Welcome to Momentum Health's patient resource about Stress Fracture of the Hip.
Stress fractures of the hip once most commonly affected military personnel who marched and ran day after day. Today, stress fractures of the hip are more common in athletes, especially distance runners.
There are two types of stress fractures. Insufficiency fractures are breaks in abnormal bone under normal force. Fatigue fractures are breaks in normal bone that has been put under extreme force. Fatigue fractures are usually caused by new, strenuous, very repetitive activities, such as marching or distance running. Most stress fractures of the hip are fatigue fractures. The stress fractures this article refers to are fatigue fractures.
This guide will help you understand:
how a stress fracture develops
how doctors diagnose the condition
what treatment options are available
Hear from some of our patients who we treated for Hip Pain
“
I was in chronic hip pain for 3.5 long years. I tried every treatment known to man including chiropractic,physio, massage, acupuncture, and even spinal decompression. Everyone who treated me came to... ”
“ I was in chronic hip pain for 3.5 long years. I tried every treatment known to man including chiropractic,physio, massage, acupuncture, and even spinal decompression. Everyone who treated me came to quick conclusions as to what my issue was with no formal assessment, and everyone claimed they could help me. Needless to say they were unsuccessful.
Thank God for Jocelyn! I went to see her for a massage one day and she genuinely cared about my pain and she did a casual assessment to try to locate the cause of my pain. She is the strongest and best massage therapist I have ever got. She urged me to try chiropractic care again with Dr Brad. In my first session with him he did a full assessment with proper diagnostic testing and he confirmed what Jocelyn thought it was. With regular appointments with Dr Brad my pain was close to gone in 3 weeks.
I have continued to see the physiotherapy team which includes Alexis and Ankit. With trying diligently to do my exercises, I am pain free.
Thank you momentum health creekside! I will forever refer to you as my dream team!
Oh, and the reception team is excellent! ”
“
I recently had the pleasure of visiting Dr Carpino and Physiotherapist Russ Gothard for some back and hip pain I was experiencing. I can't say enough good things about the care I received. Both... ”
“ I recently had the pleasure of visiting Dr Carpino and Physiotherapist Russ Gothard for some back and hip pain I was experiencing. I can't say enough good things about the care I received. Both professionals were incredibly knowledgeable, attentive, and skilled. They took the time to listen to my concerns and tailored their treatments to my specific needs which also included the GLAD Back program. After just a few sessions, I felt a significant improvement in my pain levels, overall mobility and pain management. I highly recommend Dr Carpino and Pysiotherapist Russ Gothard to anyone in need of chiropractic or physiotherapy services at Momentum Health. Also a big thanks to massage therapist Meagan Fishly who also played an important role in dealing with my injuries. ”
“
I’ve been seeing Heather for just over two months now and she has made a HUGE difference in my life. I have chronic pain in my back and hip that has been plaguing me for over 10 years. I’ve been... ”
“ I’ve been seeing Heather for just over two months now and she has made a HUGE difference in my life. I have chronic pain in my back and hip that has been plaguing me for over 10 years. I’ve been countless doctor, physios and trainers for my pain and for the first time I feel like I have someone who is determined to get to the bottom of my issue, teamed up with the knowledge and experience to do so. The red cord/ dry needle system that she uses is so smart I honestly can’t understand why I’ve never heard of it before, it doesn’t make sense why more physios aren’t using it! If you’re like me and have feel like you have tried everything for you pain and nothing is making a real difference I cannot recommend Heather enough, she has over 35 years of experience and genuinely cares about helping you get better. ”
“
I recently attended a GLA:D program for education and exercise for osteoarthritis at Momentum Health in Seton in Calgary, Alberta. I was under the care of Dr. Teac Engen 2 times a week for 7 weeks of... ”
