4 signs of a hip stress fracture [+ urgent plan of action]

Hip stress fractures can present as a vague but persistent hip, buttock or groin pain.

The injury is due to a slow break down of the bone but the symptoms can come on suddenly, after jumping off a small ledge or mid-run.

Hip stress fractures are more common in females and most prevalent in endurance sports such as distance running.

They’re also seen in military cadets due to the nature of the physical demands and the less-than-ideal footwear.

Pain from a hip stress fracture can be quite vague and hard to place.

Clinically, there is no specific test that diagnoses a hip stress fracture and it can be positive on a variety of other tests that would normally indicate different conditions.

That’s why they are often confused with gluteal tendinopathy or chronic hip muscle fatigue due to their common aggravating activities and symptoms.

Signs you might have a hip stress fracture

Symptoms can often start quite mild, and you’re thinking that it may not be worthwhile going to a Physiotherapist for a diagnosis.

If you’re severely limited in what you can do (eg. struggling to walk), or if the pain is getting worse quickly (eg. mild to severe in a few days), minimise your walking and standing and get to a doctor of Physiotherapist as soon as possible!!

There are specific types of hip stress fractures that can cause major, life-long issues and potentially ruin your hip joint.

Two of these types of bone injuries, tension-side femoral neck stress fractures and avascular necrosis, are known for their severe pain and rapid escalation of pain.

For the majority of hip stress fractures though, the symptoms and consequences are far more mild.

1. Lingering pain

One of the most telling symptoms with a hip stress fracture is the lingering ache for more than 24 hours after exercise.

You head out for a run or even a brisk walk and the hip aches continuously for more than 24 hours, even when you’re not putting weight on it.

2. Pain with weight transfer

It can hurt to transfer your weight on or off the leg.

If you’re standing on the good leg and you step on to the bad leg, it causes a sudden rise in your hip pain.

If you’re standing on the painful leg and then switch to the good leg, you’ll often experience a wave of pain as you take pressure off the leg.

3. Pain in every direction

Most injuries hurt if you stretch them, or if you squash them, or if you apply pressure to it.

A hip stress fracture is a little unique – it hurts to actively move the leg in all directions but nothing hurts to push on.

4. No clear cause

The pain might otherwise feel like a torn muscle or hip labral tear, but there’s no reason why those injuries should have happened.

Unlike muscle tears or similar, hip stress fractures don’t happen due to a sudden overload, or a quick sprint.

They come on seemingly without reason – and an injury without an obvious event is a big warning sign!

Imaging for hip stress fractures

Imaging is vital to confirm the presence and location of the fracture.

An Xray may spot an older hip stress fracture but it’s very hit-and-miss.

MRI is the go-to scan for this injury – it rarely misses them, even if a crack in the bone hasn’t developed yet.

It also needs to accurately identify the exact location and severity of the bone injury.

One particular location, referred to as a “tension-side” 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 (as mentioned above).

Rehab for hip stress fractures

The prognosis for most hip stress fractures is very good, although the timeframe and initial approach differs significantly.

For compression-side (lower) hip stress fractures, you can expect to be able to keep walking around without crutches.

You can start strength work as soon as the pain settles (around 2 weeks) and return to activities like running after 8 weeks.

For tension-side stress fractures, we take all weight off the leg with crutches or even a wheelchair to allow it to heal.

Light strength training kicks in around 3-4 weeks but it’s usually 6-8 weeks before you can return to gym-based strength work.

Running is usually reintroduced around 12-16 weeks but only after another MRI shows that the fracture site is healing well.

For any hip stress fracture location, the rehab should also focus on identifying 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 but may be due to inactivity and not related to your cause.

Key points to remember if you’re suspecting a hip stress fracture

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 classic causes like 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 can cause a similar pain?

Deep hip muscle fatigue.

Gluteal tendinopathy.

Lower back pain, referring pain across the hip.

Hip osteoarthritis.

Hip labral tears.

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