Early treatment of chronic hip pain in young athletes may have long term impact on health

Treating young athletes with chronic hip pain may be the key to slowing or halting the progression of degenerative hip disease.

Recently, increased understanding of hip structural abnormalities has allowed specialists to better identify underlying hip conditions that previously went unrecognized and to more accurately diagnose hip problems in children, teens and young adults.

"Adolescent hip pain often strikes young athletes with structural abnormalities sooner than their less active counterparts, due to the stress their level of activity places on the hip," said Ernest L. Sink, M.D., co-director of the Center for Hip Preservation at Hospital for Special Surgery in New York City. Dr. Sink is also a member of the HSS Pediatric Orthopedic Service. His practice focuses on hip disorders and dysplasia in infants, children, adolescents and young adults.

"Any persistent hip pain in adolescents and young adults isn't normal and should be evaluated with an x-ray and physical exam to make sure there's no underlying structural problem that needs treatment," Dr. Sink recommended.

In a recent online interview on the subject of adolescents and children with hip pain, Dr. Sink hoped to help patients, parents, coaches, physicians, and others to better understand the implications of chronic hip pain and its role in hip disease. This interview with Dr. Sink is available on the Center for Hip Preservation at Hospital for Special Surgery website (www.hss.edu/hippain). Formed in 2009, the Center provides individuals experiencing hip pain with proper diagnosis and treatment through innovative diagnostic imaging techniques, a full complement of non-operative and surgical approaches, and less invasive surgical procedures including arthroscopic surgery.

Increasingly, early treatment of chronic hip pain in young athletes and performers may have a long term impact on the health and mobility of the hip. With improved imaging techniques and a careful physical evaluation, it is simpler to diagnose some of the more subtle problems that cause hip pain. These more accurate diagnostic capabilities combined with improved treatments make it possible for hip specialists to slow or halt the progression of degenerative hip disease, return patients to their chosen activities, and sometimes reduce the need for more extensive surgeries.

"An occasional ache in the groin or hip may not be something about which a parent or young athlete should be concerned," explained Dr. Sink. "But, chronic pain that does not improve should be evaluated by a surgeon who sees hip problems on a day-to-day basis." Such hip pain occurs in young women and young men who place stress on their hips with sports (especially in dancers, hurdlers or baseball catchers) because these individuals' activities involve the hip moving beyond its normal constraints.

With more than 44 million children and adolescents participating in sports nationwide, it's important for parents, coaches and dance instructors to know what to look for in young athletes and performers who may be at risk:

•An adolescent with chronic hip or groin pain that is interfering with their sports or performing.

•A history of hip problems in the family.

•Risk factors for hip dysplasia found by a pediatrician that previously had not caused symptoms. Hip dysplasia can remain silent for many years and manifest itself via hip pain during adolescence.

•The difference between growing pains and chronic hip pain. Growing pains usually occur in children under the age of 10 and take the form of pain in the legs, knee and hips at night after a day of activity. The following day, however, the child is usually up and active. Chronic hip pain prevents a child from participating in activities at their usual level of intensity.

"I always tell my patients that it's important to conserve the hip and to manage an underlying structural problem early, before it gets too late," explained Dr. Sink, who studied hip surgery techniques under the world-renowned Reinhold Ganz, M.D., at the University of Berne in Switzerland.

Dr. Sink performs a range of hip surgical procedures, including hip osteotomy, Ganz or periacetabular osteotomy (PAO) and surgical hip dislocation. Conditions for which young patients are commonly referred to Dr. Sink include hip dysplasia in all ages including developmental dysplasia of the hip (DDH), labral tears, femoroacetabular impingement, Perthes disease and slipped capital femoral epiphysis (SCFE).

"Sometimes if too much time goes by and a patient is living with this pain on an ongoing basis, when they finally do come to us, we look at the radiograph and it's too late to do anything effective," Dr. Sink continued. "Through education of other physicians, parents, coaches and instructors about what to look for, hip conditions can be managed with effective treatments specific to a patient's particular problem."