Spatial Recurrence Is More Common Than Local Recurrence in Youth Athletes With Groin, Anterior Knee, and Heel Pain: A Retrospective Observational Study

ObjectiveTo determine the incidence and transition patterns of local and spatial recurrence among youth athletes presenting with groin pain (GP), anterior knee pain (AKP), and heel pain (HP). DesignRetrospective observational study. SettingSingle sports medicine clinic. ParticipantsYouth athletes who visited the clinic between January 2017 and November 2025 for GP, AKP, or HP. A total of 769 clinical episodes were included. Independent VariablesPain-site transitions and laterality were extracted from electronic medical records. No therapeutic interventions were evaluated. Recurrence patterns were classified as local or spatial and further subclassified into contralateral same-site, adjacent-site, and remote-site recurrence. Main Outcome MeasureTrue recurrence, defined as an episode with at least one prior visit for GP, AKP, or HP within the preceding 12 months. ResultsAmong 769 episodes, 130 episodes (16.9%; 95% confidence interval [CI], 14.4- 19.7) represented true recurrence. Local recurrence accounted for 57 episodes (7.4%; 95% CI, 5.8-9.5), whereas spatial recurrence accounted for 73 episodes (9.5%; 95% CI, 7.6-11.8). Among spatial recurrences, 26 episodes (35.6%) were contralateral same-site, 42 (57.5%) adjacent-site, and 5 (6.8%) remote-site recurrence. Transitions most frequently occurred between GP and AKP and between AKP and HP, whereas direct transitions between GP and HP were uncommon. ConclusionsRecurrence after symptom resolution in youth athletes more often involves spatial transitions to anatomically adjacent sites rather than simple local recurrence. These findings support interpreting recurrence within a whole-body functional framework and may facilitate refined recurrence risk assessment and comprehensive intervention strategies. Clinical RelevanceClinicians should evaluate recurrent pain beyond the symptomatic region, which may improve recurrence prevention and return-to-sport decision-making.