• Hip stress fractures can present as a vague but persistent hip, buttock or groin pain
• They are more common in females and most prevalent in endurance sports such as distance running
• The pain is often confused with gluteal tendinopathy or chronic gluteal muscle fatigue or strains due to its common aggravating factors and symptoms

TIPS

• One of the most telling symptoms with a hip stress fracture is the lingering ache for more than 24 hours after exercise
• Imaging is vital to confirm the presence and location of the fracture. One particular location of stress fracture, on the upper side of the neck of femur (joining section between the shaft and ball of the femur) is prone to progression to complete fracture. For this location, we take all weight off the leg with crutches or even a wheelchair to allow it to heal
• Identify the causative loading pattern as soon as possible. This is often a loss of hip joint range or strength but this must be assessed early. Both weakness and stiffness will be present after a week or two of reduced activity and may not be related to your cause

MYTHS

• Hip stress fractures don’t generate huge amounts of pain. The pain can be quite mild and often leads to the assumption that it isn’t painful enough to be fractured
• Anti-inflammatories (such as Nurofen or Voltaren) will completely relieve the pain from a stress fracture. This allows people to continue exercising but prevents the bone from healing itself effectively, making the fracture worse
• Hip stress fractures don’t require big weekly distances or excessive body weight. They’re quite common in average to slight builds and at regular to low weekly running distances

WHAT ELSE COULD IT BE?

• Deep hip muscle fatigue
• Gluteal tendinopathy
• Lower back pain, referring pain across the hip
• Hip osteoarthritis
• Hip labral tears