Hip Stress Fracture: A Common Injury in Runners
A hip stress fracture is a crack that develops near the ball-and-socket hip joint from repetitive microtrauma. Over time, this micro-injury leads to bone swelling and, eventually, a fracture — unlike a fracture from a single high force such as a fall. So, how do you detect a stress fracture in the hip, and how is it managed?
This page is part of our wider stress fracture management guide, which covers the principles across all sites.
What are the symptoms of a hip stress fracture?
People with a hip stress fracture are usually very active — endurance runners, military recruits, sportspeople — though anyone who suddenly increases their activity is at risk.
Symptoms typically include an ache in the hip, groin, or front of the thigh that worsens with walking and running and eases with rest. In severe cases, high-level pain appears at rest or at night. Moving the hip joint brings on the pain, and the hip stress fracture hop test is positive.
Hip stress fracture on MRI
Imaging confirms the presence and location. An early stress fracture can appear normal on X-ray, so an MRI is usually needed to show bone swelling and the fracture line.
Bone stress occurs at two main sites: the neck of the femur and the pubic rami. The exact spot on the femoral neck matters for prognosis. An inferior (bottom) neck-of-femur stress fracture usually settles with prolonged rest. A superior (top) neck-of-femur stress fracture is more serious and may not heal with offloading alone.
What causes a hip stress fracture?
Repetitive activity normally strengthens bone. But excessive volume or intensity causes bone fatigue and leads to faster breakdown than rebuilding. The commonest site is the femoral neck, and doctors worry about it because continued stress can produce a complete, displaced fracture and even cut the blood supply, leading to hip osteonecrosis. Stress fractures elsewhere in the pelvis are less concerning.
Underlying bone weakness raises the risk. Conditions such as vitamin D deficiency or hormonal problems can weaken bone, so testing for them matters.
How is a hip stress fracture treated?
Stopping the aggravating activity is the foundation, and rest brings almost immediate relief. Severe cases may need crutches. We generally avoid anti-inflammatories such as ibuprofen, which can slow bone healing and mask pain — risking a complete break.
As pain improves, normal activities such as walking resume gradually, with cross-training (cycling, swimming) to maintain fitness. A physiotherapist then strengthens the hips and lower limbs to protect against future bone stress. You’re usually ready to run once pain-free with all other activities — a good rule is to wait at least three months, then follow a walk/run programme.
Surgery may be needed for a complete break or a superior neck-of-femur fracture, but most patients don’t need it.
Frequently asked questions about hip stress fractures
How long does a neck-of-femur stress fracture take to heal?
These are often underestimated. It usually takes 4–6 months before returning to regular running.
What conditions are associated with a hip stress fracture?
Besides excessive training, bone-health conditions raise the risk — osteoporosis and vitamin D deficiency. In athletes who eat too few calories, hormonal changes weaken bones and increase risk. In suspect cases, we consider blood tests (vitamin D, B12, folate, ferritin, bone profile, inflammatory markers) and a DEXA bone density scan.
Are pelvic rami stress fractures treated the same as neck-of-femur fractures?
Yes — similarly. Runners can also get sacral stress fractures. But neck-of-femur fractures are more concerning because they can progress to a complete fracture and threaten the hip’s blood supply.
Can shockwave therapy help a hip stress fracture?
Possibly. Recent evidence suggests focused shockwave may aid bone healing in stress fractures — typically 3–5 sessions of high-energy focused shockwave alongside other treatment, sometimes repeated during return to running.
Can I walk on a hip stress fracture?
Often, but cautiously, and only after diagnosis. A femoral-neck stress fracture, in particular, should not be loaded until assessed — walking on it risks turning a stress fracture into a complete break that may need surgery.
Final word from Sport Doctor London about hip stress fractures
The gradual onset of hip, groin, or thigh pain in a runner could be a hip stress fracture. Early diagnosis is vital — it enables prompt treatment and protects the femoral neck. See a sports medicine consultant for expert diagnosis and management.
To book a one-stop hip assessment with Dr Masci in London, contact his team here or call +44 (0) 203 488 0350.
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