What's an Avulsion Fracture?

Many young athletes suffer avulsion injuries. Learn what they are and how to prevent them by strengthening your muscles and bones.

Avulsion Injury

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An avulsion fracture occurs when tendons or ligaments attached to a bone, along with a piece of that bone, get pulled away from the main part of the bone. In this situation, the break is not compound and not completely separated from its contact with two pieces of the same bone.

Many young athletes experience this kind of injury in the lower back/hip/pelvic region.

Generally, the healing period for avulsion injuries depends on the severity of the bone separation. If the bone-to-bone gap is too wide, surgery may be the only option. Removing bone spurs post-rehabilitation may require additional surgery.

Fortunately, many avulsion injuries do not require surgery. For example, in most cases, the hamstring can heal within four to eight weeks. The RICE method (rest, ice, compression and elevation) can speed up the healing process. In some cases, you may need crutches. But with rest, the bone will naturally mend itself.


To prevent avulsion injuries, you need to correct muscle imbalances and train your hip flexors, extensors, abductors and adductors. Perform simple hip patterns in sets of 10 to strengthen a problematic joint structure. Also, pay attention to your calcium intake: insufficient calcium weakens bones and can cause the muscle to "snap" the bone.

Putting your body through rigorous strength routines strengthens both your bones and muscles. Larger muscles require stronger bones.

From a strength perspective, resting can cause muscular imbalances and atrophy, as well as neutralization of muscles near the injury. The bone must be fully healed before you can address these issues. Follow up with Range of Motion training to regain mobility in the joint. This will ensure properly flexible muscles and help prevent further injury.

Once you've regained ROM, stability, and flexibility, you can begin strength training.

As always, consult your doctor to be sure you are healed. Returning to play too soon can cause a career-ending injury. Be smart and realistic about healing time, and you will be on a steady road to recovery.

Hip Pattern Exercise

  • Attach a band, cable or Velcro-strapped weight to your ankle.
  • Complete 10 reps of each pattern movement: flexion, extension, abduction and adduction.

The great thing about this exercise is that it engages all your secondary hip muscles. Work each leg individually, and be sure to transfer your weight to the planted foot. Keep a passively flexed knee. This is sometimes referred to as "soft." Do not lock the knee of the planted foot. Control through the torso by maintaining a stable core.

Flexion: Flex the entire leg from the hip joint, as if you were trying to touch your toes to your forehead. Pull your toes toward your ankle.

Extension: The opposite of flexion. Extend your leg behind you, beginning at the hip, as if you were trying to touch your heel to the back of your head. Keep your foot flexed as well.

Abduction: Increase the width between your legs by pushing the loaded leg laterally away from the midline of your body.

Adduction: Decrease the space between your legs by squeezing the loaded leg toward the midline of your body. The planted leg/foot should be straight. Bring the loaded leg in front of the planted leg. Try to get your loaded knee slightly outside your planted knee. That will ensure you are properly engaging your adductors.

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