Iliac Apophysitis – 3 Important symptoms, causes, risk factors, prognosis, treatment

What is Iliac Apophysitis

• Iliac apophysitis is a condition that develops when one of the three growth plates (apophyses) of the large pelvic bone (ilium) becomes inflamed and causes hip pain. Growth plates are areas of cartilage that eventually harden into solid bone.
• Iliac apophysitis can happen when the muscles of the hips and abdomen forcefully pull at the site where they attach to the pelvic bone.
• As a result, repeated movements (overuse) can irritate the muscles and tendons, or one strong, sudden movement may cause the tendon to completely tear from the bone (avulsion).

What are the causes?

Some common causes of iliad apophysitis include:

1. Repetitive Overuse: Engaging in repetitive and intense physical activities, such as running, jumping, or kicking, can put significant stress on the muscles and tendons that attach to the pelvic bone. This repetitive stress can lead to inflammation and strain on the growth plate, causing apophysitis.
2. Rapid Growth: During periods of rapid growth, the bones may lengthen faster than the muscles and tendons can adapt. This imbalance can lead to increased tension at the attachment points and increase the risk of apophysitis.
3. Muscle Imbalance: Muscle imbalances or weaknesses in the muscles surrounding the pelvis can lead to uneven distribution of forces during movement. This can contribute to excessive stress on specific attachment points.
4. Sport-Specific Movements: Sports that involve sudden and forceful movements, such as sprinting or sudden changes in direction, can increase the risk of iliad apophysitis.
5. Incomplete Healing: If a previous injury or inflammation in the pelvic area is not allowed to fully heal before resuming intense physical activities, it can predispose an individual to iliad apophysitis.
6. Biomechanical Factors: Certain structural or biomechanical factors, such as leg length discrepancies or abnormal gait patterns, can contribute to increased stress on the pelvic attachments.
7. Poor Conditioning: Inadequate conditioning, lack of proper warm-up or stretching, and improper training techniques can increase the risk of pelvic apophysitis.
8. Age and Growth: Adolescents experiencing growth spurts are particularly susceptible to iliad apophysitis due to the changing dynamics between growing bones and developing muscles.

Iliac Apophysitis is caused by overuse or forceful movements of the muscles of the hips, pelvis, and trunk.

What increases the risk of Iliac Apophysitis?

This condition is more likely to develop in young athletes who participate in sports or activities that involve frequent lifting of the hip and leg or bending or twisting of the trunk. These include:

• Running.
• Dancing.
• Soccer.
• Gymnastics.

What are the symptoms of Iliac Apophysitis?

1. Dull pain in the hip or groin is the main symptom of this condition.
2. The pain may get worse over time or with activity.
3. The upper pelvic bones may also be painful to the touch (tenderness).

How is this diagnosed?

• Iliac Apophysitis is diagnosed based on your symptoms, medical history, and a physical exam.
• During the exam, your health care provider will check your hip for areas of tenderness.
• You may have X-rays to look at the bony structures or have an MRI to look at the muscles, tendons, and ligaments.

How is this treated?

Treatment for Iliac Apophysitis includes:

• Stopping all sports and activities until pain and other symptoms go away, then gradually returning to activities.
• Icing the painful area to ease swelling and pain.
• Taking anti-inflammatory medicine to reduce pain and swelling.
• Using crutches to support your weight as told by your health care provider, if walking or standing is painful.
• Doing exercises to strengthen the hip and abdominal muscles (physical therapy) when healing has started.

In rare cases, a serious avulsion may require surgery.

How is Iliac Apophysitis prevented?

• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Give your body time to rest between periods of activity.
• Work with a coach or trainer to ensure that you use proper technique during athletic activity.
• Include in a variety of activities in your workouts (cross-train).
• Maintain physical fitness, including:
  • Strength.
  • Flexibility.

Contact a health care provider if:

• You have sudden, new difficulty or pain when walking, standing, or sitting.
• You cannot walk normally or without a limp.

Follow these instructions at home:

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If directed, apply ice to the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Gradually return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Keep all follow-up visits as told by your health care provider. This is important.
• Use crutches as told by your health care provider, if this applies.

What research says about Iliac Apophysitis?