“ I recently attended a GLA:D program for education and exercise for osteoarthritis at Momentum Health in Seton in Calgary, Alberta. I was under the care of Dr. Teac Engen 2 times a week for 7 weeks of education exercises for the hips and knees. During that time, I learned valuable resistance training to help build up the areas around the hip and knee joints. The sessions were professionally carried out and I was treated with kindness and understanding. Dr. Engen created an environment for me to excel. He communicated through word and action. He lead by example and allowed me to discuss my feelings openly. He seeks input and involvement from others. He recognizes the contributions of others. I am comfortable going back to the program in the future if I need additional help. Sincerely Linda Rogers ”
“
Russ, Mark and Safia were extremely knowledgeable and helpful in helping me with the GLAD program. Anybody with arthritis in the knees, or the hips should go to Monument health at Deerfoot City and... ”
“ Russ, Mark and Safia were extremely knowledgeable and helpful in helping me with the GLAD program. Anybody with arthritis in the knees, or the hips should go to Monument health at Deerfoot City and check out the GLAD program. ”
“
Participated in GLA:D hip knee clinic. Excellent program and well supervised exercise routines and instruction. Suggest anyone with hip-knee issues to look at program earlier rather than later. ”
“ Participated in GLA:D hip knee clinic. Excellent program and well supervised exercise routines and instruction. Suggest anyone with hip-knee issues to look at program earlier rather than later. ”
“
I work with Amber (massage) and Dr. Moore (chiro) for calf, hip and back issues. They work together to ensure I receive the treatments I need. The "homework" is easy to incorporate into my every day... ”
“ I work with Amber (massage) and Dr. Moore (chiro) for calf, hip and back issues. They work together to ensure I receive the treatments I need. The "homework" is easy to incorporate into my every day routines. I am feeling better and better. I really trust that my health and progress is the priority. I highly recommend coming here for any ailment. ”
“
The team at Momentum Health Westbrook have been awesome! I came in with a bunked hip and after two sessions and an personally crafted plan to get me back to tip top shape; I am happy with what I am... ”
“ The team at Momentum Health Westbrook have been awesome! I came in with a bunked hip and after two sessions and an personally crafted plan to get me back to tip top shape; I am happy with what I am experience. I would recommend Momentum Health Westbrook to anyone in need of physio! Thank you!!! ”
“
Marjo is a gem. I have a desk job, so the knots in my shoulders and hips are epic - but she manages to work them out every time. If you want a deep massage that has great results, she is the right... ”
“ Marjo is a gem. I have a desk job, so the knots in my shoulders and hips are epic - but she manages to work them out every time. If you want a deep massage that has great results, she is the right person to see. ”
“
I have been enrolled in the GLA:D Knee/Hip program since April 19th and have been delighted with the progress. I have bone on bone on the lateral portion of my right knee and have found over the weeks... ”
“ I have been enrolled in the GLA:D Knee/Hip program since April 19th and have been delighted with the progress. I have bone on bone on the lateral portion of my right knee and have found over the weeks that I am getting stronger and definitely have less crepitus. I was able to hike Grassy Lakes; the more challenging side too. Today Dr. Carpino has started to work on other areas. He is competent, very knowledgeable, and a truly kind, caring Chiropractor. ”
“
Just a note to say thanks so much for all your help in my Hip recovery. Dr. Wowk, thanks so much for taking the time to give a detailed and proper diagnosis, and recommendations for recovery regarding... ”
“ Just a note to say thanks so much for all your help in my Hip recovery. Dr. Wowk, thanks so much for taking the time to give a detailed and proper diagnosis, and recommendations for recovery regarding my injury. Rebecca, thank you so much for providing the proper physio program that related to my injury. Matt, thank you so much for providing the stretching program and making it so I could download it on my phone. Prior to visiting Momentum, I had suffered with this injury for 3 + months, due to not having had a proper diagnose or rehab program from another physio provider. It was a blessing that my Dr. referred me to Momentum Health. After only 3 months in your program, with follow up advice and physio, I am happy to say that I was finally able to go on a proper hike on May 5. I was able to do 12.5 Kms with 300 M elevation and I feel great. No soreness in the affected area and I am back to normal. I continue to do the stretches you provided and am following all the advice that was given me, and I have learned to pay attention when my body tells me something isn't quite right. Thank you All so very much! ”
“
From the beginning the staff have been excellent. This is an excellent program for anyone with Osteoarthritis in your knees or hips, as you can avoid surgery by doing the exercises and movements... ”
