Adolescent hip pain is common due to the combination of rapid growth phases and increasingly active lifestyles, which places stress on developing bones and soft tissues. Diagnosis can be challenging because pain originating in the hip frequently refers, or travels, to the thigh or knee, rather than pointing directly to the joint itself. While many causes of hip discomfort are minor, ranging from simple muscle strains to overuse injuries, some require prompt medical attention to prevent long-term damage.
Common Overuse and Soft Tissue Injuries
The majority of hip pain in active teenagers results from repetitive microtrauma to muscles, tendons, and fluid-filled sacs around the joint. These soft tissue injuries are typically manageable and resolve with activity modification and rest. Hip flexor strains are common, especially in sports like soccer, track, and dance, where sudden movements and sprinting are frequent actions responsible for lifting the knee toward the chest.
Tendinitis is another frequent cause of pain in this age group, often affecting the iliopsoas tendon deep in the groin area. Repetitive hip flexion and rotation can irritate this tendon, leading to a dull ache that worsens with activity. Trochanteric bursitis, involving inflammation of the bursa on the outside of the hip, typically causes pain when lying on the affected side or after prolonged periods of walking or running.
Some teens also experience snapping hip syndrome, which is characterized by an audible or palpable snapping sensation around the hip joint. This is usually caused by a tight iliotibial (IT) band or a hip flexor tendon sliding over the bony structures of the hip or pelvis. These soft tissue conditions generally improve with a temporary reduction in physical activity, the application of ice, and targeted physical therapy to improve flexibility and strength.
Conditions Involving the Growth Plate
Hip pain in a growing adolescent must always be evaluated for conditions involving the growth plate. The primary concern is Slipped Capital Femoral Epiphysis (SCFE), where the head of the femur slips backward and downward off the neck of the bone. SCFE requires urgent treatment to prevent long-term complications, such as avascular necrosis, which is the death of bone tissue due to loss of blood supply.
SCFE is most prevalent in adolescents between the ages of 11 and 16, particularly during periods of rapid growth, and obesity is a significant risk factor. The symptoms can be subtle and may include a limp, an inability to bear full weight on the leg, or pain felt not in the hip, but exclusively in the knee or thigh. In severe, unstable cases, the leg may visibly turn outward, and the teen will be unable to walk.
A less severe, but still growth-related, issue is apophysitis, which is an inflammation where large tendons attach to the growing bone. Apophyses are specialized growth plates vulnerable to overuse injuries from repetitive pulling, such as sprinting or jumping. Common sites include the iliac crest and the anterior superior iliac spine (ASIS), where the hip and abdominal muscles attach, causing localized tenderness.
Apophysitis causes a dull pain that worsens with activity, and it is frequently mistaken for a muscle strain because of the location of the pain. Unlike SCFE, apophysitis is self-limiting and resolves once the growth plate fully fuses, typically requiring only rest, ice, and temporary activity modification for management.
Structural Issues Within the Hip Joint
Chronic hip pain in teens can stem from mechanical problems related to the shape of the hip’s ball-and-socket joint, often referred to as structural issues. Femoroacetabular Impingement (FAI), or hip impingement, occurs when there is an abnormal shape to the ball or the socket, causing the bones to rub against each other during movement. This abnormal contact over time can damage the cartilage and the labrum within the joint.
Teens with FAI often report a deep pain in the groin, especially when sitting for long periods or performing actions involving deep hip flexion, such as squatting. The condition is a recognized precursor to the early onset of hip arthritis if left unaddressed. The repetitive pinching from FAI can lead to a labral tear, which is damage to the ring of cartilage that lines the rim of the hip socket.
The labrum helps to seal the joint and provide stability. A tear can cause symptoms such as catching, locking, or a persistent ache deep within the joint. Diagnosis of FAI and labral tears often requires imaging like X-rays to assess bone shape and Magnetic Resonance Imaging (MRI) to visualize the soft tissue structures.
When to Seek Professional Medical Evaluation
While many cases of adolescent hip pain are minor, certain signs warrant immediate medical evaluation to rule out serious conditions. These “red flag” symptoms include a sudden onset of severe pain, particularly if it occurred without trauma, or an inability to bear any weight on the affected leg. Pain that is intense enough to wake the teen from sleep, or pain accompanied by a fever, requires urgent assessment by a physician.
Pain that radiates down to the knee without any knee symptoms should also prompt a medical visit, as this is a common presentation for serious hip problems like SCFE. If hip pain persists for more than two weeks despite a period of rest and activity modification, a medical professional should be consulted. The diagnostic process begins with a thorough physical examination and typically includes plain X-rays of the hip and pelvis to assess the bony anatomy and growth plates.
If the initial evaluation is inconclusive, advanced imaging such as an MRI may be ordered to visualize soft tissue injuries or early signs of bone damage. Timely and accurate diagnosis is necessary to prevent long-term complications, especially with growth plate disorders, and help preserve hip joint function into adulthood.