An apophysis (not to be confused with apophysitis) is a growth plate that provides a point for a muscle to attach to the bone. Growth plates are made up of cartilage that is softer and more vulnerable to injury than mature bone.
When the muscle attached to the apophysis is excessively tight or overused, it can put increased tension and stress on the apophysis, which results in irritation and inflammation. This is called apophysitis.
There are several apophyses at the hip and pelvis that can be affected. Pelvic/hip apophysitis most commonly affects adolescents between 12 and 18 years of age.
Apophysitis is an overuse injury that typically occurs after repeatedly straining the muscles attached to the apophysis. Apophysitis of the pelvis/hip usually affects runners, sprinters, dancers, soccer players and ice hockey players. Adolescent athletes with excessively tight hip and thigh muscles are also prone to pelvis/hip apophysitis.
The apophyses most commonly affected are the anterior superior iliac spine (ASIS), the anterior inferior iliac spine (AIIS), the ishial tuberosity and the iliac crest. The muscles that attach to these apophyses flex and extend the hip and rotate and twist the pelvis and trunk. (See the diagram below.)
Apophysitis could be mistaken for a muscle string. Your doctor may order additional imaging such as an x-ray to determine whether there has been widening, irregularity, or fracture of the apophysis in addition to reviewing your symptoms and examining the injured area.
Your doctor will recommend rest from any activities that irritate the apophysis until the pain and tenderness go away. Anti-inflammatory medicine such as ibuprofen or Aleve can also help with pain. It may take as long as two to three months for the pain to resolve and the apophysis to heal.
Once your athlete is pain-free with daily activities and the x-rays look normal, a gradual return to activities is recommended. Stretching and gently strengthening the muscles that attach to the affected apophysis can also assist with healing.
The goal is to return your child to playing sports as quickly and safely as possible. If a patient returns to physical activity too soon, the injury may return with worse severity. This could lead to chronic pain and difficulty playing sports. In general, the longer you have symptoms before starting treatment, the longer it will take to get better.
Keep in mind that everyone recovers at a different rate. In some cases, it can take up to 3 months for a patient to finish healing. Safely returning to sport occurs when full range of motion and strength have returned in addition to their radiographs displaying a complete healing of the apophysis.
Apophysitis can be prevented if the athlete performs proper warm-up exercises before starting any activity. If there are any tight muscle groups, stretching the area is recommended.
If there is any pain, keep the athlete from playing. Pain is a sign of injury, stress, or overuse and should not be ignored. Rest is required for the injured area to heal. If the pain does not resolve after a couple days of rest, consult your physician.
