk or stand

Hip pain in children, teens, and young adults may be caused by injury, a structural condition, disease, or an infection. If left untreated, hip pain can become worse and eventually lead to early arthritis. Therefore, it’s very important to have your child’s hip examined by a specialist who can diagnose the problem and treat it appropriately.

Hip injury

• Hip avulsion fracture, an overuse injury in which extreme or repeated physical exertion causes a piece of the growth plate to separate from the rest of the bone.
• Labral tear, a tear in the rubbery tissue (labrum) that normally cushions the edge of the hip joint.
• Hip fracture, an acute injury, usually caused by a car accident or extreme impact that breaks one or more bones of the hip.
• Slipped capital femoral epiphysis, damage to the growth plate at the upper end of the femur that causes the femoral head to slip off the top of the bone.
• Bursitis, inflammation of the fluid-filled bursae that cushion the hip joint.
• Iliotibial band (IT band) syndrome, an overuse injury in which the IT band that runs from the hip to the knee along the outside of the thigh becomes irritated and painful.
• Muscle strain, an injury to a muscle or tendon, also known as a pulled muscle.

Structural hip issues

• Hip dysplasia, a condition that occurs when the hip socket is too shallow, allowing the femoral head to slip fully or partially out of the socket.
• Hip impingement, also known as femoroacetabular impingement, a condition that occurs when the femoral head, hip socket, or both develop abnormally, creating friction between the bones.

Disease or infection

• Legg-Calve-Perthes disease, also known as Perthes disease, a degenerative condition in which the femoral head temporarily loses its blood supply, causing the bone to break down.
• Septic arthritis, an infection of the joint tissues and fluid (synovial fluid) that lubricates the joint. The infection usually reaches the joint through the blood stream, though joints can also become infected due to surgery or injury.

Hip pain in athletes

Athletes experience hip pain for a wide number of reasons. In basketball and soccer, for instance, the repeated impact of running, twisting, and rapid direction changes can strain athletes’ hips. Gymnastics and dance involve extreme positions that can also strain the hips.

Athletes tend to experience hip pain from hip dysplasia or hip impingement sooner than non-athletes due to the physical demands of their sport. (But playing sports does not cause these conditions.)

Whatever the cause, playing through hip pain typically leads to more pain and greater risk of long-term injury.

Proper treatment of hip pain starts with an accurate diagnosis.

Your child’s doctor will start with your child’s health history, including their age and medical history, when the pain started, how severe it is, what triggers it, and where it is located. They may also ask about the sports your child plays, how often they train and at what intensity, and any injuries they’ve had in the past.

For the physical exam, the doctor will test the range of motion of your child’s hip, palpate the muscles around the hip, and look at whether the hips are level when your child is standing. They may ask you child to sit, stand, walk, and run as part of the exam. They’ll also test the strength of the muscles in the hip.

Diagnosis of hip pain often includes imaging tests that help identify structural abnormalities like hip dysplasia. These tests may include an X-ray, MRI, CT scan, or ultrasound (sonogram).

Your child’s treatment for hip pain depends on the underlying cause.

Non-invasive treatment may include rest, ice, anti-inflammatory medication, and physical therapy. Some children need to wear a special brace or cast to hold the hip in place while it heals. More serious conditions, like hip dysplasia or Perthes disease, may require surgery.

While unplanned downtime from sports or physical activity may be unwelcome, it may be essential to slow or stop the progression of a serious hip condition so that your child can return to activity with a greatly reduced risk of hip problems in the future.

The Child and Young Adult Hip Preservation Program at Boston Children’s Hospital is at the forefront of research and innovation. Our multi-disciplinary team specializes in diagnosing causes of hip pain and providing non-surgical and surgical treatments to help children, adolescents, and young adults live healthy, active lives.

We have treated thousands of children with every level of complexity and severity of hip problem. Our hip specialists have pioneered minimally invasive procedures as well as open surgical techniques to help treat patients of all ages. While we always aim to provide the least invasive form of care, we perform more periacetabular osteotomy (PAO) procedures every year than any other hospital in the country, often in combination with arthroscopy (if indicated).

Our goal is the same as yours: to help your child get better so they can return to being healthy, active, and pain-free.