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Hip Bone or Joint Injury

Hip Stress Fracture | Symptoms, Risk Factors and Diagnosis

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Posted 2 months ago


by James McCormack

Stress Fracture in Hip

A hip stress fracture is a painful condition that can occur following increased stress on the hip joint. A stress fracture in the hip is typically seen in professional athletes, military recruits, endurance runners, and other athletes with high volumes of high-impact training. It is caused by the repetitive stress of the bone that causes this injury, unlike a fracture which is usually caused by a single high-force incident such as a fall.

The most common area of a stress fracture is the neck of the femur. This is a narrow and angled portion of the bone. A stress fracture to this area is of concern as continued weight bearing on this injury can cause a full fracture due to the forces going through the weakened structure. In addition, the blood supply to the upper portion of the femur, called the head, can be disrupted by a stress or full fracture, which can lead to the death of this tissue, called avascular necrosis. This is a serious condition that can result in the need for a total hip replacement if left untreated.

Risk Factors Of Hip Stress Fractures

The major risk factors of a stress fracture of the hip include a rapid increase in training volume without adequate rest, recovery and sleep, low body weight and/or eating disorder, and osteoporosis or osteopenia, hypothyroidism or low vitamin D. There are other factors that can increase the risk such as excessive alcohol or caffeine consumption, smoking, lack of activity and certain medications such as oral steroids, long term use of proton pump inhibitors, and some anti-epileptics (Wright et al, 2015) and (Krabak et al, 2021).

Weight-bearing and impact exercise can make the bones stronger, but only when done at an appropriate rate. If too much is done, the effect with be to weaken the bones, which can result in a bone stress response or stress fracture.

Hip Stress Fracture Symptoms

The most common symptom of a hip stress fracture is pain that worsens with activity. Usually, pain is located in the hip or groin, or at the front of the thigh. Less often, a hip stress fracture will present with buttock pain.  In more severe or advanced cases, pain can persist at rest and may be noticed overnight. 

There is rarely an area that you can specifically press to feel your pain. This is because it is the bone, deep within the joint that is affected and not a superficial structure. Pain will be reproduced with impact. Meaning that you may feel it when you land on that leg when you run, hop on that leg, or even when walking.

What does a hip stress fracture feel like? 

Stress fracture hip symptoms are usually described as feeling like a deep ache type of pain, and only sharper pain as the fracture worsens. Sharper and more intense pain is usually only felt on aggravating activities, including weight bearing, walking, running, or jumping. Initially, it is common for patients to describe that they feel aware of their hip, or that it feels a bit uncomfortable. If training continues this will usually worsen to the clearer symptoms of pain.

Female Hip Stress Fracture

Women are more likely to develop stress fractures than men, within the athletic population female runners are most at risk (Wentz et al, 2011). Women are particularly at risk of fractures, including stress fractures during menopause, as the reduction of oestrogen affects bone density. Osteopenia and osteoporosis are more likely in post-menopausal women, a risk factor for a hip stress fracture.

A useful warning sign and a certain risk factor for stress fracture are menstrual irregularities or absence, and delayed menarche. These are symptoms that are often overlooked or considered “normal” within certain sports where low body weight is desired such as gymnastics and running. However, this symptom is not normal and should not be overlooked but investigated as it can be used as a sign that the body is not healthy.

Hip Stress Fracture Diagnosis

A clinical diagnosis of a hip stress fracture will be with a medical doctor or physical therapist. If they suspect this injury from your history and from their physical examination they will refer you on for diagnostic imaging to confirm the diagnosis.

The most accurate form of imaging for a stress fracture is an MRI scan. 

Do I have a hip stress fracture quiz?

As the symptoms of a hip stress fracture can be mild initially and variable in terms of quality, location, and intensity it can be helpful to know these 3 hip stress fracture quiz questions. These are likely to be positive if you have a hip stress fracture. The more of these questions that you answer “yes” to, the more you should suspect you have a hip stress fracture and seek the assessment of a medical doctor or physical therapist urgently.

  • Do you have pain in your hip, groin, or down your thigh that worsens with exercise?
  • Do you have pain in your hip, groin, or down your thigh when hopping?
  • Do you have an ache in your hip, groin, or down your thigh when at rest?

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments.

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