A stress fracture of the hip is an injury close to the ball and socket hip joint. Stress fractures are injuries to the bone caused by repetitive microtrauma. Over time, this micro-injury leads to bone swelling and eventually a fracture. It differs from fractures caused by a high force, such as a fall or bike accident. So, how do you detect a hip stress fracture, and what is the management?
What are the symptoms of a hip stress fracture?
Usually, people with stress fractures in the hip are very active, such as endurance runners, military recruits, and sportspeople. However, even ordinary people who suddenly increase their activity over a short period are at risk.
Generally, symptoms include an ache in the hip, groin, or front of the thigh that worsens with activity such as walking and running. The pain slowly gets better with rest. In severe cases of a hip stress fracture, high-level pain may be present at rest or at night.
If you think you might have a stress fracture in your hip, it is essential to see your doctor. Moving your hip joint will bring on your pain. Also, the hip stress fracture hop test is positive.
Hip stress fracture MRI
Getting a picture of your hip is often essential to confirm the presence and location of a stress fracture. If the stress fracture is early, an X-ray may be normal. However, an MRI scan is needed to see bone swelling and fracture in most cases.
Often, bone stress occurs at two locations: the neck of the femur and the pubic rami. For neck of femur bone stress, the exact spot of the bone stress is important for prognosis. The inferior (bottom) neck of femur will settle with prolonged rest. However, the superior (top) neck of femur bone stress is more severe and may not heal with offloading. MRI depicted below is an inferior neck of femur stress reaction.
Causes
Generally, repetitive activity such as walking, running, and sports increases bone turnover, which usually strengthens the bone. However, if the activity is excessive in volume or intensity, bone can fatigue and break down.
The most common site of a stress fracture in hip is the femoral neck. Doctors worry about stress fractures in this region because continued stress can produce a complete and displaced fracture. In addition, the blood supply can be cut, leading to bone death and hip osteonecrosis. Stress fractures can occur in other pelvis areas but are less concerning and rarely lead to severe problems.
Also, people who develop hip stress fractures may have an underlying weakness in bone density that makes them more susceptible. In addition, certain medical conditions such as Vitamin D deficiency or hormonal problems can trigger bone weakness and increase stress fracture risk. Therefore, speaking to your doctor about testing for these other conditions is essential.
Treatment
People must stop their activities. Rest provides almost immediate relief. In severe cases, crutches might be needed to help heal and reduce pain. Generally, we recommend avoiding pain medications such as ibuprofen. These pain medications can slow bone healing and mask pain, potentially leading to a complete break.
As the pain improves, you can slowly resume normal activities such as walking. Also, cross-training exercise such as cycling and swimming is allowed to maintain your fitness. Your physiotherapist will prescribe exercises to strengthen your hips and lower legs to protect you from future bone stress.
Usually, you are ready to run once you are pain-free with all other activities. A rule of thumb is to wait at least three months before resuming running. Then, a walk/run program is often prescribed to load your hip gradually.
Surgery may be required in some cases where the fracture is a complete break or located in the superior (top) of the neck of the femur. However, generally, most patients do not need surgery.
Other frequently asked questions:
How long does it take for a neck of femur stress fracture to heal?
Generally, we underestimate how long these stress fractures take to heal. However, as a rule, they take 4- 6 months before people can get back to regular running.
What conditions are associated with a hip stress fracture?
In addition to excessive training, certain medical conditions can predispose to pelvic stress fractures. Some of these conditions that affect your bone health include osteoporosis and Vitamin D deficiency. You should speak to your doctor about whether you need investigations.
Are pelvic rami stress fractures treated the same as neck of femur stress fractures?
Yes. Pelvic rami stress fractures are treated similarly. Also, runners can suffer from sacral stress fractures. However, neck of femur stress fractures are more concerning as they can lead to a complete fracture and loss of blood supply to the hip joint.
Final word from Sportdoctorlondon about stress fracture in the hip
The gradual onset of hip pain in runners could be a stress fracture in hip. Early diagnosis is vital to start immediate treatment and get you on track. You should see a Sports Medicine consultant for expert diagnosis and management.
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