A Study conducted on adolescent runners to analyse the Iliac apophysitis and stress fractures. Twenty-one cases of overuse injury to the iliac crest apophysis is presented.

It can be a significant cause of disability to the adolescent middle and long distance runner.

All cases resolved with 4 to 6 weeks of rest.

What is the prognosis?

Here are some key points to consider regarding the prognosis of iliac apophysitis:

1. Self-limiting condition: Iliac apophysitis is typically a self-limiting condition, meaning that it tends to improve and resolve with time as the affected individual completes their growth and the growth plate matures.
2. Duration of symptoms: The duration of symptoms can vary from weeks to months. In most cases, with appropriate management and activity modification, symptoms gradually improve over time. However, it may take several months for the symptoms to completely resolve.
3. Treatment and activity modification: The prognosis can be improved with appropriate treatment and activity modification. This often involves a period of rest or reduced activity to allow the affected area to heal. Physical therapy may be recommended to help strengthen the surrounding muscles and improve flexibility. Pain management techniques, such as ice application or nonsteroidal anti-inflammatory drugs (NSAIDs), may also be used to alleviate symptoms.
4. Recurrence: While iliac apophysitis generally resolves with appropriate management, there is a potential for recurrence, especially if the affected individual returns to high-impact or repetitive activities too quickly or without proper rehabilitation.
5. Long-term implications: In most cases, once the growth plate has matured and the individual has completed their growth, the symptoms of iliac apophysitis resolve completely. However, in some instances, there may be residual pain or mild limitations in hip mobility. These long-term implications are relatively uncommon and tend to be minor.

It’s important to consult with a healthcare professional, such as a pediatrician, orthopedic specialist, or sports medicine specialist, for a proper diagnosis and management plan for iliac apophysitis.

They can provide personalized guidance based on the individual’s specific condition, age, activity level, and other relevant factors to ensure appropriate treatment and a favorable prognosis.

Iliac Apophysitis Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your hip and pelvis. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Quadriceps, prone

1. Lie on your abdomen on a firm surface, such as a bed or padded floor.
2. Bend your left / right knee and hold your ankle. If you cannot reach your ankle or pant leg, loop a belt around your foot and grab the belt instead.
3. Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your thigh and knee.
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise B: Prone press-ups (lumbar extension)

1. Lie on your abdomen on the floor.
2. Place your forearms next to you on the floor with your hands palm-down and near your head.
3. Keeping your back as relaxed as possible, slowly straighten your elbows while keeping your hips on the floor. Adjust your hands as needed to be comfortable.
4. Hold this position for __________ seconds.
5. Slowly return to the starting position.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise C: Lunge (hip flexors)

1. Kneel on the floor on your left / right knee. Bend your other knee so it is directly over your ankle.
2. Keep good posture with your head over your shoulders. Tuck your tailbone underneath you. This will prevent your back from arching too much.
3. You should feel a gentle stretch in the front of your thigh or hip. If you do not feel a stretch, slowly lunge forward with your chest up.
4. Hold this position for __________ seconds.
5. Slowly return to the starting position.

Repeat __________ times. Complete this stretch __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your abdominals and your core muscles. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise D: Pelvic tilt (deep abdominals)

1. Lie on your back on a firm bed or the floor.
2. Keeping your legs in front of you, bend your knees so they are both pointed toward the ceiling and your feet are flat on the floor.
3. Tense your lower abdominal muscles to press your lower back into the floor.
4. Hold this position for __________ seconds.
5. Relax your muscles slowly and completely.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Quadruped lift

1. Get on your hands and knees on a firm surface. If you are on a hard floor, you may want to use padding to cushion your knees, such as an exercise mat.
2. Line up your arms and legs. Your hands should be below your shoulders, and your knees should be below your hips.
3. Lift your right leg behind you. At the same time, raise your left arm and straighten it in front of you.
   1. Do not lift your leg higher than your hip.
   2. Do not lift your arm higher than your shoulder.
4. Keep your balance carefully while you keep your core muscles tight and your hips square to the ground. Do not hold your breath or arch your back.
5. Slowly return to the starting position.
6. Repeat with your left leg and your right arm.

Repeat __________ times. Complete this exercise __________ times a day.