PPC LAB INJURY – by Dr. Chad Peters
Why Young Athletes Get Front Hip Pain
And why you need to handle it differently than a classic sprain/strain
Keighly was a freshman who made the varsity track team.
She was running the 100, the 200, and a couple relays. Her speed was starting to show up in a real way. You could see it in races. She was closing late, pulling away from girls she used to run even with, and beginning to separate herself.
This is usually the phase where everything starts to click. Confidence goes up, times drop, and the workload quietly increases with it.
Then the pain started.
It was right in the very front of the hip. Not deep and not vague. Very specific. Right along the front edge of the pelvis, what most people think of as the “wings” of the hips. Even her jeans seemed to hit that exact spot and irritate it.
Sitting in class bothered it. Getting up after sitting was worse. Warmups felt stiff.
Strangely, practice itself often made it feel better. Once she got moving, things loosened up and the pain would settle down.
But the drive home was different.
That’s when it would light up. Sometimes sharp, sometimes a deep ache, but always worse than it should have been. More importantly, it wasn’t trending in the right direction.
It was getting worse.
The First Miss
At first, everyone thought it was tight hip flexors and treated it that way. Stretching, deep tissue work, all the usual tools.
It didn’t help. If anything, it made it worse.
Her mother decided to get it checked out.
After a quick evaluation, her pediatrician ordered X-rays. They were looking for the bigger problems. A fracture and/or avulsion injury, (where a tendon actually pulls a piece of bone away.) In an athlete like this, that risk is real because of the growth plate.
The films came back clean.
Nothing there. You’re fine.
Cleared for athletics.
And That’s Where It Goes Wrong
Because she wasn’t fine.
What This Actually Is
This is not a muscle strain. It is not just tight hip flexors.
This is a bony stress reaction at the ASIS, Iliac Crest, AIIS, and the hip bone itself, the trochanter. Commonly, the front edge of the pelvis where key muscles attach.
In a young athlete, that area is not a fully hardened anchor point yet. What is one gigantic and solid piece as an adult, is a multi pieced, growing, and very alive area in younger populations (often into college!) This area is still developing, still adapting, and still more vulnerable than the rest of the system.
When force is applied over and over through sprinting, jumping, and explosive work, the system does not fail at the muscle.
It fails at the point where the muscle and tendon attaches to the bone.
The muscle is doing its job. The tendon is doing its job. The bone is the weak link.
That is where the pain comes from.
The Growth Phase Problem
Kids do not grow in a smooth, steady line. They grow in phases.
During certain phases, muscles get stronger and more efficient. Tendons transfer force well. But the bone has not fully caught up yet.
That mismatch matters.
You end up with a strong pull and efficient force transfer being directed into an immature anchor point. Over time, that creates irritation right at the bone.
You’ve Seen This Before, Just Somewhere Else
This pattern is not new. We just give it different names depending on where it shows up.
- Osgood-Schlatter disease at the knee
- Sever’s disease at the heel
- Spondylolysis in the low back
Same concept. Different location. Despite the names, these are not diseases but syndromes, sequences, and…there’s a lot going on.
These are all traction-based stress reactions at immature bone.
So Why Didn’t It Show Up?
Because imaging is designed to pick up structural damage.
These issues can get bad enough to show up, but more often they start before there is enough structural change to be seen on X-ray, MRI, or CT. At most, you might see inflammation. Often, you see nothing.
This is what we call subclinical.
The process is happening even if the picture looks normal.
If You Wait for It to Show Up
If you wait until imaging clearly shows something, you are no longer dealing with a stress reaction.
Now you are dealing with a stress fracture or an avulsion injury.
That is exactly what we are trying to avoid.
Why Practice Felt Better, But Wasn’t
This is where people get fooled.
Movement can temporarily reduce pain. Warm tissue moves better and the nervous system will quiet things down once activity starts.
So it feels like it is improving.
What is actually happening is the athlete is continuing to load an irritated structure that has not adapted yet. Once things cool down, the pain returns, often worse than before.
That pattern matters.
What Not To Do
This is where well-meaning plans miss.
Treating this like a soft tissue strain, aggressively stretching it, pushing sprint volume, or ignoring localized bony tenderness will almost always make it worse.
That is how a manageable problem turns into a bigger one.
The PPC Lab Approach
This is not an automatic shutdown injury, but it is absolutely a management problem.
The goal is not to guess and not to wait. The goal is to control the environment so the athlete can keep moving forward without pushing the system over the edge.
1. Reduce the Load Without Deconditioning
Sprint volume needs to be adjusted. High-force starts and aggressive cutting may need to be limited.
At the same time, the athlete should continue to move. This is not about shutting them down. It is about guiding what they are doing.
Think of it like a pitch count in baseball. There is an optimal window of output. Doing nothing is too little. Pushing too far re-aggravates the issue.
Find that middle ground.
2. Respect the Bone
At the end of the day, this is a bone issue, and more specifically a growth plate issue.
That means timelines are less reliable and pain scales are not always helpful.
You are dealing with a developing structure under stress. That changes how aggressive you can be and how quickly you progress.
3. Clean Up the Pattern
This is where good help matters.
A practitioner, an athletic trainer, a coach who pays attention, or ideally a combination of all three. Add in an athlete who understands what is happening, and decision making improves significantly.
The athlete will always know more about how it feels day to day than anyone else.
That matters.
4. Build Back With a Plan
This is not linear.
It may vary day to day. You find the edge of irritation and stay just under it. If you cross that line too often, the body will force the issue.
There is a better plan than “rest for two weeks” or “push through it.”
The best plan is adaptable.
Coach / Parent Quick Guide
What do we actually do?
I get it.
I’m a parent of growing athletes. I’m a sports-based doctor and I coach. I live right in the middle of this.
The question is always the same.
What do we do?
the easiest approach is Shut it down. Wait. Hope.
Clinically, I can do better than that.
This is not black and white. It is not as simple as “I feel fine,” and it is not always best to shut it down for six to eight weeks, even though that is common. Instead of fighting the gray, accept it.
This type of issue requires management. It is a day-to-day process that involves paying attention, making small adjustments, and responding to what the athlete is showing you.
Better understanding leads to less fear. Less fear leads to better decisions. Better decisions lead to better outcomes.
What You Should Be Watching
Pay attention to how the athlete responds.
Look at pain during and after activity. Watch how they walk. Watch how they move. See if they are protecting the area or moving normally.
Compare today to yesterday.
That matters more than the calendar.
How Decisions Should Be Made
Not by timeline.
You test. You observe. You adjust.
Some days you move forward. Some days you pull back. Sometimes you may need a week or more complete shutdown period to calm things down.
That is part of the process.
Return to Play Matters
As speed and explosive work are added back in, there needs to be a clear progression.
Not guesswork. Not just going by feel.
A plan.
The Takeaway
Nothing showed up does not mean nothing is wrong.
It often means you caught it early enough to do something about it.
And with young athletes, early is exactly where you want to be.
Keighly’s Outcome
Keighly managed her “superior iliac crest stress” issue remarkably well.
There were ups and downs throughout the season. Pain would flare at times, and there were moments of regression, but she missed very few meets. Her practice volume was lower than her teammates, but it was still productive.
It was a challenging year. Frustrating at times.
But by the district meet, she was moving well again. Smooth. Fast. Confident.
She qualified for the finals in the 100 and ran the second leg on both the 4×100 and 4×200 relays.
She is still growing. Still adapting.
Some problems do not need more rest.
They need a better plan.