“ From the beginning the staff have been excellent. This is an excellent program for anyone with Osteoarthritis in your knees or hips, as you can avoid surgery by doing the exercises and movements taught in this program. Thank you Carley for explaining the GLA:D program to us at the beginning. Josh( Kinesiologist),did an excellent job of teaching us proper exercise and movements to alleviate pain in these joints. If we were not doing it right he would correct us. I really noticed less pain in my right knee and left hip. I would recommend this program to anyone having hip and knee pain. Thank you, Madeline ”
“
Good morning i have been having nerve problems and numbness in my left leg hip and ankle, since i have been coming there i have been treated with respect and kindness for my problem, i feel very... ”
“ Good morning i have been having nerve problems and numbness in my left leg hip and ankle, since i have been coming there i have been treated with respect and kindness for my problem, i feel very confident that the team there will help me to get better if possible. Russ is awesum he has done things that no other physio place has tried i believe he accutually cares about my injury and healing process. Hats off to all of you i would recommend treatment here for anyone who has issues with your body. ”
“
Momentum Health Westbrook is a very modern clinic with the latest equipment. The entire facility is kept very clean which is extremely important these days. I had developed lower back problems and... ”
“ Momentum Health Westbrook is a very modern clinic with the latest equipment. The entire facility is kept very clean which is extremely important these days. I had developed lower back problems and could only walk about 30 yards with a cane. I was thoroughly assessed and the problem was identified. I was then put on a great exercise program. A physiotherapist and a kinesiologist work as a team. I went to the clinic 8 times. As well as showing me the best exercises to do, they also did lots of hands on work. This included dry needling (IMS), hip flexor release and traction. At the end of my 8 sessions I could walk around 2km before I had to sit down. I use walking poles, but this is mostly to steady myself. I am sure if I continue to do my exercises faithfully, that my problem will keep lessening. I highly recommend this clinic. ”
The femur is the large bone in the thigh. The ball-shaped head of the femur fits into a socket in the pelvis, called the acetabulum. When a stress fracture occurs in the hip, it usually involves the femoral neck, the short section of bone that connects the head of the femur to the main shaft of the bone. The femoral neck is a thinner part of the femur. Stress fractures are hairline cracks in the bone that can grow larger over time if not treated properly.
Hip
The femoral neck has to withstand extreme force even during normal activities, such as standing still. The normal contraction of muscles during walking makes this stress even higher. Running triples the stress on the femoral neck.
Surgeons put fatigue fractures of the femoral neck into three categories. Compression fractures occur on the underside of the femoral neck. Tension fractures occur on the upper side of the bone and can cause more problems than fractures on the underside of the femoral neck. In displaced fractures, the bone cracks all the way through, and the two bones no longer line up correctly.
Three Categories
A displaced stress fracture is a very serious problem in a young adult because it may lead to damage to the blood vessels going into the upper end of the hip bone. This can cause a very serious complication known as avascular necrosis (AVN) of the hip.
Patients with fatigue stress fractures of the hip are also likely to have muscle and tendon injuries and swelling of the synovial lining (the lubricated lining) of the hip joint.
Stress fractures can also happen in the shaft of the femur bone, the greater trochanter, and the pelvis bone. The greater trochanter is a large bump below the neck of the femur. The buttock muscles that move the hip connect to this part of the femur.
Doctors think that putting extreme stress on the bone over and over again causes stress fractures of the hip. Think of how you can break a metal paper clip by bending it back and forth repeatedly.
Bones can usually adapt to repetitive stress, and any change in the function of a bone causes it to change the way it is built. This is how small bumps and ridges form on bones. The tendons pull on these areas, and the bone adapts by building up. This is normal. But extreme stress repeated too often can overwhelm the bone's ability to adapt. This is especially true when someone suddenly begins a new, strenuous, repetitive activity such as running.
