Hip Impingement in a 10-Year-Old: Sports Participation
A 10-year-old child with femoroacetabular impingement can participate in sports, but should avoid high-repetitive hip flexion activities (ice hockey, basketball, soccer) that train more than three times weekly, as these accelerate cam deformity development during skeletal immaturity. 1
Understanding FAI Risk in Growing Athletes
The critical issue is skeletal immaturity. At age 10, the femoral physis remains open and vulnerable to repetitive mechanical stress. High-level training (≥3 sessions/week) in sports requiring deep hip flexion, cutting, and pivoting directly increases the risk of developing or worsening cam-type FAI deformity. 1 This represents a unique pediatric consideration—the condition can actually be caused or exacerbated by the wrong sport selection during growth.
Sport Selection Strategy
Recommended activities for this age group include:
- Running, swimming, tumbling, throwing, and catching 2
- Walking tolerable distances with family 2
- Organized sports with flexible rules, short instruction time, and emphasis on enjoyment rather than competition 2
- Activities on flat surfaces with minimal hip impingement positions 2
Sports to limit or modify:
- Ice hockey, basketball, and soccer should be restricted to less than three training sessions per week 1
- Football and other collision sports require careful consideration due to deep flexion demands 3
- Any activity causing deep groin pain with squatting, cutting, or pivoting motions should be modified 3
Conservative Management Framework
Physical activity remains recommended despite hip-related pain. 2 The treatment approach should focus on:
- Muscle balance restoration around the hip joint rather than forcing full range of motion 4
- Lower limb dynamic stability and neuromuscular control 4
- Education on avoiding end-range hip positions during activities 4
- Progressive strengthening targeting hip abductors and core stability 2, 5
Monitoring and Decision-Making
Key assessment points:
- Quantify baseline physical activity levels objectively (pedometers, activity trackers) 2
- Monitor symptoms during and after activity 2
- Assess hip internal rotation range—decreased ROM with positive impingement sign indicates active pathology 6, 7
- Obtain AP pelvis and lateral femoral head-neck radiographs to establish baseline morphology 8
Red flags requiring activity modification:
- Anterior hip pain worsening with flexion activities 6
- Decreased hip internal rotation compared to contralateral side 6
- Pain limiting participation or performance 3
Critical Pitfalls to Avoid
Do not allow unlimited high-intensity training during skeletal growth. The evidence clearly demonstrates that adolescent males training ≥3 times weekly in high-risk sports develop cam deformity at higher rates than non-athletic peers. 1 This is preventable pathology.
Do not force full hip range of motion. Unlike adult FAI management, pediatric cases require respecting the mechanical limits imposed by the morphology to prevent accelerated labral and cartilage damage. 4
Do not restrict all physical activity. Complete rest is contraindicated—physical activity is critical for health and development at this age. 2 The goal is intelligent sport selection and load management, not activity avoidance.
Shared Decision-Making
Discuss realistic expectations with the family: 2
- The relationship between hip morphology and symptoms
- How sport selection during growth affects long-term joint health
- The risk of early osteoarthritis if FAI progresses unchecked 3, 6
- That many asymptomatic individuals have FAI morphology on imaging 2
Develop individualized activity goals that balance the child's interests with joint protection during the vulnerable growth period. 2 At age 10, co-ed participation is appropriate as there are minimal sex differences in size and strength. 2