Iliac Apophysitis

with Rehab

ExitCare ImageIliac apophysitis is a condition that causes pain and inflammation over bony prominence of the pelvis (iliac crest). The iliac crest is the attachment site for the abdominal muscles. Repetitive strenuous exercises often cause weakness in the growth plate of the ileum (one of the bones of the pelvis), near where these muscles attach. Iliac apophysitis is a temporary condition in which the growth plate becomes inflamed. Occasionally the stress placed on the iliac crest will cause a bone to pull away from the growth plate (avulsion fracture). This injury is uncommon after the body becomes skeletally mature (approximately 14 years in girls and 16 years in boys).

SYMPTOMS

  • A slightly swollen, warm, and tender area along the bony bump on the side at the pelvis, above the hip (iliac crest).

  • Pain with activity, especially running, jumping, kicking, and twisting (such as batting or pitching in baseball).

  • Symptoms that slowly worsen.

CAUSES

Iliac apophysitis is caused by repetitive stress placed on the iliac crest and the associated growth plate.

RISK INCREASES WITH:

  • Strenuous conditioning routines, especially if they involve a rapid increase in intensity, duration, or frequency.

  • Sports that require body twisting (golf, batting or pitching in baseball).

  • Sports that require sprinting and kicking (soccer or kicking in football).

  • Growth spurts.

  • Poor strength and flexibility.

PREVENTION

  • Warm up and stretch appropriately before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Exercise moderately, avoiding extremes.

  • Learn and use proper technique, especially avoiding cross-body arm motion with running.

  • Avoid rapid or extreme change in training or activity.

PROGNOSIS

The prognosis for iliac apophysitis depends on the severity of injury. Mild cases can be expected to resolve with only a slight reduction in training intensity, duration, and frequency. Moderate and severe cases may require significantly reduced activity for 4 to 6 weeks.

RELATED COMPLICATIONS

  • Bone infection.

  • Recurrent symptoms, especially if activity is resumed too soon.

  • Prolonged healing time if usual activities are resumed too soon.

  • Avulsion of the iliac crest (bone pulls off and away from the pelvis).

TREATMENT

Treatment initially involves ice and medication to help reduce pain and inflammation. Strengthening and stretching exercises of the abdominal muscles may help reduce pain, as well as modifying activities so they do not include any motions that cause increased pain. For moderate or severe cases it is important to rest and allow the body to heal. It is recommended that you have a gradual return to sport after recovery. For cases of iliac apophysitis that become chronic, one may be referred to a therapist for further evaluation and treatment.

MEDICATION

  • If pain medication is necessary, nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication within 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

  • Ointments applied to the skin may be helpful.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 4 weeks, despite treatment.

  • You have a fever greater than 102° F (38.9° C).

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Apophysitis, Iliac

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image STRETCH - Quadriceps, Prone

  • Lie on your stomach on a firm surface, such as a bed or padded floor.

  • Bend your right / left knee and grasp your ankle. If you are unable to reach, your ankle or pant leg, use a belt around your foot to lengthen your reach.

  • 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/or knee.

  • Hold this position for __________ seconds.

  • Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH – Extension, Prone on Elbows

  • Lie on your stomach on the floor, a bed will be too soft. Place your palms about shoulder width apart and at the height of your head.

  • Place your elbows under your shoulders. If this is too painful, stack pillows under your chest.

  • Allow your body to relax so that your hips drop lower and make contact more completely with the floor.

  • Hold this position for __________ seconds.

  • Slowly return to lying flat on the floor.

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

ExitCare Image RANGE OF MOTION – Extension, Prone Press Ups

  • Lie on your stomach on the floor, a bed will be too soft. Place your palms about shoulder width apart and at the height of your head.

  • Keeping your back as relaxed as possible, slowly straighten your elbows while keeping your hips on the floor. You may adjust the placement of your hands to maximize your comfort. As you gain motion, your hands will come more underneath your shoulders.

  • Hold this position __________ seconds.

  • Slowly return to lying flat on the floor.

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

ExitCare Image STRETCH – Low Trunk Rotation

  • Lie on a firm bed or floor. 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.

  • Extend your arms out to the side. This will stabilize your upper body by keeping your shoulders in contact with the floor.

  • Gently and slowly drop both knees together to one side until you feel a gentle stretch in your lower back. Hold for __________ seconds.

  • Tense your stomach muscles to support your lower back as you bring your knees back to the starting position. Repeat the exercise to the other side.

Repeat __________ times. Complete this exercise __________ times per day

STRENGTHENING EXERCISES - Apophysitis, Iliac

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

ExitCare Image STRENGTHENING – Deep Abdominals, Pelvic Tilt

  • Lie on a firm bed or floor. 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.

  • Tense your lower abdominal muscles to press your low back into the floor. This motion will rotate your pelvis so that your tail bone is scooping upwards rather than pointing at your feet or into the floor.

  • With a gentle tension and even breathing, hold this position for __________ seconds.

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

ExitCare Image STRENGTHENING – Abdominals, Crunches

  • Lie on a firm bed or floor. 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. Cross your arms over your chest.

  • Slightly tip your chin down without bending your neck.

  • Tense your abdominals and slowly lift your trunk high enough to just clear your shoulder blades. Lifting higher can put excessive stress on the low back and does not further strengthen your abdominal muscles.

  • Control your return to the starting position.

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

ExitCare Image STRENGTHENING – Lower Abdominals, Double Knee Lift

  • Lie on a firm bed or floor. 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.

  • Tense your abdominal muscles to brace your lower back and slowly lift both of your knees until they come over your hips. Be certain not to hold your breath.

  • Hold __________ seconds. Using your abdominal muscles, return to the starting position in a slow and controlled manner.

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