Fatigue fractures are related to both the amount of exercise and how fast people increase their exercise program. The more people run or march, the more likely they are to develop a fatigue fracture. Research suggests that most athletes who develop stress fractures have been training for at least two years, six or more times a week. A stress fracture is more likely to occur after an increase in how far, how often, and how hard a person goes.
Women are up to 10 times more likely to develop fatigue fractures than men. The reasons for this are unclear. Hormonal changes may make women athletes' bones more likely to fracture. Eating disorders, which are more common in women athletes, may also make bones more likely to fracture.
Age also makes stress fractures of the hip more likely. This is thought to be due to declining levels of physical fitness more than age.
Symptoms
Most patients with stress fractures of the hip feel pain in the front of the groin while standing and moving. Rest usually makes the pain go away. Patients may limp. Strenuous activities, such as running and climbing stairs, may be so painful that the patient must stop doing them.
Diagnosis
When you visit Momentum Health, our physiotherapist will take a detailed medical history and ask many questions about your activities and exercise. We will also physically examine the painful hip. One of our main goals will be to determine if other problems, such as muscle or tendon injuries, are causing some or all of your pain.
Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the physiotherapists at Momentum Health have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.
Momentum Health provides services for physiotherapy in Calgary.
Our Treatment
The treatment you receive will depend on the type of fracture you have.
Non-surgical Rehabilitation
Nonsurgical treatment for compression-type fatigue fractures is typically tried before surgery is considered. Your Momentum Health physiotherapist will direct you to stay off the affected leg, using crutches if necessary, and rest the hip for at least four to six weeks.
Treating a stress fracture without surgery will require you to strictly avoid putting weight down on the foot of the injured leg when standing or walking. When the bones begin to heal, you'll be able to put more weight on your foot as you stand and walk.
We can help manage your initial pain with hot and cold treatments. Patients may also want to consult with their doctor or pharmacist regarding the use of pain relief or anti-inflammatory medication. Our physiotherapist can direct your rehabilitation to help you improve strength and flexibility in the hip and to make sure you are able to safely resume your activities. With care, these fractures tend to heal without surgical intervention.
Post-surgical Rehabilitation
Recovery after surgery for hip fracture depends on the type of procedure used. The aim of most surgical procedures for a fractured hip is to help people get moving and walking as quickly as possible. This helps them avoid dangerous complications that can happen from being immobilized, such as pneumonia, blood clots, joint stiffness, and pain.
Once you are able to leave the house, visits to Momentum Health may be needed for patients who are still having problems walking or who need to get back to physically heavy work or activities.
At Momentum Health, our goal is to help you keep your pain under control, improve your range of motion, and maximize strength and control in your ankle. When your recovery is well under way, regular visits to our office will end. We will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.
Momentum Health provides services for physiotherapy in Calgary.
Surgery
In some patients with a fracture under the femoral neck, MRIs and other imaging tests sometimes show an unstable fracture that needs to be surgically fixed.
The surgical procedure is the same whether the stress fracture is stable or there is only a slight displacement of the bones. If your surgeon recommends surgery for a stress fracture of the hip, several large metal screws will be inserted through the femoral neck to hold the fractured bones in place while the fracture heals.
To perform this procedure, a small incision is made on the side of the upper thigh. With the help of a special X-ray machine called a fluoroscope, the surgeon can insert the metal screws into the proper position while watching the X-ray image on a TV screen.
When the ends of the bones show a large displacement, surgeons aren't in total agreement about which surgery is best. Most surgeons agree that younger, active patients benefit if surgery is done to save the femoral head. This method also uses screws to connect the two sections of bone.
To avoid problems with AVN, other surgeons feel that older, less active patients should have part or all of the hip joint replaced. If the socket of the joint is healthy, the surgeon may decide to replace only the ball portion of the joint, a procedure called hemiarthroplasty.
